Ragab Seham M, Fathy Waleed M, El-Aziz Walaa FAbd, Helal Rasha T
Department of Pediatrics, Faculty of Medicine, Menoufia University. Naser street, Shebeen El-koom, