Abstract
Early detection of iron overload cardiomyopathy is an important strategy for decreasing the mortality rate of patients with transfusion-dependent thalassemia (TDT). Although cardiac magnetic resonance (CMR) T2* is effective in detecting cardiac iron deposition, it is costly and not generally available. We investigated whether heart rate variability (HRV) can be used as a screening method of iron overload cardiomyopathy in TDT patients. HRV, evaluated by 24-h Holter monitoring, non-transferrin bound iron (NTBI), serum ferritin, left ventricular (LV) ejection fraction (LVEF), and CMR-T2* were determined. Patients with a cardiac iron overload condition had a significantly higher low frequency/high frequency (LF/HF) ratio than patients without a cardiac iron overload condition. Log-serum ferritin (r = −0.41, P=0.008), serum NTBI (r = −0.313, P=0.029), and LF/HF ratio (r = −0.286, P=0.043) showed a significant correlation with CMR-T2*, however only the LF/HF ratio was significantly correlated with LVEF (r = −0.264, P=0.043). These significant correlations between HRV and CMR-T2* and LVEF in TDT confirmed the beneficial role of HRV as a potential early screening tool of cardiac iron overload in thalassemia patients, especially in a medical center in which CMR T2* is not available. A larger number of TDT patients with cardiac iron overload are needed to confirm this finding.
Highlights
Thalassemia is a hereditary hematologic disorder resulting from abnormal production of the globin chains of hemoglobin
Since 7 patients were not evaluated by cardiac magnetic resonance (CMR) T2*, only 59 Transfusion-dependent thalassemia (TDT) patients were included in a statistical analysis
The receiver operative characteristic (ROC) analysis demonstrated a good accuracy of low-frequency power (LF)/high-frequency power (HF) ratio enabling a prediction of cardiac iron overload status
Summary
Thalassemia is a hereditary hematologic disorder resulting from abnormal production of the globin chains of hemoglobin. These changes can cause a variety of clinical pictures, from normal red blood cell concentration to stillbirth due to severe hemoglobinopathy. Iron chelators are available, the success rate of chelation is limited because iron overload cardiomyopathy can be c 2018 The Author(s).
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