1
|
Zhou Y, Cao Y, Fang Z, Huang K, Yang M, Pang G, Zhao J, Liu Y, Luo J. Research on the clinical factors of cardiac iron deposition in children with beta-thalassemia major. Eur J Pediatr 2024; 183:875-882. [PMID: 37938353 PMCID: PMC10912130 DOI: 10.1007/s00431-023-05300-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
Magnetic resonance imaging (MRI) T2* is the gold standard for detecting iron deposition in cardiac tissue, but the technique has limitations and cannot be fully performed in paediatric thalassemia patients. The aim of this study was to analyse clinical data to identify other predictors of cardiac iron deposition. A retrospective analysis was performed on 370 children with β-TM. According to the cardiac MRI results, patients were allocated to a cardiac deposition group and noncardiac deposition group. Multivariate analysis revealed that genotype and corrected QT interval were associated with cardiac iron deposition, indicating that the-β0/β0 genotype conferred greater susceptibility to cardiac iron deposition. Receiver operating characteristic curve (ROC) analysis was performed, and the area under the curve (AUC) of genotype was 0.651. The AUC for the corrected QT interval was 0.711, at a cut-off value of 418.5 ms. ROC analysis of the combined genotype and corrected QT interval showed an AUC of 0.762 with 81.3% sensitivity and 64.7% specificity. Compared to patients with the β+/β+ and β0β+ genotypes, β0β0 children with β-TM were more likely to have cardiac iron deposition. Conclusion: The genotype and QTc interval can be used to predict cardiac iron deposition in children with β-TM who are unable to undergo MRI T2 testing.
Collapse
Affiliation(s)
- Yuhang Zhou
- Department of Pediatrics, The First Affiliated Hospital Of Guangxi Medical University, Nanning, China
| | - Yaxuan Cao
- Department of Pediatrics, The First Affiliated Hospital Of Guangxi Medical University, Nanning, China
| | - Zhenhua Fang
- Department of Pediatrics, The First Affiliated Hospital Of Guangxi Medical University, Nanning, China
| | - Ken Huang
- Department of Pediatrics, The First Affiliated Hospital Of Guangxi Medical University, Nanning, China
| | - Mengxin Yang
- Department of Pediatrics, The First Affiliated Hospital Of Guangxi Medical University, Nanning, China
| | - Guanxiu Pang
- Department of Pediatrics, The First Affiliated Hospital Of Guangxi Medical University, Nanning, China
| | - Jie Zhao
- Department of Pediatrics, The First Affiliated Hospital Of Guangxi Medical University, Nanning, China
| | - Yang Liu
- Department of Pediatrics, The First Affiliated Hospital Of Guangxi Medical University, Nanning, China
| | - Jianming Luo
- Department of Pediatrics, The First Affiliated Hospital Of Guangxi Medical University, Nanning, China.
| |
Collapse
|
2
|
Echocardiographic evaluation of left atrial strain for predicting iron overload in pediatric patients with β-thalassemia with preserved ejection fraction. Int J Cardiovasc Imaging 2023; 39:895-906. [PMID: 36607471 DOI: 10.1007/s10554-022-02788-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/24/2022] [Indexed: 01/07/2023]
Abstract
Pediatric patients with β-thalassemia (β-TM) with preserved ejection fraction may experience early myocardial damage. This prospective study aimed to investigate left atrial (LA) function restructure in pediatric patients with β-TM by two-dimensional speckle tracking echocardiography (2D-STE) and evaluate the value of LA strain for predicting myocardial iron overload (MIO). We recruited 50 β-TM pediatric patients and 30 healthy children aged 3-14 years. The patients were assigned to a normal left ventricular (LV) lesion group (n = 20) and an enlarged LV lesion group (n = 30). Subjects all underwent echocardiography to measure conventional cardiac function parameters and LA strain parameters. The results displayed that LA reservoir strain (LASr), conduit strain (LAScd), contractile strain (LASct) and strain rate were significantly reduced in pediatric patients with β-TM with preserved ejection fraction. LASr, LAScd, and LASct were negatively correlated with the E/e' ratio, of which LASr had the most significant correlation (r = - 0.69, P < 0.001). LASr and LASct correlated positively with T2* (r = 0.70 and 0.62, respectively, all P < 0.001). In the multiple regression, LASr and LASct were independent predictors for T2*. The areas under the curve for LASr and LASct were 0.87 (P < 0.001) and 0.78 (P = 0.004), respectively. Our results demonstrated that LA strains were dramatically impaired in pediatric patients with β-TM, and LASr is an efficient indicator for detecting LV early diastolic dysfunction in β-TM pediatric patients and reflects early myocardial damage. LASr and LASct were independently predictive of MIO, but LASr was a more sensitive predictor.
