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