The early cardiac involvement in patients with β-thalassemia major

Abstract

Cardiac complications, heart failure and arrhythmias remain the major causes of death in thalassemia major. To detect the early cardiac involvement in β-thalassemic patients. 56 Patients (pts) with β-thalassemia major and transfusion burden ⩾12 times/year (age 6–16 years) were included in our study, classified into three groups according to serum ferritin, group I: 21 pts with ferritin level <2500 ng/ml, group II: 23 pts with ferritin level 2500–5000 and group III: 12 pts with ferritin level >5000 ng/ml. They were subjected to detailed clinical evaluation, routine laboratory investigations, serum ferritin level, ECG {corrected QT intervals (QTc) and QT dispersion(QTd)}, echocardiography for measurement of left atrial (LA) active emptying fraction, Systolic (peak systolic wave, Q–S peak duration) and diastolic functions of left ventricle using standard and tissue Doppler imaging (TDI). Groups III and II showed a significant increase in LV septal and posterior wall thickness than group I while QTc and QTd were increased significantly only in group III compared to group I ( P = 0.00, 0.01). LV diastolic function and LA active emptying fraction were significantly impaired in group III and II compared to group I while LV systolic function parameters by TDI were impaired significantly in group III compared to group I with insignificant difference by standard echocardiography. The increase in LV septal and posterior wall thickness precedes ECG changes. Also LV diastolic dysfunction and impaired LA active emptying fraction precede LV systolic dysfunction.