A study of echocardiographic changes in patients of thalassemia major

Abstract

Background: Thalassemia major is a chronic hematological disorder. Regular blood transfusion is the only modality of long-term survival for these patients. This leads to iron overload, the heart being the most severely affected organ. The gold standard for detecting myocardial iron deposition is cardiac MRI. However, very few patients can afford this investigation. Hence, authors carried out this study to find out whether early iron overload can be detected by echocardiography which is a simple and less expensive tool. The objective of this study was to document echocardiographic changes of cardiac iron overload in patients of thalassemia major even before appearance of symptoms.Methods: A comparative cohort study conducted from January 2018 to October 2018 in the Department of Paediatrics of SSG Hospital, and Government Medical College, Vadodara. The case group consisted of 35 patients of Thalassemia major. 35 age and sex matched normal children were selected as controls. Relevant blood investigations were performed in cases. 2-Dimensional M-Mode Echocardiography was performed in both patients and controls. Thalassemia major patients were compared to normal healthy children for various parameters in echocardiography indicating the systolic and diastolic function. Proportion and percentage were calculated for descriptive analysis. Independent t-Test was applied between two groups to find out significance level.Results: For all parameters except End systolic volume and fractional shortening, p values were less than 0.05 which is significant. 85% (30/35) had increase in interventricular septal dimensions (IVSD), 97%(34/35) had increase in posterior wall dimensions (PWD), 82%(29/35) had increased left ventricular internal diameter diastole(LVIDD), 88%(31/35) had increased left ventricular internal diameter systole (LVIDS), 80%(28/35) had increased E/A RATIO .Ejection fraction was affected in 77%(27/35).This shows that patients of thalassemia major have significant cardiac dysfunction; possibly because of cardiac iron overload.Conclusions: Echocardiography is an effective tool for screening cardiac iron overload in patients of thalassemia major and should be done periodically in all patients.

Value of Speckle Tracking Echocardiography for Detection of Clinically Silent Left and Right Ventricular Dysfunction in Patients with β-Thalassemia Major

“…[11] Compared with controls, the diastolic indices of LV in beta thalassemia major patients showed significantly higher E wave velocity which confirmed by Ragab et al, 2015 who studied 25 patients with beta-thalassemia major and 20 healthy controls to investigate non-overt cardiac dysfunctions in beta thalassemia major patients using pulsed wave Tissue Doppler Imaging (TD I) and its relation to iron overload and brain natriuretic peptide and found that significant increase of E wave velocity in additional to non-significant difference of A wave velocity and E/A ratio in beta thalassemia major patient comparing with health control group [12]. Similar results to these findings were recorded by Chanpura et al, 2019 this study included 35 patients with beta-thalassemia major and 35 healthy to document echocardiographic changes of cardiac iron overload in patients of thalassemia major even before appearance of symptoms and found that E wave velocity was significantly high in beta thalassemia major patient comparing with health control group [13] .The study also found that A wave velocity and E/A ratio were significantly high in beta thalassemia major patient comparing with health control group. This was further confirmed by Ebru et al, 2010.…”