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Noori NM, Teimouri A. Aortic elasticity changes in thalassemia due to heart and liver iron deposition. CASPIAN JOURNAL OF INTERNAL MEDICINE 2023; 14:460-469. [PMID: 37520866 PMCID: PMC10379797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/16/2022] [Accepted: 04/13/2022] [Indexed: 08/01/2023]
Abstract
Background Iron overload is connected with an expanded prevalence of thalassemia due to heart impairment. This considers pointing to survey changes in thalassemia's aortic elasticity due to iron deposition in the heart and liver of children. Methods This case-control study was performed on 80 healthy and 160 thalassemia patients. The subjects gathered from educational pediatric hospital of Ali Asghar in Zahedan, Iran, from 2019 to 2021. Echocardiography parameters were measured. Ferritin, lipids profile, cardiac and liver MRI T2 * measured in patients only. Aortic elasticity parameters were aortic strain, aortic stiffness β index, aortic distensibility and pressure strain elastic modulus. Data analyzed by SPSS,p< 0.05 was considered as significant. Results Diastolic blood pressure (p<0.001), aortic diameter in diastole (p<0.001), aortic diameter in systole (p<0.001), ferritin (p<0.001), aortic strain (p<0.001), aortic distensibility(p<0.001), pressure strain elastic modulus (p<0.001) and aortic stiffness β index (p<0.001) were changed significantly in thalassemia patients compared to controls. From these variables, AoD, AoS, ferritin, AS and AD increased in thalassemia. Ferritin was higher in thalassemia patients with abnormal heart iron deposition (2131.89±1992.74 v.s 4887.66±3122.59 ng/ml). Considering the level of liver iron deposition, ferritin did not change in patients. Our highlighted variables did not change in patients based on the groups of ferritin. Conclusion Concluded that AoD, AoS, ferritin, AS and AD increased in thalassemia patients. Ferritin increased in thalassemia with abnormal iron overload in the heart but did not change in the liver. Recommended MRI T2* to evaluate dynamic functions of liver and heart in thalassemia patients.
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Affiliation(s)
- Noor Mohammad Noori
- Children and Adolescents Health research center, Research Institute of cellular and Molecular Science in Infectious Diseases , Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Teimouri
- Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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Salama K, Khaled HZ, El Dien HMS, Afifi RARAA, Shaheen NMM, El Wahab MAMA. Assessment of Cardiac Functions and Arrhythmia in Children with Beta-Thalassemia Major and Beta-Thalassemia Intermedia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Heart disease is a major complication in thalassemic patients. Heart injuries in iron overload cases include arrhythmia, pulmonary hypertension, systolic/diastolic dysfunction, and heart failure.
AIM: This study aimed to assess cardiac functions and arrhythmia in children with β-thalassemia major (TM) and β-thalassemia intermedia (TI) and its relation to cardiac iron overload.
METHODS: Thirty β-TM patients and 30 β-TI patients were evaluated using echocardiography and 24-h ambulatory electrocardiogram monitoring (Holter). Among these patients, 15 β-TM and 15 β-TI patients were evaluated using cardiac magnetic resonance imaging T2* by single breath-hold multi-echo technique.
RESULTS: Arrhythmia was detected significantly more in β-TM patients than β-TI (p = 0.049). Nine (30%) β-TM and five (16.6%) β-TI patients had Sinus tachycardia. Two (6.7%) β-TM patients compared to one (3.33%) β-TI patient had supraventricular tachycardia runs. Three (10%) β-TM and one (3.33%) β-TI patient had extreme sinus tachycardia. Two (3.3%) β-TI patients had sinus bradycardia, while two (3.3%) β-TM patients had incomplete Right bundle branch block. Regarding echo parameters: Isovolumic relaxation time (IVRT), Left ventricle myocardial performance index (MPI LV), Right ventricle myocardial performance index (MPI RV) and end systolic pulmonary artery pressure, were significantly higher in β-TM than TI group (p < 0.05). Fractional shortening, Ejection fraction were significantly lower in β-TM than TI group (p < 0.001). A statistically significant negative correlation was found between cardiac T2* and each of (IVRT, MPI LV, MPI RV) (p ˂ 0.05).
CONCLUSION: Arrhythmias are more common in the β-TM group. Systolic, diastolic dysfunction and high pulmonary pressure are more prevalent in TM than in TI. Global myocardial performance is more impaired in TM than in TI patients. Iron overload has a deleterious effect on cardiac function.
