Biventricular and bia-trial strain by cardiac magnetic resonance in thalassaemia intermedia: patterns and correlates

The aim of this cross-sectional study was to investigate the association of biventricular and biatrial strain parameters with demographics, clinical data, cardiovascular magnetic resonance (CMR) findings, and cardiac complications (atrial fibrillation and pulmonary hypertension) in a cohort of patients with β-thalassaemia intermedia (β-TI).

We considered 43 patients with β-TI (53.5 % females, mean age: 44.31 ± 14.38 years) who were consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassaemia (E-MIOT) project. Additionally, we included 25 healthy controls comparable for age and sex distribution (48 % females, mean age: 40.28 ± 7.65 years). Left and right atrial and ventricular strain parameters were analysed using CMR feature tracking with dedicated software.

Compared to the healthy control group, patients with β-TI demonstrated lower right ventricular (RV) global circumferential strain and RV global radial strain. However, no differences were found in left atrial (LA), left ventricular (LV), or right atrial deformation parameters. β-TI patients with at least one cardiac segment with T2∗<20 ms showed significantly reduced LV global longitudinal strain (GLS) and RV GLS. Patients with cardiac complications exhibited significantly impaired LA reservoir and conduit strain parameters compared to those without cardiac complications.

In patients with β-TI, only RV strain parameters were impaired compared to control subjects. Both RV and LV GLS were reduced in patients with β-TI with at least one cardiac segment showing myocardial iron overload. Furthermore, patients with cardiac complications exhibited impaired LA strain parameters.