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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.
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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.
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Kumar I, Aggarwal P, Gupta V, Verma A, Kumar S, Shukla RC. Cardiac T2* magnetic resonance analysis of membranous interventricular septum in assessment of cardiac iron overload in pediatric thalassemia patients: A pilot study. Indian J Radiol Imaging 2021; 29:33-39. [PMID: 31000939 PMCID: PMC6467041 DOI: 10.4103/ijri.ijri_395_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Cardiac iron deposition in transfusion-dependent thalassemia patients is patchy in distribution. Purpose: The purpose of this study is to assess the correlation between T2* matrices of membranous interventricular septum (MIVS) and T2* values of muscular interventricular septum (IVS) on magnetic resonance imaging (MRI) and to evaluate the relationship of myocardial T2* at these two locations with MRI-estimated liver iron concentrations (LIC) and electrocardiographic (ECG) parameters. Material and Methods: MRI of heart and liver was performed in 16 consecutive pediatric patients of transfusion-dependent thalassemia major to calculate liver iron concentration and T2* time of membranous and muscular IVS. ECG parameters of these patients were charted and correlated with MRI parameters. Results: No significant correlation between T2* values of muscular IVS and MIVS was observed. Mean T2* of MIVS (9.8 ms) was significantly lower than that of muscular IVS (26.9 ms). T2* of MIVS correlated strongly with LIC where as a weak correlation was observed between T2* of IVS and LIC. Significantly higher mean QTc (corrected QT interval) value (439.86 ms) was seen in patients with T2* IVS <20 ms. Conclusion: Addition of T2* analysis of MIVS to the existing MRI protocol, consisting of muscular IVS analysis, may offer a more sensitive estimation of cardiac iron overload.
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Affiliation(s)
- Ishan Kumar
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Priyanka Aggarwal
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vineeta Gupta
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ashish Verma
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Suwen Kumar
- Department of Cardiology, Queen's Medical Center, Honolulu, Hawaii, USA
| | - Ram C Shukla
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Parsaee M, Fazelifar AF, Ansaripour E, Azarkeyvan A, Ghadrdoost B, Charmizadeh A, Behjati M. The Role of Heart Rate Variability and Fragmented QRS for Determination of Subclinical Cardiac Involvement in Beta-Thalassemia Major. Pulse (Basel) 2020; 8:15-20. [PMID: 32999874 DOI: 10.1159/000505556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/17/2019] [Indexed: 11/19/2022] Open
Abstract
Background Iron accumulation leads to increased susceptibility to cardiovascular diseases in thalassemia major (TM) patients. Depressed heart rate variability (HRV) and development of arrhythmia are among the manifestations of subclinical cardiac involvement in TM cases. Determination of subclinical cardiac involvement is essential for preventive measures. Thus, we aimed to evaluate the best method for identification of subclinical cardiac dysfunction in TM cases. Materials and Methods In this prospective study, 45 TM and 45 non-TM cases, who were referred for cardiac evaluation, were enrolled. Exclusion criteria included non-sinus rhythm and overt cardiac disease. TM cases underwent cardiac MRI, electrocardiography (ECG), and Holter monitoring. TM cases were divided into two groups of normal versus iron overload with a cardiac T2* of more or less than 20 ms, respectively. The non-TM cases underwent only ECG and Holter monitoring. Results We observed no significant difference regarding HRV between normal versus iron overload TM and non-TM cases. Higher rates of premature atrial complex, low limb voltage, low atrial rhythm, as well as minimum and average HR with lower QRS duration and PR interval were detected in TM versus non-TM cases (p value <0.05). Conclusions We observed a higher prevalence of low limb voltage and low atrial rhythm in TM cases versus non-TM cases. Indeed, the role of fragmented QRS (fQRS) for subclinical detection of cardiac disease in TM cases is still so controversial and needs more evaluation. Application of HRV and fQRS in this regard may need to be performed at the right time point after initiation of blood transfusion, but this needs to be determined.
