Evaluation of ECG and echocardiographic findings in patients aged 2 to 18 years affected with thalassemia major

Abstract

BackgroundAnemia and accumulation of iron in the tissues following prolonged transfusion engenders ventricular dysfunction in the form of heart failure and arrhythmia, which are in fact the most life-threatening complications in patients with thalassemia major. ObjectivesThe aim of this study was to evaluate ECG and echocardiographic changes in patients with thalassemia major. MethodsIn this cross-sectional research, 72 patients with thalassemia major aged 2–18 years were studied over a period of six months. Patients were assigned into two groups of less than or equal to 10 years and over 10 years; moreover, 72 healthy subjects were included in the study as a control group. Patients were divided into two groups of ferritin less than or equal to 2000 ng/ml and above 2000 ng/ml in terms of the average ferritin of the previous six months. And finally, ECG, 24-hour Holter ECG monitoring, and echocardiography were performed for all patients. ResultsECG changes were observed in 43 patients (59.7%) most of whom (35 patients) showed ferritin above 2000 ng/ml. Twenty-eight patients (65.1%) with ECG abnormality showed T-wave changes as flattening and negative T-wave. Other changes included PAC (n = 9), PVC (n = 3), paroxysmal AF (n = 1), and RBBB (n = 2). Sinus tachycardia was seen in 18 patients (25%), 13 of whom had ferritin above 2000 ng/ml. In all patients with thalassemia major bearing ferritin above 2000 ng/ml, P duration and P dispersion proved to be longer than the normal population. In addition, in the group over 10 years with ferritin above 2000 ng/ml, QTc and QT dispersion was longer than the normal population. LVEF in both groups up to ferritin below 2000 ng/ml was at the normal range and gradually lowered to less than 55% with increasing ferritin from 2000 ng/ml. Systolic pulmonary arterial pressure gradually elevated with decreasing LVEF from 65% to 45% and heightened from 12 mm Hg to 40 mm Hg. However, with further decrease in EF, while LVEF fell lower than 45%, SPAP again escalated to 52 mm Hg. ConclusionsOur study demonstrated that ECG changes in thalassemia major patients are directly associated with serum ferritin level and occur earlier compared to echocardiographic changes.