Collapse
|
3
|
Mah K, Mertens L. Echocardiographic Assessment of Right Ventricular Function in Paediatric Heart Disease: A Practical Clinical Approach. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:136-157. [PMID: 37970496 PMCID: PMC10642122 DOI: 10.1016/j.cjcpc.2022.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2023]
Abstract
As the right ventricle (RV) plays an integral role in different paediatric heart diseases, the accurate assessment of RV size and function is essential in the diagnosis, management, and prognostication of congenital and acquired cardiac lesions. Yet, echocardiographic evaluation of the RV is challenging because of its complex and variable morphology, its different physiology compared with the left ventricle, and its capability to adapt to different loading conditions associated with congenital and acquired heart diseases within certain ranges. Reliable echocardiographic detection of RV systolic and diastolic dysfunction remains challenging while important for patient management. This review provides an updated, practical approach to assessing RV function in structurally normal hearts and in children with common congenital heart defects and in those with pulmonary hypertension. We also review the impact of tricuspid valve function on RV functional parameters. There is no single functional RV parameter that uniquely describes RV function; instead a combination of different parameters is recommended in clinical practice. Qualitative and quantitative analysis of RV function will be reviewed including more recent techniques such as speckle tracking and 3D echocardiography.
Collapse
Affiliation(s)
- Kandice Mah
- Division of Cardiology, BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luc Mertens
- Department of Paediatrics, Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Whipple NS, Joshi VM, Naik RJ, Mentnech T, McFarland MM, Nolan VG, Hankins JS. Sickle cell disease and ventricular myocardial strain: A systematic review. Pediatr Blood Cancer 2021; 68:e28973. [PMID: 33742492 PMCID: PMC9116158 DOI: 10.1002/pbc.28973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 01/18/2021] [Accepted: 02/08/2021] [Indexed: 12/21/2022]
Abstract
Cardiac disease is the primary cause of death in sickle cell disease (SCD). Cardiac abnormalities begin in childhood and progress throughout life. Right and left ventricular (RV, LV) myocardial strain are early markers of systolic dysfunction but are not well investigated among individuals with SCD. The objectives of this review were to (1) identify all published studies that have evaluated ventricular myocardial strain, (2) summarize their values, and (3) compare findings with those obtained from controls. From search results of four electronic databases-Medline, Embase, Scopus, and Web of Science-42 potential articles were identified, of which 18 articles and 17 studies met eligibility criteria for inclusion. The evaluated studies demonstrate that RV and LV myocardial strain are generally abnormal in individuals with SCD compared with controls, despite having normal ejection/shortening fraction. Myocardial strain has been inconsistently evaluated in this population and should be considered any time an echocardiogram is performed.
Collapse
Affiliation(s)
- Nicholas S. Whipple
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Vijaya M. Joshi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee College of Medicine, Memphis, TN, USA,Cardiopulmonary Services, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ronak J. Naik
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee College of Medicine, Memphis, TN, USA,Cardiopulmonary Services, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Tisha Mentnech
- North Carolina State University Libraries, Raleigh, NC, USA
| | - Mary M. McFarland
- Eccles Health Sciences Library, University of Utah, Salt Lake City, Utah, USA
| | - Vikki G. Nolan
- Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis, School of Public Health, Memphis, TN, USA
| | - Jane S. Hankins
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, TN, USA
| |
Collapse
|