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Usefulness of Pulsed Wave Tissue Doppler Imaging in Assessment of Left Ventricular Functions in Children with Beta-Thalassemia Major

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Abstract

Objective

To evaluate the changes in the LV systolic and diastolic function in children with beta-thalassemia major (β-TM) using pulsed wave tissue doppler (TD) echocardiography.

Methods

Clinical, conventional echo doppler and pulsed wave tissue doppler imaging parameters were compared in 40 beta-thalassemia major patients (mean age, 6.52 ± 3.5 y) and 25 age and sex matched normal subjects (mean age, 6.5 ± 2.7 y).

Results

There were no significant statistical differences between mean fractional shortening (FS) and ejection fraction (EF) of left ventricle (LV) of the patients and control group. Children with beta-thalassemia had significantly lower E′ wave velocities measured at the left ventricular septal annulus (8.1 ± 3.3 vs. 13 ± 2.5, P < 0.001), lateral margin of the mitral annulus (9.1 ± 5.4 vs. 13.3 ± 2.5, P < 0.001) and lateral margin of the tricuspid annulus (9.3 ± 3.9 vs. 13.3 ± 2.5, P < 0.001) when compared to the control group. Furthermore children with beta-thalassemia had significantly lower E′/A′ wave ratio at the left ventricular septal annulus (0.76 ± 0.34 vs. 1.36 ± 0.23), lateral margin of the mitral annulus (0.83 ± 0.17 vs. 1.28 ± 0.22), and lateral margin of the tricuspid annulus ((0.90 ± 0.27 vs. 1.26 ± 0.23, (P < 0.05) when compared to the control group.

Conclusions

This study showed that patients with beta-thalassemia major and normal conventional echo doppler parameters had statistically significant changes detected by pulsed wave tissue doppler imaging.

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References

  1. Ehlers KH, Levin AR, Markenson AL, Marcus JR, Klein AA, Hilgartner MW. Longitudinal study of cardiac function in thalassemia major. Ann N Y Acad Sci. 1980;344:397–404.

    Article  PubMed  CAS  Google Scholar 

  2. Olivieri NF, Nathan DG, MacMillan JH, et al. Survival in medically treated patients with homozygous beta-Thalassemia. N Engl J Med. 1994;331:574–8.

    Article  PubMed  CAS  Google Scholar 

  3. Vogel M, Anderson LJ, Holden S. Tissue doppler echocardiography in patients with thalassaemia detects early myocardial iron dysfunction related to myocardial iron overload. Eur Heart J. 2003;24:113–9.

    Article  PubMed  CAS  Google Scholar 

  4. Hahalis G, Manolis AS, Gerasimidou I, Alexopoulos D, Sitafidis G, Kourakli A. Right ventricular diastolic function in beta-thalassemia major: Echocardiographic and clinical correlates. Am Heart J. 2001;141:428–34.

    Article  PubMed  CAS  Google Scholar 

  5. Khraiche D, Pellerin D. Tissue Doppler, Doppler Strain, and Non-Doppler Strain: Tips, Limitations, and Applications. In: Nihoyannopoulos P, Kisslo J, eds. Echocardiography. 1st ed. London: Springer; 2009. p. 79–100.

    Chapter  Google Scholar 

  6. Hamdy AM. Use of strain and tissue velocity imaging for early detection of regional myocardial dysfunction in patients with beta thalassemia. Eur J Echocardiographr. 2007;8:102–9.

    Article  Google Scholar 

  7. Kremastinos DT, Tiniakos G, Theodorakis GN, Katritsis DG. Heart failure/cardiac transplantation: Myocarditis in beta-thalassemia major: A cause of heart failure. Circulation. 1995;91:66–71.

    Article  PubMed  CAS  Google Scholar 

  8. Amoozgar H, Farhani N, Karimi M. Early echocardiographic findings in beta-thalassemia intermedia patients using standard and tissue doppler methods. Pediatr Cardiol. 2011;32:154–9.

    Article  PubMed  Google Scholar 

  9. Iarussi D, Di Salvo G, Pergola V, et al. Pulsed doppler tissue imaging and myocardial function in thalassemia major. Heart Vessels. 2003;18:1–6.

    Article  PubMed  Google Scholar 

  10. Teichholz LE, Kreulen T, Herman MV, Gorlin R. Problems in echocardiographic volume determinations: Echocardiographic -angiographic correlations in the presence or absence of asynergy. Am J Cardiol. 1976;37:7–11.