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Affiliation(s)
- Mozhgan Parsaee
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Farjam Fazelifar
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Ansaripour
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azita Azarkeyvan
- Research Center of Iranian Blood Transfusion Organization, Thalassemia Clinic, Tehran, Iran
| | - Behshid Ghadrdoost
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ashraf Charmizadeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Behjati
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Snel GJH, van den Boomen M, Hernandez LM, Nguyen CT, Sosnovik DE, Velthuis BK, Slart RHJA, Borra RJH, Prakken NHJ. Cardiovascular magnetic resonance native T 2 and T 2* quantitative values for cardiomyopathies and heart transplantations: a systematic review and meta-analysis. J Cardiovasc Magn Reson 2020; 22:34. [PMID: 32393281 PMCID: PMC7212597 DOI: 10.1186/s12968-020-00627-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/16/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The clinical application of cardiovascular magnetic resonance (CMR) T2 and T2* mapping is currently limited as ranges for healthy and cardiac diseases are poorly defined. In this meta-analysis we aimed to determine the weighted mean of T2 and T2* mapping values in patients with myocardial infarction (MI), heart transplantation, non-ischemic cardiomyopathies (NICM) and hypertension, and the standardized mean difference (SMD) of each population with healthy controls. Additionally, the variation of mapping outcomes between studies was investigated. METHODS The PRISMA guidelines were followed after literature searches on PubMed and Embase. Studies reporting CMR T2 or T2* values measured in patients were included. The SMD was calculated using a random effects model and a meta-regression analysis was performed for populations with sufficient published data. RESULTS One hundred fifty-four studies, including 13,804 patient and 4392 control measurements, were included. T2 values were higher in patients with MI, heart transplantation, sarcoidosis, systemic lupus erythematosus, amyloidosis, hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and myocarditis (SMD of 2.17, 1.05, 0.87, 1.39, 1.62, 1.95, 1.90 and 1.33, respectively, P < 0.01) compared with controls. T2 values in iron overload patients (SMD = - 0.54, P = 0.30) and Anderson-Fabry disease patients (SMD = 0.52, P = 0.17) did both not differ from controls. T2* values were lower in patients with MI and iron overload (SMD of - 1.99 and - 2.39, respectively, P < 0.01) compared with controls. T2* values in HCM patients (SMD = - 0.61, P = 0.22), DCM patients (SMD = - 0.54, P = 0.06) and hypertension patients (SMD = - 1.46, P = 0.10) did not differ from controls. Multiple CMR acquisition and patient demographic factors were assessed as significant covariates, thereby influencing the mapping outcomes and causing variation between studies. CONCLUSIONS The clinical utility of T2 and T2* mapping to distinguish affected myocardium in patients with cardiomyopathies or heart transplantation from healthy myocardium seemed to be confirmed based on this meta-analysis. Nevertheless, variation of mapping values between studies complicates comparison with external values and therefore require local healthy reference values to clinically interpret quantitative values. Furthermore, disease differentiation seems limited, since changes in T2 and T2* values of most cardiomyopathies are similar.
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Affiliation(s)
- G J H Snel
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - M van den Boomen
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - L M Hernandez
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - C T Nguyen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - D E Sosnovik
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Division of Health Sciences and Technology, Harvard-MIT, 7 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - B K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, University of Twente, Dienstweg 1, 7522 ND, Enschede, The Netherlands
| | - R J H Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - N H J Prakken
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Dagar S, Emektar E, Corbacioglu SK, Demirci OL, Tandogan M, Cevik Y. Evaluation of electrocardiographic parameters in patients with epileptic seizure. Acta Neurol Belg 2020; 120:321-327. [PMID: 31297670 DOI: 10.1007/s13760-019-01182-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 07/02/2019] [Indexed: 11/24/2022]
Abstract
The aim of the study is to evaluate the changes in electrocardiographic parameters, including QTc dispersion (QTcd), Tpeak-Tend (Tp-e)/QTc ratio and P-wave dispersion (Pd), during the period without seizure activation in patients, presented to the emergency department (ED) with epileptic seizures. This prospective case-control study was conducted between January 2017 and January 2018. Patients, over 18 years old and presented to the ED with epileptic seizure, were consecutively included in the study. Interictal period ECGs of patients were obtained at least 2 hours after the end of the postictal period. ST-segment changes, QT interval, corrected QT interval (QTc), QTd, Pd, Tp-e, Tp-e dispersion (Tp-ed), Tp-e/QTc ratio and arrhythmias were evaluated in interictal ECGs. A total of 103 epileptic patients and 31 control cases were included in the study. Heart rate, QTc, QTcd, Pd, Tp-ed and Tp-e/QTc ratio were significantly higher in the epilepsy group than in the control group (p < 0.05 for all values). No statistically significant difference in those parameters was observed between the patients with known epilepsy and the patients who had seizure for the first time. There was also no statistically significant difference between patients who had recurrent seizures during the observation period and who did not. The patients with epileptic seizures had increased Pd, QTd, QTcd, Tp-ed and Tpe/QTc ratio during interictal period compared to healthy subjects. These electrocardiographic changes might be associated with an increased risk of dysrhythmia. However, prospective large cohorts with short- and long-term follow-up are needed for clinical reflections.
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Affiliation(s)
- Seda Dagar
- Department of Emergency Medicine, Kecioren Training and Research Hospital, Ankara, Turkey.
| | - Emine Emektar
- Department of Emergency Medicine, Kecioren Training and Research Hospital, Ankara, Turkey
| | | | - Osman Lutfi Demirci
- Department of Emergency Medicine, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Meral Tandogan
- Department of Emergency Medicine, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Yunsur Cevik
- Department of Emergency Medicine, Kecioren Training and Research Hospital, Ankara, Turkey
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6
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QT Prolongation and Associated Ventricular Tachycardia due to Cardiac Iron Load in a Patient with Thalassemia Major. Case Rep Hematol 2019; 2019:5791094. [PMID: 31316843 PMCID: PMC6604464 DOI: 10.1155/2019/5791094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/01/2019] [Accepted: 04/18/2019] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 23-year-old male with thalassemia major who developed long QT and continuous ventricular tachycardia (VT). Electrocardiography, echocardiography, and cardiac magnetic resonance imaging (MRI) were used for diagnosis and risk stratification. VT causes and treatments are presented and discussed. Ventricular arrhythmia can be treated by normalizing QT interval with high-dose beta-blocker therapy. However, MRI-compatible internal cardiac defibrillator implantation was performed due to the high risk in this patient.
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7
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Patel H. Presidential address. Indian J Radiol Imaging 2019; 29:4-5. [PMID: 31000934 PMCID: PMC6467027 DOI: 10.4103/ijri.ijri_73_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hemant Patel
- President Elect, Indian Radiological and Imaging Association (IRIA), Consultant & Director, Gujarat Imaging Centre, Postgraduate Institute of Radiology and Imaging, Samved Hospital, Navarangpura, Ahmedabad - 380 009, Gujarat, India
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Emektar E, Çorbacıoğlu ŞK, Korucu O, Ramadan S, Uzunosmanoğlu H, Kan E, Çevik Y. The evaluation of a new marker of transmyocardial repolarization parameters in ischemic stroke patients; T peak-T end (T p-e), T p-e/QT c. Acta Neurol Belg 2017; 117:461-467. [PMID: 28110482 DOI: 10.1007/s13760-017-0744-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/04/2017] [Indexed: 11/26/2022]
Abstract
The cardiovascular manifestations of acute ischemic stroke have been well known. Several electrocardiography (ECG) abnormalities have been reported in patients following acute stroke, including QT interval prolongation, ST segment deviation and T-wave changes. This study aimed to investigate the changes in transmyocardial repolarization parameters, in ischemic stroke patients. The study is a prospective, blind, and controlled clinical study. The patients without cardiac disease who received ischemic stroke diagnoses were included in the study. ECG was received from the patients in the first hour and 72 h. The P, QT, T p-e, T p-e dispersion, and the T p-e/QT ratio were calculated. Moreover, fifty-five stroke patients and 35 control subjects were included to the study. All dispersion values and T p-e/QTc ratio in patients group were higher than those of control group (p < 0.05 for all values). When evaluated between ECGs' on first and third days, it was found that decreasing on all dispersion values and T p-e/QTc ratio in ECGs on third day than ECGs on first day (p < 0.05 for all values). QT, QTc, and T p-e dispersions values in patients who have insular lobe involvement were higher than those of patients who do not have insular lobe involvement (p < 0.001 for all values). In this study, we showed that acute stroke increases that P d, QTd, QTcd and new repolarization markers T p-e and T p-e/QTc, during first 24 and 72 h in acute stroke patients without cardiovascular disease compared with the control group. The physicians should be aware about ventricular dysrhythmias in patients with ischemic stroke and these patients closely observed with cardiac monitoring, especially within first 24 h, and especially patients with insular lobe involvement.