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Ahmed RA, Salih AF, Omer SH, Rahman HS, Rasool LK. Early Detection of Iron Overload Cardiomyopathy in Transfusion Dependent Thalassemia Patients in Sulaimaniyah City, Iraq. Ther Clin Risk Manag 2022; 18:259-271. [PMID: 35345642 PMCID: PMC8957332 DOI: 10.2147/tcrm.s354574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Lifelong blood transfusion is recommended for patients with transfusion-dependent thalassemia (TDT) that lead to iron overload and results in cardiomyopathy (CM). Aim To assess the accuracy of several electrocardiographic (ECG) data in patients at high risk of arrhythmia, early detection of structural and functional changes in left atrium and ventricle using ECG and echocardiography (two dimensional, M-mode echocardiography along with Doppler studies), and to observe the correlations between plasma B-type atrial natriuretic peptide (BNP)/serum ferritin and ECG with Doppler as well as echocardiographic changes in patients with TDT. Methods The current prospective case-control study included 75 TDT patients and 74 control subjects with the mean age of 9.55 and 9.93 years, respectively. Participants were assessed for the socio-demographic, physical examinations, serum ferritin, plasma BNP, ECG, 2D echocardiography, and tissue/pulse wave Doppler. Results The mean of serum ferritin and plasma BNP were significantly (p<0.001) higher in the cases (1475.19 ng/mL and 47.63 pg/mL, respectively) than controls (41.3 ng/mL and BNP 23.37 pg/mL, respectively). ECG findings showed significant higher P-wave dispersion, QRS duration, QT duration and dispersion, and JTc dispersion in cases than controls. Echocardiography findings revealed diastolic dysfunction with preserved ejection fraction (EF) in thalassemia cases, as well as significant higher left ventricular (LV) mass, LV internal diameters during systole and diastole (LVIDs and d) and LV posterior wall thickness during diastole (LVPWd) in cases than controls (p<0.05). Also, a significant (p<0.05) correlation between BNP and QT dispersion was found in patients. Conclusion These findings suggest the usefulness of ECG, 2D echocardiographic, Doppler studies and plasma BNP, with no significant beneficial effect of serum ferritin level in detecting early cardiac changes in patients with TDT.
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Affiliation(s)
- Rana Adnan Ahmed
- Department of Physiology, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq
| | - Aso Faeq Salih
- Department of Pediatrics, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq
| | - Shirwan Hamasalih Omer
- Department of Physiology, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq
| | - Heshu Sulaiman Rahman
- Department of Physiology, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq.,Department of Medical Laboratory Sciences, Komar University of Science and Technology, Sulaimaniyah, Republic of Iraq
| | - Luqman Khalid Rasool
- Hiwa Hematology/Oncology Hospital and Sulaimaniyah Thalassemia and Congenital Blood Disorders Center, Sulaimaniyah, Republic of Iraq
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Noori NM, Teimouri A, Keshavarz K, Moradi M. Assessment of Aortic Elasticity and the Doppler Tissue Echocardiography in Thalassemia Major Children. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1713595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractCardiovascular diseases are the most common illness that needs special medical care in thalassemia particularly in children and adolescents. We aimed to compare aortic stiffness in thalassemia major and healthy children. The study included 65 asymptomatic thalassemia major 6 to 19-year–old children without known history of heart disease and 65 age- and sex-matched healthy controls. Arterial stiffness indices determined using two-dimensional (2D) and Doppler echocardiography. Data were analyzed by SPSS 20.0 with 0.05 as significant error. From the study, results showed that systolic (p = 0.009) and diastolic (p < 0.001) blood pressures were higher in controls. Left ventricular mass index (LVMI) was higher in patients (p < 0.001). Aortic stiffness index (p < 0.001), pulse pressure (p < 0.001), and pressure strain elastic modulus (p < 0.001) were higher in patients, while aortic strain (p < 0.002) and aortic distensibility (p < 0.001) were lower significantly. Aortic stiffness index was correlated with diastole aorta (p = 0.005), systole aorta (p < 0.001), and LVMI (p < 0.001). Strain was correlated with diastole aorta (p < 0.001). Pulse pressure was correlated with systolic blood pressure (p < 0.001), diastolic blood pressure (p = 0.002) significantly. Aortic distensibility was correlated with systolic blood pressure (p = 0.039) and diastole aorta (p < 0.001) significantly. The pressure strain elastic modulus was correlated only with diastole aorta (p = 0.029). Concluded, aortic stiffness index, pulse pressure, and pressure strain elastic modulus were higher in thalassemia children, while aortic strain and aortic distensibility were lower. This increase may result in reduction of mechanical efficiency of the heart. Therefore, assessment of aortic elastic properties as nontraditional cardiovascular risk factors may contribute to the identification of cardiovascular risks in children with thalassemia
