title: Assessment of the relationship between fragmented QRS and cardiac iron overload in patients with beta-thalassemia major.
abstract: OBJECTIVE
  Beta-thalassemia major (TM) is a genetic hemoglobin disorder causing chronic hemolytic anemia. Since cardiac insufficiency and arrhythmias are the primary causes of mortality in such patients, monitoring of cardiac iron load is important in management of the disorder. The purpose of this study was to investigate the importance of fragmented QRS (fQRS) and its relation to the cardiac T2* value for the evaluation of cardiac iron load in TM patients.
  
  
  METHODS
  This retrospective study included 103 TM patients. The patients' T2* values, measured by cardiac MRI and 12-lead surface ECGs, were interpreted. The cardiac T2* values under 20 were considered as cardiac iron overload. The relationship between the cardiac T2* value and fQRS in ECG was investigated.
  
  
  RESULTS
  The median age of the patients was 22.6 ± 6.6 years. All patients were on regular blood transfusions and iron chelators. The patients had no risk factors for coronary artery disease. In 50 (48%) patients fQRS was detected, and in 37 (74%) of these the T2* values were low. 86% of patients with cardiac involvement (37) had fQRS, but 22% of patients with non-involvement (13) had fQRS (p < 0.001).
  
  
  CONCLUSIONS
  Since cardiac involvement is the primary cause of mortality in TM patients, the early diagnosis of cardiac dysfunction is of vital importance. The search for fQRS in the ECGs of these patients, particularly when cardiac T2* values cannot be determined and followed, is a non-expensive and easy-to-attain method for therapy management.
authors.affiliation: Clinic of Cardiology, Antalya Education and Research Hospital; Antalya-Turkey. dr.nermin@mynet.com.
authors.forename: Nermin
authors.initials: N
authors.lastname: Bayar
authors.forename: Erdal
authors.initials: E
authors.lastname: Kurtoğlu
authors.forename: Şakir
authors.initials: Ş
authors.lastname: Arslan
authors.forename: Zehra
authors.initials: Z
authors.lastname: Erkal
authors.forename: Serkan
authors.initials: S
authors.lastname: Çay
authors.forename: Göksel
authors.initials: G
authors.lastname: Çağırcı
authors.forename: Burak
authors.initials: B
authors.lastname: Deveci
authors.forename: Selçuk
authors.initials: S
authors.lastname: Küçükseymen
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use; D019190:Iron Overload / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult; D017086:beta-Thalassemia / Q000097:blood / Q000503:physiopathology*
chemical_list: D007502:Iron Chelating Agents