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Affiliation(s)
- Emine Emektar
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey.
| | - Şeref Kerem Çorbacıoğlu
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey
| | - Osman Korucu
- Department of Neurology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Selma Ramadan
- Department of Radiology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Hüseyin Uzunosmanoğlu
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey
| | - Eda Kan
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey
| | - Yunsur Çevik
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey
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9
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Electrocardiographic abnormalities and arrhythmic risk markers in adult patients with beta thalassemia major. Int J Cardiol 2016; 221:932-6. [DOI: 10.1016/j.ijcard.2016.07.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/04/2016] [Indexed: 11/22/2022]
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10
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Henriksen LF, Petri AS, Hasselbalch HC, Kanters JK, Ellervik C. Increased iron stores prolong the QT interval - a general population study including 20 261 individuals and meta-analysis of thalassaemia major. Br J Haematol 2016; 174:776-85. [DOI: 10.1111/bjh.14099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/07/2016] [Indexed: 01/08/2023]
Affiliation(s)
| | - Anne-Sofie Petri
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Hans Carl Hasselbalch
- Department of Haematology; Roskilde Hospital; Copenhagen University Hospital; Copenhagen Denmark
| | - Jørgen Kim Kanters
- Laboratory of Experimental Cardiology; Department of Biomedical Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Christina Ellervik
- Department of Laboratory Medicine; Boston Children's Hospital; Boston MA USA
- The General Population Study; Nykøbing Falster Hospital; Nykøbing Falster Denmark
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11
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Castro-Torres Y, Carmona-Puerta R, Katholi RE. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice. World J Clin Cases 2015; 3:705-720. [PMID: 26301231 PMCID: PMC4539410 DOI: 10.12998/wjcc.v3.i8.705] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 02/22/2015] [Accepted: 06/08/2015] [Indexed: 02/05/2023] Open
Abstract
Malignant cardiac arrhythmias which result in sudden cardiac death may be present in individuals apparently healthy or be associated with other medical conditions. The way to predict their appearance represents a challenge for the medical community due to the tragic outcomes in most cases. In the last two decades some ventricular repolarization (VR) markers have been found to be useful to predict malignant cardiac arrhythmias in several clinical conditions. The corrected QT, QT dispersion, Tpeak-Tend, Tpeak-Tend dispersion and Tp-e/QT have been studied and implemented in clinical practice for this purpose. These markers are obtained from 12 lead surface electrocardiogram. In this review we discuss how these markers have demonstrated to be effective to predict malignant arrhythmias in medical conditions such as long and short QT syndromes, Brugada syndrome, early repolarization syndrome, acute myocardial ischemia, heart failure, hypertension, diabetes mellitus, obesity and highly trained athletes. Also the main pathophysiological mechanisms that explain the arrhythmogenic predisposition in these diseases and the basis for the VR markers are discussed. However, the same results have not been found in all conditions. Further studies are needed to reach a global consensus in order to incorporate these VR parameters in risk stratification of these patients.
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12
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Noori NM, Mahjoubifard M, Mohammadi M, Jahangiri Fard A, Abassi A, Farzanegan B. Comparison of QT Dispersion With Left Ventricular Mass Index in Early Diagnosis of Cardiac Dysfunction in Patients With β-Thalassemia Major. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e11698. [PMID: 25031849 PMCID: PMC4082509 DOI: 10.5812/ircmj.11698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 11/19/2013] [Accepted: 12/19/2013] [Indexed: 12/02/2022]
Abstract
Background: In electrocardiography (ECG), QT is the interval between the onset of Q wave to the end of the T wave. This interval may be a sign of changes in the ventricular structure in hematologic disorders such as thalassemia major. Objectives: The main goal of this study was to compare the diagnostic value of corrected QT dispersion (QTcd) and QT dispersion (QTd) with left ventricular mass (LVM) and left ventricular mass index (LVMI) as well as to determine their sensitivity and specificity in early detection of the cardiac involvement in patients with β-thalassemia major. Patients and Methods: In a case-control study, 60 patients older than ten years of age with thalassemia major who received regular blood transfusion and iron chelators were selected as the case group and were compared with 60 healthy age- and sex-matched subjects. All patients had myocardial performance index (MPI) of more than 0.5 and MPI for controls was less than 0.5. Echocardiography and ECG were performed for both groups and data were analyzed using appropriate statistical tests. Results: The mean age of cases and controls were 16 ± 2.8 and 16.08 ± 3.01 years, respectively. Male to female ratio was 33:27 in case group and 31:29 in the control group. LVMI in the case group was greater than control group. QTd and QTcd were larger in case group than in control group. The sensitivity and specificity of LVM, LVMI, QTd, and QTcd were as follows: 88.3%, 77.1%; 86.7%, 80%; 93.8%, 80%; and 91.7%, 86.7%, respectively. Conclusions: This study showed acceptable sensitivity and specificity of QTcd and QTd in comparison to LVMI; it seems that standard ECG can be used for early diagnosis of cardiac involvement in asymptomatic patients with thalassemia major.