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Affiliation(s)
- Noor Mohammad Noori
- Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Teimouri
- Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Malihe Moradi
- School of Medicine, University of Medical Science, Zahedan, Iran
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Cardiac Iron Overload by MRI in Children With B-Thalassemia Major and its Correlation With Cardiac Function by Echocardiography. J Pediatr Hematol Oncol 2020; 42:398-402. [PMID: 32251156 DOI: 10.1097/mph.0000000000001786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Serial echocardiography is strongly recommended in asymptomatic B-thalassemia major (TM) patients for early detection of subtle cardiac dysfunction. T2*magnetic resonance imaging (MRI) is a noninvasive measurement of myocardial iron burden. Yet, it is not always available in many centers. Our study aimed to evaluate the myocardial function in TM patients using different echocardiographic modalities and to correlate these findings with cardiac T2*MRI. PATIENTS AND METHODS This is a cross-sectional study that was carried out on 140 children with a mean age of 10.9±3.7 years. One hundred children with TM and 40 healthy children were matched for age and sex as a control group. Serum ferritin, serum iron, and iron-binding capacity were measured. Cardiac iron overload was assessed by T2*MRI and cardiac function was assessed by echocardiography. The local ethics committee approved the study. RESULTS Among 100 children with TM, only 32% had cardiac iron overload of 8.525±5.45 detected by cardiac T2*MRI. Iron deposition correlated significantly with age. Markers of iron overload were significantly correlated with cardiac T2*MRI. There were significantly lower values of myocardial performance index, longitudinal strain, circumferential strain, area strain, and radial strain in TM patients compared with the controls (P<0.001). Only the myocardial performance index was correlated with T2*MRI. CONCLUSIONS This study confirms that some parameters measured by tissue Doppler imaging such as the myocardial performance index could be useful for the early detection of cardiac impairment in asymptomatic TM patients when cardiac MRI is lacking. Further studies on a large scale to identify other parameters with high sensitivity are recommended.
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Duyuler S. Myocardial Performance in Elite Athletes: The Role of Homocysteine, Iron, and Lipids. Med Sci Monit 2019; 25:1194-1203. [PMID: 30760696 PMCID: PMC6383440 DOI: 10.12659/msm.913561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background The myocardial performance index (MPI) is a comprehensive measure of global systolic and diastolic function of the ventricle, and it has an inverse correlation with maximal oxygen consumption. In this study, the potential association between left ventricle MPI and biochemical biomarkers (including iron, homocysteine, and lipids) in elite athletes was investigated. Material/Methods This cross-sectional observational study consisted of 80 young male elite soccer and basketball players (age: 18–34 years) examined for a seasonal medical check-up. Cardiological examinations and transthoracic echocardiography of these athletes were performed and blood samples were analyzed according to standard laboratory protocols. Tissue Doppler recording was acquired from the mitral annulus using apical 4-chamber view and then the tissue Doppler-derived MPI was computed. Results Athletes were separated into 2 groups based on MPI values (MPI ≤0.40 and MPI >0.40), and baseline demographic, clinical, and biochemical variables of the study participants were compared between these 2 groups. Serum triglyceride, high-density lipoprotein, total cholesterol, homocysteine levels, and iron parameters did not significantly differ between groups, while low-density lipoprotein level was significantly lower in the MPI ≤0.40 group (103.8±26.0 mg/dl vs. 116.8±30.2 mg/dl; p=0.043). Correlation analysis and multivariate linear regression analysis demonstrated a significant association between low-density lipoprotein and MPI. Conclusions In this study, various biochemical markers were evaluated for possible association with left ventricle MPI as a surrogate of cardiac performance. Among these biomarkers, only low-density lipoprotein was significantly associated with MPI in elite athletes.
