title: The Diagnostic Value of Pulsed Wave Tissue Doppler Imaging in Asymptomatic Beta- Thalassemia Major Children and Young Adults; Relation to Chemical Biomarkers of Left Ventricular Function and Iron Overload.
abstract: BACKGROUND
  Cardiac iron toxicity is the leading cause of death among β-halassaemia major (TM) patients. Once heart failure becomes overt, it is difficult to reverse.
  
  
  OBJECTIVE
  To investigate non-overt cardiac dysfunctions in TM patients using pulsed wave Tissue Doppler Imaging (TD I) and its relation to iron overload and brain natriuretic peptide (BNP).
  
  
  METHODS
  Thorough clinical, conventional echo and pulsed wave TDI parameters were compared between asymptomatic 25 β-TM patients and 20 age and gender matched individuals. Serum ferritin and plasma BNP levels were assayed by ELISA.
  
  
  RESULTS
  TM patients had significant higher mitral inflow early diastolic (E) wave and non significant other conventional echo parameters. In the patient group, pulsed wave TDI revealed systolic dysfunctions, in the form of significant higher isovolumetric contraction time (ICT), and lower ejection time (E T), with diastolic dysfunction in the form of higher isovolumetric relaxation time (IRT), and lower mitral annulus early diastolic velocity E' (12.07 ±2.06 vs 15.04±2.65, P= 0.003) compared to the controls. Plasma BNP was higher in patients compared to the controls. Plasma BNP and serum ferritin had a significant correlation with each other and with pulsed wave conventional and TDI indices of systolic and diastolic functions. Patients with E/E' ≥ 8 had significant higher serum ferritin and plasma BNP levels compared to those with ratio < 8 without a difference in Hb levels.
  
  
  CONCLUSIONS
  Pulsed wave TDI is an important diagnostic tool for latent cardiac dysfunction in iron-loaded TM patients and is related to iron overload and BNP.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Menoufia University. Naser street, Shebeen El-koom, Menoufia, Egypt.
authors.forename: Seham M
authors.initials: SM
authors.lastname: Ragab
authors.affiliation: Department of Clinical pathology, Faculty of Medicine, Menoufia University. Naser street, Shebeen El-koom, Menoufia, Egypt.
authors.forename: Waleed M
authors.initials: WM
authors.lastname: Fathy
authors.affiliation: Department of Cardiology, Faculty of Medicine, Menoufia University. Naser street, Shebeen El-koom, Menoufia, Egypt.
authors.forename: Walaa FAbd
authors.initials: WF
authors.lastname: El-Aziz
authors.affiliation: Department of Clinical pathology, Faculty of Medicine, Menoufia University. Naser street, Shebeen El-koom, Menoufia, Egypt.
authors.forename: Rasha T
authors.initials: RT
authors.lastname: Helal