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Affiliation(s)
- Noor Mohammad Noori
- Children and Adolescents’ Health Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Maziar Mahjoubifard
- Children and Adolescents’ Health Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding Author: Maziar Mahjoubifard, Children and Adolescents’ Health Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-9151418089, E-mail:
| | - Mehdi Mohammadi
- Children and Adolescents’ Health Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Alireza Jahangiri Fard
- Tracheal Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | | | - Behrooz Farzanegan
- Tracheal Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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13
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Staikou C, Stavroulakis E, Karmaniolou I. A narrative review of peri-operative management of patients with thalassaemia. Anaesthesia 2014; 69:494-510. [DOI: 10.1111/anae.12591] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 01/19/2023]
Affiliation(s)
- C. Staikou
- Department of Anaesthesia; Aretaieio University Hospital; Athens Greece
| | - E. Stavroulakis
- Department of Anaesthesia; Aretaieio University Hospital; Athens Greece
| | - I. Karmaniolou
- Department of Anaesthesia; Royal National Orthopaedic Hospital; Stanmore UK
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Spatial repolarization heterogeneity detected by magnetocardiography correlates with cardiac iron overload and adverse cardiac events in beta-thalassemia major. PLoS One 2014; 9:e86524. [PMID: 24475137 PMCID: PMC3903540 DOI: 10.1371/journal.pone.0086524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 12/10/2013] [Indexed: 11/19/2022] Open
Abstract
Background Patients with transfusion-dependent beta-thalassemia major (TM) are at risk for myocardial iron overload and cardiac complications. Spatial repolarization heterogeneity is known to be elevated in patients with certain cardiac diseases, but little is known in TM patients. The purpose of this study was to evaluate spatial repolarization heterogeneity in patients with TM, and to investigate the relationships between spatial repolarization heterogeneity, cardiac iron load, and adverse cardiac events. Methods and Results Fifty patients with TM and 55 control subjects received 64-channel magnetocardiography (MCG) to determine spatial repolarization heterogeneity, which was evaluated by a smoothness index of QTc (SI-QTc), a standard deviation of QTc (SD-QTc), and a QTc dispersion. Left ventricular function and myocardial T2* values were assessed by cardiac magnetic resonance. Patients with TM had significantly greater SI-QTc, SD-QTc, and QTc dispersion compared to the control subjects (all p values<0.001). Spatial repolarization heterogeneity was even more pronounced in patients with significant iron overload (T2*<20 ms, n = 20) compared to those with normal T2* (all p values<0.001). Loge cardiac T2* correlated with SI-QTc (r = −0.609, p<0.001), SD-QTc (r = −0.572, p<0.001), and QTc dispersion (r = −0.622, p<0.001), while all these indices had no relationship with measurements of the left ventricular geometry or function. At the time of study, 10 patients had either heart failure or arrhythmia. All 3 indices of repolarization heterogeneity were related to the presence of adverse cardiac events, with areas under the receiver operating characteristic curves (ranged between 0.79 and 0.86), similar to that of cardiac T2*. Conclusions Multichannel MCG demonstrated that patients with TM had increased spatial repolarization heterogeneity, which is related to myocardial iron load and adverse cardiac events.
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A new marker for myocardial injury in carbon monoxide poisoning: T peak–T end. Am J Emerg Med 2013; 31:1651-5. [DOI: 10.1016/j.ajem.2013.08.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/19/2013] [Indexed: 11/17/2022] Open
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