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Echocardiographic Left Atrial Stiffness Index Predicts Myocardial Iron Overload in Pediatric β-Thalassemia
Yiqun Guan1, Yan Deng1, Xiao Li1
1Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Insights
The left atrial stiffness index (LASI) effectively predicts myocardial iron overload (MIO) in pediatric thalassemia patients. This novel marker shows higher accuracy than other measures, aiding early detection and management of MIO.
Area of Science:
- Cardiology
- Pediatric Hematology
- Medical Imaging
Background:
- Myocardial iron overload (MIO) is a critical complication in thalassemia major, leading to significant mortality.
- Early detection of MIO is crucial for timely intervention in pediatric patients with β-thalassemia.
Purpose of the Study:
- To assess the predictive capability of the left atrial stiffness index (LASI) for MIO in pediatric patients with β-thalassemia.
- To compare the diagnostic accuracy of LASI with other cardiac strain parameters for MIO prediction.
Main Methods:
- A study included 105 pediatric thalassemia patients and 30 healthy controls.
- Patients were stratified into tertiles based on LASI values.
- Myocardial iron overload (MIO) was quantified using cardiac magnetic resonance (CMR) T2* imaging.
Main Results:
- LASI was significantly lower in patients compared to controls (p < 0.001).
- LASI showed a strong negative correlation with CMR T2* values (r = -0.76, p < 0.001).
- LASI demonstrated the highest diagnostic accuracy (AUC = 0.90) for predicting MIO, outperforming GLS and LASr.
Conclusions:
- The left atrial stiffness index (LASI) is a reliable predictor of myocardial iron overload in pediatric thalassemia.
- LASI offers a promising, non-invasive tool for assessing MIO, aiding clinical management.
- Further research can explore LASI's role in monitoring treatment efficacy for MIO.
Objectives:
Myocardial iron overload (MIO) is the leading cause of mortality among individuals with thalassemia major. This study aimed to evaluate the predictive value of the left atrial stiffness index (LASI) for MIO among β-thalassemia pediatric patients.
Methods:
A total of 105 children with thalassemia and 30 healthy controls were included in the study. The patients were categorized into three groups on the basis of LASI tertiles. MIO was assessed via cardiac magnetic resonance (CMR) T2* imaging.
Results:
The LASI differed significantly between patients and controls (p < 0.001). The LASI and E/e' ratio were negatively correlated with the CMR T2* value (LASI: r = -0.76, p < 0.001; E/e': r = -0.48, p < 0.001), whereas left atrial reservoir strain (LASr), global longitudinal strain (GLS), and left atrial strain conduit strain (LAScd) were positively correlated with the CMR T2* value (LASr: r = 0.64, p = 0.002; GLS: r = 0.70, p < 0.001; LAScd: r = 0.57, p = 0.009). Restricted cubic spline (RCS) analysis revealed nonlinear associations between the LASI, GLS, and CMR T2* values (nonlinearity p < 0.001). In pediatric thalassemia patients, the LASI, GLS, and LASr independently predicted MIO. The LASI demonstrated the highest diagnostic accuracy (AUC = 0.90; optimal cutoff: 22.68%), outperforming GLS (AUC = 0.76; cutoff: 18.70%) and LASr (AUC = 0.80; cutoff: 37.05%) (DeLong test: p = 0.048 vs. GLS; p = 0.022 vs. LASr).
Conclusions:
The LASI is strongly correlated with the CMR T2* value and is a promising tool for predicting MIO in pediatric patients with thalassemia.
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