Detection of Early Right Ventricular Dysfunction in Young Patients With Thalassemia Major Using Tissue Doppler Imaging.
BACKGROUND
Myocardial iron overload is the most common cause of mortality in patients with thalassemia major (TM), also known as beta-thalassemia. T2* cardiovascular magnetic resonance imaging (MRI) is the best way of monitoring cardiac iron, and new echocardiographic techniques can be used to assess cardiac function.


OBJECTIVE
The aim of this study was to assess the systolic and diastolic right ventricular (RV) function of patients with TM using tissue Doppler imaging (TDI) and to determine whether this echocardiographic technique is an adequate diagnostic tool for the screening and detection of subclinical cardiac dysfunction.


METHODS
Eighty-four patients with TM were evaluated by conventional echocardiography and pulse-wave TDI. The data of the TM group (Group 1) were compared with that of 85 age- and sex-matched healthy controls (Group 2). Cardiovascular T2* MRI examinations were performed in 49 of the 85 patients.


RESULTS
The patients with TM had significantly lower values for weight, height, body mass index, systolic arterial pressure, deceleration time, E'/A', and ejection time (ET) than the controls. Group 1 also had significantly higher values for peak early diastolic velocity (E) over peak late diastolic velocity (A), peak early diastolic velocity of TDI (E'), peak late diastolic velocity of TDI (A'), E/E', isovolumetric relaxation time, isovolumetric contraction time, and RV magnetic perfusion imaging (MPI) than Group 2.


CONCLUSIONS
RV diastolic dysfunction occurs before systolic deterioration in patients with TM and cannot be screened with conventional echocardiographic techniques. In routine practice, TDI measurements, MPI (for global function) and the E/E' parameter (for diastolic function) can be used to screen and detect early RV dysfunction.
Department of Pediatric Cardiology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
Helen
H
Bornaun
Department of Pediatric Cardiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Reyhan
R
Dedeoglu
Department of Pediatric Cardiology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
Kazim
K
Oztarhan
Institute of Health Sciences, Uskudar University, Istanbul, Turkey.
Savas
S
Dedeoglu
Department of Pediatrics, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
Erkan
E
Erfidan
Department of Pediatric Hematology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
Muge
M
Gundogdu
Department of Pediatric Hematology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
Gonul
G
Aydogan
Departments of Statistics, Istanbul Commerce University, Istanbul, Turkey.
Dicle
D
Cengiz
Beta-Thalassemia; Echocardiography; Ventricular Function; Young Patients