This study assessed 33 multi-transfused thalassemic children with iron overload using tissue Doppler imaging (TDI), strain imaging (SI), and conventional 2D echocardiography compared to 32 healthy controls. While 2D echocardiography showed higher left ventricular dimensions and mass in thalassemic children, ejection fraction and diastolic parameters were normal. TDI velocities were normal at the septum but lower at the lateral wall in thalassemic children. SI and strain rate imaging parameters were significantly lower in thalassemic children across all measured segments. The study concludes that while ejection fraction remains normal with 2D echocardiography, TDI and SI can detect early and regional myocardial involvement not seen with conventional

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)

4. Results… (Baseline parameters)
RESULTS (BASELINE PARAMETERS)

5. Results… (2D Echocardiographic parameters)
RESULTS (2D ECHO PARAMETERS)

6. Results (Tissue Doppler Imaging parameters)
RESULTS (TISSUE DOPPLER IMAGING)
p< 0.01 p: value: not significant

7. Results… (Strain & Strain Rate Imaging parameters)
RESULTS (STRAIN+ SRI PARAMETERS)
p< 0.01 p< 0.01

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…