Abstract
Background and Objective: Cardiovascular involvement due to iron overload is the leading cause of morbidity and mortality in patients diagnosed with beta-thalassaemia major (β-TM). However many patients remain asymptomatic until the late stage. In this cross-sectional study, we investigated the role of real-time three-dimensional (RT3D) echocardiography findings and endothelial dysfunction parameters in asymptomatic β-TM patients, and the relationship between these parameters and cardiac magnetic resonanace imaging (MRI) T2 * value.
Methods: 51 asymptomatic β-TM patients who were receiving regular blood transfusions were evaluated by two-dimensional (2D) and RT3D echocardiography examinations including endothelial dysfunction parameters. The study population was divided into two subgroups based on their cardiac MRI T2* values (MRI T2* ≤20ms and >20ms). The relationships between serum ferritin levels, 2D and RT3D echocardiography measurements, endothelial dysfunction parameters, and cardiac MRI T2* values were investigated.
Results: Among the echocardiographic findings, although all left ventricle ejection fraction (LVEF) values obtained by 2D echocardiography were within normal limits (≥50%), they were not associated with MRI T2* values. LVEFRT3D (53.25 +2.33 vs 58.81 +1.02), SDI12 (6.53 +0.56 vs 2.85 +0.48), and SDI16 (7.65 +0.75 vs 3.26 +0.49) were significantly different and negatively corraleted between groups with MRı T2* ≤20ms and >20ms, respectively. Flow-mediated dilatation (FMD) (6.08% + 0.34 vs 14.46% + 1.12), aortic strain (7.79% + 2.19 vs 12.76% + 4.19), and serum ferritin values were significantly different and negatively corraleted between groups with T2* ≤20ms and >20ms, respectively.
Conclusion: Decreased LVEF and increased SDI by RT3D echocardiography could be earlier parameters of early cardiac deterioration. Decreased FMD and aortic strain may be good predictors of sublinical cardiovascular involvement in asymptomatic patients with β-TM.
Key words: Beta-thalassaemia major, Cardiovascular involvement, Endothelial dysfunction parameters, Left ventricular systolic dyssynchrony index, Real-time 3D echocardiography