Global longitudinal strain as an Indicator of cardiac Iron overload in thalassemia patients

Abstract

Background and objectiveCardiac involvement due to iron overload is the most common cause of morbidity and mortality in patients with thalassemia, and many patients remain asymptomatic until the late stages. Therefore, early detection of heart problems in such patients at subclinical stages can improve the prognosis of these patients. We investigated the role of speckled tracking (SI) and tissue Doppler echocardiography (TDI) in early detection of iron overload in these patients.Methods52 thalassemic patients who were receiving regular blood transfusion with normal global LV function were examined by two- and three-dimensional echocardiography. Cardiac MRI was done and T2* images were considered as the non-invasive gold standard for evaluating cardiac iron deposition. Serum ferritin level was assessed and the relationships between serum ferritin levels and echo finding with cardiac MRI T2* was investigated.ResultsNo significant relationship was seen between serum ferritin levels and cardiac MRI T2*. Among the echocardiographic findings, septal systolic myocardial velocity (P = 0.002 and r = 0.43) and global strain (GLS) (P = 0.000 and r = 0.60) were significantly associated with T2*. A GLS < 19.5 could predict a T2* level below 20 by 82.14% sensitivity and 86.36% specificity (area under the curve = 0.87; p < 0.0001).ConclusionWhile serum ferritin level and ejection fraction are not useful candidates, GLS may be used as a valuable marker to screen thalassemia patients for myocardial iron deposition, using a cut off value below − 19.5. This approach may facilitate the cardiac follow up, reduce the costs, and contribute to preventing deterioration of cardiac function in countries with limited availability of cardiac MRI.

Left ventricular deformation mechanics over time in patients with thalassemia major with and without iron overload

“…Monte et al [22] and Li et al [23] found no correlation between left ventricular deformational parameters and T2* signals. Our study is in agreement with others [24,25], where they found a correlation of longitudinal strain with the T2* signal. It is noteworthy that in our study, iron-overloaded patients had similar LVEFs compared to non-iron-overloaded patients.…”

“…Chronic tissue hypoxia in addition to chronic anemia, nutritional deficiencies and viral infections may contribute to the different susceptibilities to iron overload and cardiac damage. Moreover, myocardial fibrosis has been revealed in CMR studies in both iron-and non-iron-overload patients [32]: longlasting consequences of previous damage could explain the contradictory results on the correlation between the actual CMR T2* signal and left ventricular deformational parameters [22][23][24][25]32]. Our results demonstrated a significant correlation between liver and heart iron load assessed by MRI-T2*, while this correlation was lost at follow-up.…”

Global longitudinal strain for prediction of ventricular arrhythmia in patients with heart failure

“…Similarly, in Park and colleagues' study, GLS (not LVEF) was an independent predictor of death among the cases suffering from HF with reduced EF, HF with mid‐range EF, and HF with preserved EF 12 . In a study by Abtahi et al ., it was shown that GLS was a more appropriate predictor of iron cardiac overload among thalassemia cases, while LVEF was not capable of such detection 13 . It is also utilized to evaluate LV remodelling, which may occur following an acute MI 22 …”

“…Speckle‐tracking echocardiography (STE) has been reported as a non‐Doppler‐oriented and angle‐independent evaluation technique of the LVEF. Measuring the length of myocardial segments is performed by tracking the displacement of myocardial speckles via an algorithm 13 . As measuring the STE is done directly, variety in ventricular loading, compliance of myocardium, and afterload properties have less influence on it compared with LVEF 14 .…”

Initial Dosage Optimization of Tacrolimus in Pediatric Patients With Thalassemia Major Undergoing Hematopoietic Stem Cell Transplantation Based on Population Pharmacokinetics

“…4,5 Transfusions are the common therapy for thalassemia but are associated with huge physical harm to patients, including transfusion reactions, alloimmunization, infection, and iron overload-induced multiorgan dysfunction despite using iron chelation. 3,6,7 Since Thomas et al 8 reported the first sibling bone marrow transplantation for thalassemia in 1982, allogeneic hematopoietic stem cell transplantation (allo-HSCT) has become an effectively curative approach for thalassemia. 2,9 Graft-versus-host disease (GVHD) is a severe complication of allo-HSCT and currently recognized as the major cause of transplant failure and transplant-related mortality.…”