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Affiliation(s)
- Serkan Duyuler
- Cardiology Clinic, Acıbadem Ankara Hospital, Acıbadem University, Ankara, Turkey
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Ibrahim MH, Azab AA, Kamal NM, Salama MA, Ebrahim SA, Shahin AM, El-Sadek AE, Abdulghany WE, Sherief LM, Abdallah EA. Early detection of myocardial dysfunction in poorly treated pediatric thalassemia children and adolescents: Two Saudi centers experience. Ann Med Surg (Lond) 2016; 9:6-11. [PMID: 27330742 PMCID: PMC4900296 DOI: 10.1016/j.amsu.2016.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 05/15/2016] [Accepted: 05/16/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND & OBJECTIVE Cardiac complications are among the most serious complications in Beta Thalassemia Major Patients. Our aim was to evaluate the value of tissue Doppler imaging (TDI) for early detection of myocardial dysfunction in pediatric and adolescent patients with B-TM before development of overt heart failure or cardiomyopathy. PATIENTS AND METHODS 100 thalassemic patients below 18 years old and 100 healthy, age & sex matched controls were enrolled in our case-control study. Cases were selected from those attending outpatient clinics and inpatient wards, King Abdulaziz University hospital and Alhada Armed Forces Hospital, Saudi Arabia, between January 2014 and January 2015. They were subjected to echo-Doppler examination for both septal and lateral walls of the basal mitral and tricuspid annuli assessing the systolic myocardial velocity (S wave), early diastolic myocardial velocity (Ea wave) and late diastolic myocardial velocity (Aa wave). RESULTS Patients with thalassemia have RV and LV dysfunction on the basis of abnormal TDI derived myocardial velocities. There was a statistically significant differences between patients and controls regarding (Aa) and (S) of the septal wall of the basal mitral annulus and (Ea) of the lateral wall of the mitral annulus. Also patients with thalassemia have significantly higher (S) of the basal tricuspid annulus. These abnormalities were not detected by conventional echo-Doppler. CONCLUSION Clinically asymptomatic thalassemic children and adolescents who had normal global functions by conventional echo-Doppler were found to have abnormal left ventricular and right ventricular dysfunctions detected by TDI. TDI is superior to Echo-Doppler in detection of early myocardial damage in asymptomatic thalassaemic patients.
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Affiliation(s)
- Mohamed H. Ibrahim
- Department of Cardiology, Faculty of Medicine, Benha University, Benha, Egypt
- King Abdulaziz University Hospital, Saudi Arabia
| | - Ahmed A. Azab
- Department of Pediatrics, Faculty of Medicine, Benha University, Benha, Egypt
- Elhada Armed Forces Hospital, Saudi Arabia
| | - Naglaa M. Kamal
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
- Elhada Armed Forces Hospital, Saudi Arabia
| | - Mostafa A. Salama
- Department of Pediatrics, Faculty of Medicine, Benha University, Benha, Egypt
- Elhada Armed Forces Hospital, Saudi Arabia
| | - Soha A. Ebrahim
- Department of Pediatrics, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ashraf M. Shahin
- Department of Pediatrics, Faculty of Medicine, Benha University, Benha, Egypt
| | - Akram E. El-Sadek
- Department of Pediatrics, Faculty of Medicine, Benha University, Benha, Egypt
| | | | - Laila M. Sherief
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Enas A.A. Abdallah
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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Sanhal CY, Kara O, Yucel A. Can fetal left ventricular modified myocardial performance index predict adverse perinatal outcomes in intrahepatic cholestasis of pregnancy? J Matern Fetal Neonatal Med 2016; 30:911-916. [PMID: 27186866 DOI: 10.1080/14767058.2016.1190824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate fetal left ventricular function using the left ventricular modified myocardial performance index (mod-MPI) and E wave/A wave peak velocity (E/A) ratio, and to explore the success of mod-MPI in the prediction of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP). METHODS Forty-one ICP cases were compared with 41 gestational age-matched healthy controls. Opening and closing clicks of the mitral and aortic valves were used to define the three time periods [ejection time (ET), isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT)], which were employed in the calculation of mod-MPI [mod-MPI = (ICT + IRT)/ET]. The E/A ratio was calculated as well. RESULTS Fetal left ventricular mod-MPI values were significantly higher in the ICP group compared to controls (0.56 ± 0.09 versus 0.37 ± 0.04, p < 0.001), whereas the E/A ratio was lower (0.62 ± 0.11 versus 0.69 ± 0.10, p = 0.011). The optimal cutoff level for mod-MPI in prediction of adverse perinatal outcomes was >0.48 [sensitivity: 81.8%, specificity: 67.6%, area under the curve (AUC): 0.750, 95% CI: 0.613-0.887, p = 0.008]. CONCLUSIONS Fetuses of ICP cases have significant left ventricular dysfunction. Mod-MPI can be used in the prediction of adverse perinatal outcomes in ICP.
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Affiliation(s)
- Cem Yasar Sanhal
- a Department of Perinatology , Zekai Tahir Burak Women's Health Care, Training and Research Hospital , Ankara , Turkey
| | - Ozgur Kara
- a Department of Perinatology , Zekai Tahir Burak Women's Health Care, Training and Research Hospital , Ankara , Turkey
| | - Aykan Yucel
- a Department of Perinatology , Zekai Tahir Burak Women's Health Care, Training and Research Hospital , Ankara , Turkey
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