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THALASSEMIA: VENTRICULAR DYSFUNCTION ASSESSMENT
1. TISSUE DOPPLER, STRAIN IMAGING AND
CONVENTIONAL 2- DIMENSIONAL
ECHOCARDIOGRAPHIC ASSESSMENTS IN MULTI-
TRANSFUSED THALASSEMIC CHILDREN WITH IRON
OVERLOAD
Murtaza Kamal, Nitin K Rao, Suman Vyas
Department of Pediatric Cardiology, Star Hospitals,
Hyderabad, India
2. Introduction…
INTRODUCTION
Disorder of hemoglobin chain
synthesis: 10-12,000/ year
Multiple transfusions+more absorption
Deposition in different tissues: Heart,
liver, gonads, pancreas
Aggressive chelation: Prevents, delays,
even reverts
Early recognition: Disease modification:
Difficult—> Global ventricular function+
exercise capacity remains normal until
late in disease process
2D ECHO: Subtle cardiac dysfunction
not picked
TDI, SI: Emerging: Varying results
3. Material & Methods…
MATERIAL & METHODS
Analytical cross sectional study
2-18y,beta thalassemia major: 33
15 months (Jan 18-Mar 19)
Iron overload: >1000ng/dl
Age+ sex matched healthy controls:
32
CHD/ RHD/ HF/ HT/ DM/ Dyslipidemia/
Cardiac medications: Excluded
Baseline parameters+ Detailed clinical
examination+ Echocardiographic
assessment: Conventional 2D Echo+
TDI+ SI+ SRI
iE- 33 Philips: Operator blinded to
clinical data
Lateral+ supine position; S5-1
transducer with ECG gating: 3 beats
digitally stored for offline analysis
(QLAB version 8.1)
8. Discussion…
DISCUSSION
2D ECHO:
LVEDD+ LVEDV+ LV mass higher
higher in thalassemics
Systolic parameters: LVEF
(60.94±4.038 vs 62.26±6.134; p=0.12)
similar+ MPI were normal and
comparable in 2 group (p=0.46)
Diastolic parameters were normal and
comparable in the 2 groups
TDI parameters:
Velocities at septal LV comparable
between 2 groups
Velocities at lateral LV lower than
controls
Despite comparable LVEF, differential
abnormality exists in TVI
SI+ SRI:
Significantly lower in thalassemics in
comparison to controls in all measured
segments
9. Limitations & Conclusion…
CONCLUSION
Limitations:
Single center, limited number
Single point study: Cross sectional
Serial studies needed to clarify if
changes in SI, SRI and TDI progress to
ventricular dysfunction
Analysis of each patient by more than 1
observer will improve study
MRI T2*: Gold standard; but no
comparison in present study
Ventricular dysfunction common,
increases with age Chelation reverts
EF by 2D Echo and global ventricular
function remains normal till late
TDI+ SI: Picks early+ regional
myocardial involvement
Superior to conventional 2D Echo, non
invasive, less time consuming, easily
available, less costly: Good for
resource limited setting (combined
with CMR)
10. TISSUE DOPPLER, STRAIN IMAGING AND CONVENTIONAL 2-
DIMENSIONAL ECHOCARDIOGRAPHIC ASSESSMENTS IN MULTI-
TRANSFUSED THALASSEMIC CHILDREN WITH IRON OVERLOAD
THANK YOU…