    Article  PubMed  CAS  Google Scholar 

  11. Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG; American Society of Echocardiography. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr. 2007;20:1021–41.

    Article  PubMed  Google Scholar 

  12. Galderisi M. Diastolic dysfunction and diastolic heart failure: Diagnostic, prognostic and therapeutic aspects. Cardiovas Ultrasound. 2005;3:9.

    Article  Google Scholar 

  13. Silvilairat S, Sittiwangkul R, Pongprot Y, Charoenkwan P, Phornphutkul C. Tissue doppler echocardiography reliably reflects severity of iron overload in pediatric patients with beta thalassemia. Eur J Echocardiogr. 2008;9:368–72.

    PubMed  Google Scholar 

  14. Srivastava PM, Burrell LM, Calafiore P. Lateral vs. Medial mitral annular tissue Doppler in the echocardiographic assessment of diastolic function and filling pressures: Which should we use? Eur J Echocardiogr. 2005;6:97–106.

    Article  PubMed  Google Scholar 

  15. Ferrara M, Matarese SM, Francese M, et al. Role of apolipoprotein E (APOE) polymorphism on left cardiac failure in homozygous beta thalassaemic patients. Br J Haematol. 2001;114:959–60.

    Article  PubMed  CAS  Google Scholar 

  16. Hoffband AV. A sensitive test for early myocardial iron loading. Eur Heart J. 2003;24:26–7.

    Article  PubMed  CAS  Google Scholar 

  17. Nikitin NP, Witte KK. Application of tissue doppler imaging in cardiology. Cardiology. 2004;101:170–84.

    Article  PubMed  Google Scholar 

  18. Barosi G, Arbustini E, Gavazzi A, Grasso M, Pucci A. Myocardial iron grading by endomyocardial biopsy. A clinico-pathologic study on iron overloaded patients. Eur J Haematol. 1989;42:382–8.

    Article  PubMed  CAS  Google Scholar 

  19. Liu P, Henkelman M, Joshi J, et al. Quantification of cardiac and tissue iron by nuclear magnetic resonance relaxometry in a novel murine thalassemia-cardiac iron overload model. Can J Cardiol. 1996;12:155–64.

    PubMed  CAS  Google Scholar 

  20. Gujja P, Rosing DR, Tripodi DJ, Shizukuda Y. Iron overload cardiomyopathy better understanding of an increasing disorder. J Am Coll Cardiol. 2010;56:1001–12.

    Article  PubMed  CAS  Google Scholar 

  21. Garadah TS, Mahdi N, Kassab S, Shoroqi IA, Abu-Taleb A, Jamsheer A. The pro-BNP serum level and echocardiographic tissue doppler abnormalities in patients with beta thalassemia major. Clin Med Insights Cardiol. 2010;4:135–41.

    Article  PubMed  Google Scholar 

  22. Palka P, Macdonald G, Lange A, Burstow DJ. The role of doppler left ventricular filling indexes and doppler tissue echocardiography in the assessment of cardiac involvement in hereditary hemochromatosis. J Am Soc Echocardiogr. 2002;15:884–90.

    Article  PubMed  Google Scholar 

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Contributions

AMA conceived of the study, participated in its design, data collection, analysis and drafted the manuscripts as well as in the critical review of the manuscript. HYA conceived of the study, participated in its design, did Echo, data analysis and drafted the critical review of the manuscript. All authors read and approved the final manuscript

Conflict of Interest

None.

Role of Funding Source

The cost of the study was totally financed by the researchers.

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Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine, Fayoum University, Fayoum, Egypt, 63514

    Ahmed Mahmoud Abdelmoktader

  2. Department of Cardiology, Faculty of Medicine, Fayoum University, Fayoum, Egypt

    Hany Younan Azer

Authors
  1. Ahmed Mahmoud Abdelmoktader
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  2. Hany Younan Azer
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Correspondence to Ahmed Mahmoud Abdelmoktader.

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Abdelmoktader, A.M., Azer, H.Y. Usefulness of Pulsed Wave Tissue Doppler Imaging in Assessment of Left Ventricular Functions in Children with Beta-Thalassemia Major. Indian J Pediatr 80, 721–725 (2013). https://doi.org/10.1007/s12098-013-1020-0

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  • DOI: https://doi.org/10.1007/s12098-013-1020-0

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