Augmentation of left atrial contractile function: a herald of iron overload in patients with beta thalassemia major.
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.
Shabanian
Reza
R
Department of Pediatric Cardiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Heidari-Bateni
Giv
G
Kocharian
Armen
A
Mashayekhi
Mehdi
M
Hosseinzadeh
Shahriar
S
Kiani
Abdolrazagh
A
Izadyar
Mina
M
Koochakzadeh
Leila
L
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*
D002614:Chelating Agents
Eur J Clin Invest. 1999 Nov;29(11):905-12
10583434
J Cardiol. 1995 Dec;26(6):357-66
8558414
Am Heart J. 2008 Dec;156(6):1056-64
19032999
Am J Cardiol. 2000 Nov 15;86(10):1090-6
11074205
Mayo Clin Proc. 1998 Jul;73(7):616-28
9663189
Eur J Haematol. 2008 Jun;80(6):515-22
18284626
Eur Heart J. 2001 Dec;22(23):2171-9
11913479
Eur Heart J. 2003 Feb;24(4):320-8
12581679
J Am Coll Cardiol. 1993 Jul;22(1):221-5
8509545
J Am Soc Echocardiogr. 2008 Jun;21(6):725-8
18187298
Circulation. 1993 Sep;88(3):1127-35
8353874
Lancet. 1989 Jul 1;2(8653):27-30
2567801
Cardiology. 1999;92(4):269-74
10844388
Heart Vessels. 2003 Mar;18(1):1-6
12644874
Eur J Echocardiogr. 2002 Mar;3(1):47-51
12067534
Circulation. 1991 Mar;83(3):808-16
1999031
Am Heart J. 1991 Mar;121(3 Pt 1):864-71
2000754
Lancet. 2000 Jun 10;355(9220):2051-2
10885361
Echocardiography. 2006 Jan;23(1):38-44
16412181
Am J Cardiol. 2006 Oct 1;98(7):954-9
16996882
Cardiol Young. 2009 Dec;19(6):580-8
19849873
Am J Cardiol. 1999 Oct 1;84(7):829-32
10513783
Circulation. 1990 Jul;82(1):88-94
2364528
Int J Cardiovasc Imaging. 2008 Jan;24(1):15-22
17394097
Turk J Pediatr. 1998 Apr-Jun;40(2):201-9
9677725