Bayar Nermin, Kurtoğlu Erdal, Arslan Şakir, Erkal Zehra, Çay Serkan, Çağırcı Göksel, Deveci Burak, Küçükseymen Selçuk
Clinic of Cardiology, Antalya Education and Research Hospital; Antalya-Turkey.
Anatol J Cardiol. 2015 Feb;15(2):132-6. doi: 10.5152/akd.2014.5188. Epub 2014 Apr 2.
Beta-thalassemia major (TM) is a genetic hemoglobin disorder causing chronic hemolytic anemia. Since cardiac insufficiency and arrhythmias are the primary causes of mortality in such patients, monitoring of cardiac iron load is important in management of the disorder. The purpose of this study was to investigate the importance of fragmented QRS (fQRS) and its relation to the cardiac T2* value for the evaluation of cardiac iron load in TM patients.
This retrospective study included 103 TM patients. The patients' T2* values, measured by cardiac MRI and 12-lead surface ECGs, were interpreted. The cardiac T2* values under 20 were considered as cardiac iron overload. The relationship between the cardiac T2* value and fQRS in ECG was investigated.
The median age of the patients was 22.6 ± 6.6 years. All patients were on regular blood transfusions and iron chelators. The patients had no risk factors for coronary artery disease. In 50 (48%) patients fQRS was detected, and in 37 (74%) of these the T2* values were low. 86% of patients with cardiac involvement (37) had fQRS, but 22% of patients with non-involvement (13) had fQRS (p < 0.001).
Since cardiac involvement is the primary cause of mortality in TM patients, the early diagnosis of cardiac dysfunction is of vital importance. The search for fQRS in the ECGs of these patients, particularly when cardiac T2* values cannot be determined and followed, is a non-expensive and easy-to-attain method for therapy management.
重型β地中海贫血（TM）是一种导致慢性溶血性贫血的遗传性血红蛋白疾病。由于心脏功能不全和心律失常是此类患者死亡的主要原因，因此监测心脏铁负荷对该疾病的管理很重要。本研究的目的是探讨碎裂QRS波（fQRS）的重要性及其与心脏T2*值的关系，以评估TM患者的心脏铁负荷。
这项回顾性研究纳入了103例TM患者。对通过心脏磁共振成像和12导联体表心电图测量的患者T2值进行了解读。T2值低于20被视为心脏铁过载。研究了心电图中心脏T2*值与fQRS之间的关系。
患者的中位年龄为22.6±6.6岁。所有患者均接受定期输血和铁螯合剂治疗。患者无冠状动脉疾病危险因素。50例（48%）患者检测到fQRS，其中37例（74%）T2*值较低。有心脏受累的患者中86%（37例）有fQRS，但无心脏受累的患者中22%（13例）有fQRS（p<0.001）。
由于心脏受累是TM患者死亡的主要原因，因此早期诊断心脏功能障碍至关重要。在这些患者的心电图中寻找fQRS，特别是在无法确定和跟踪心脏T2*值时，是一种用于治疗管理的低成本且易于实现的方法。
