title: Augmentation of left atrial contractile function: a herald of iron overload in patients with beta thalassemia major.
abstract: Early detection of myocardial iron overload is crucial for optimal management of patients with beta thalassemia major, which could lead to intensification of iron chelating therapy. In this study, we evaluate the conventional echocardiography and tissue Doppler imaging measurements in patients with beta thalassemia major and further introduce the assessment of atrial ejection force as a feasible price-saving approach for early detection of myocardial iron overload. During a 1-year period, 42 cases of beta thalassemia major aged <21 years and with preserved systolic function were evaluated with magnetic resonance T2* imaging (MRI T2*), conventional echocardiography, and tissue Doppler imaging techniques. Patients were classified into two groups according to their myocardial MRI T2* values, with and without critical iron loading. All patients with echocardiographic evidence of moderate and severe stages of diastolic dysfunction showed critical iron loading in their MRI T2*. After excluding those patients with severe and moderate ventricular diastolic filling abnormality, the atrial ejection force index (P = 0.002) and a number of volume indexes of the left atrium showed a significant difference between the two groups. None of the tissue Doppler imaging measurements showed a statistically significant difference between the two groups. The atrial ejection force index of 7.41, with a sensitivity of 93% and a specificity of 74%, was suggested to detect critical cardiac iron loading. These results imply that combining the atrial ejection force index with the transmitral-derived echocardiographic assessment is a feasible way to detect early stages of myocardial iron overload in patients with beta thalassemia major.
authors.affiliation: Department of Pediatric Cardiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Shabanian
authors.forename: Giv
authors.initials: G
authors.lastname: Heidari-Bateni
authors.forename: Armen
authors.initials: A
authors.lastname: Kocharian
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mashayekhi
authors.forename: Shahriar
authors.initials: S
authors.lastname: Hosseinzadeh
authors.forename: Abdolrazagh
authors.initials: A
authors.lastname: Kiani
authors.forename: Mina
authors.initials: M
authors.lastname: Izadyar
authors.forename: Leila
authors.initials: L
authors.lastname: Koochakzadeh
mesh_terms: D000293:Adolescent; D002614:Chelating Agents / Q000008:administration & dosage; D016009:Chi-Square Distribution; D004452:Echocardiography / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D019190:Iron Overload / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D017086:beta-Thalassemia / Q000150:complications*
chemical_list: D002614:Chelating Agents
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