title: Determination of early cardiac deterioration in beta-thalassaemia major by echocardiography.
abstract: OBJECTIVE
  Cardiovascular involvement is the leading cause of mortality in patients with beta-thalassaemia major (beta-TM). This cross-sectional study was performed to evaluate the earlier cardiac damage in beta-TM by echocardiography, before left ventricular (LV) systolic dysfunction was observed.
  
  
  RESULTS
  The study population consisted of 70 patients with beta-TM and was compared with age- and sex-matched healthy controls (n= 47). The study population was divided into subgroups based on serum ferritin levels and the time interval from first diagnosis. All patients and control subjects underwent transthoracic echocardiography. Mean LV ejection fractions were similar between groups (60 +/- 5% vs 62+/- 6%, P= 0.063). beta-TM patients had increased left atrial (LA) volume index, LV mass index, and right ventricle (RV) diameter index (30.3 +/- 9.9 vs 19.9 +/- 4.8, 97.0 +/-17.8 vs 80.2 +/- 13.6, and 1.50 +/- 0.17 vs 1.31 +/- 0.15; P= 0.0001, respectively). Patients with beta-TM had significantly shortened pulmonary acceleration times (133.7+/- 22.4 vs 154.9 +/- 16.5, P= 0.0001). Mitral early inflow (E) velocity and tissue Doppler (TDI) annular velocity (Em) ratios (E/Em) were also elevated (7.5 +/- 3.0 vs 6.2 +/- 1.6, respectively, P= 0.009). Serum levels of ferritin were correlated with interventricular septum (R= 0.308, P= 0.009) and posterior wall (R= 0.312, P= 0.009) thicknesses.
  
  
  CONCLUSIONS
  It is often unsuccessful to reverse iron-induced cardiac deterioration in late-stage disease when cardiac failure is already present. Increased LV mass index, LA volume index, RV diameter index, and decreased pulmonary acceleration time could be earlier parameters featuring premature cardiac remodelling in beta-TM. Increased E/Em ratio may also point out early cardiac deterioration in beta-TM patients.
authors.affiliation: Dept. of Cardiology, Tepecik Training and Research Hospital, Izmir, Turkey. . onerozdogan@yahoo.com
authors.forename: Oner
authors.initials: O
authors.lastname: Ozdogan
authors.forename: Alper
authors.initials: A
authors.lastname: Alp
authors.forename: Meral
authors.initials: M
authors.lastname: Turker
authors.forename: Berna
authors.initials: B
authors.lastname: Atabey
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011379:Prognosis; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling; D055815:Young Adult; D017086:beta-Thalassemia / Q000097:blood / Q000150:complications*
chemical_list: D005293:Ferritins