Abstract
Objectives: Strain imaging is a novel promising echocardiographic technique and strain imaging by speckle tracking has been reported recently in a few studies as a promising tool to detect early changes of myocardial deformation that could be related to myocardial iron over load in patients with β-thalassemia major. In this study, we investigated strain images in comparison with the cardiac T2* magnetic resonance imaging results.
 Materials and Methods: A total of 45 patients from a single institution’s pediatric and adult hematology centers were evaluated with strain echocardiography and T2* magnetic resonance imaging at concomitant out-patient visits. We grouped patients according to cardiac T2* magnetic resonance imaging results: <20 ms (Group 1, cardiac iron loading present) (n=12) and ≥20 ms (Group 2, no clinically significant cardiac iron loading) (n=33).
 Results: The median global longitudinal strain was measured as -19.9% (range -27.1% to -12%) in Group 1 and -20.7% (range -26.5% to -12.8%) in Group 2 (p=0.37). Using receiver operator curve analysis, global longitudinal strain value at a cutoff point of -20.45% in the ruling out T2*<20 ms with a sensitivity of 83% and a specificity of 54% was obtained.
 Conclusion: In conclusion, although T2* magnetic resonance imaging is the gold standard method, strain imaging echocardiography can be used for predicting cardiac iron accumulation, after validations were obtained in larger sample sizes.
Highlights
Cardiac iron accumulation is the most important cause of mortality for β-thalassemia major (BTM) patients [1]
The iron chelators that the patients were on during evaluation were summarized in Table 1. 66.6% and 66.7% of Group 1 and 2 patients were on deferasirox as iron chelation therapy, respectively
Diastolic dysfunction usually develops before systolic dysfunction in patients with BTM
Summary
Cardiac iron accumulation is the most important cause of mortality for β-thalassemia major (BTM) patients [1]. Increased iron absorption due to ineffective erythropoiesis and chronic blood transfusions are the cause of iron accumulation for these patients [2]. Heart and endocrine organs are the major sites of iron accumulation [2, 3]. Cardiac T2* magnetic resonance imaging (MRI) is the gold standard, non-invasive and validated method for assessment and follow-up of myocardial iron overload indirectly [4]. Cardiac T2* value below 10 ms, is indicative for severe iron accumulation and T2* values above 20 ms indicates the absence of clinically significant iron accumulation. Range of T2* value between 10-20 ms indicates cardiac iron loading [5, 6]. Access to cardiac T2* MRI is still limited in many centers [7]
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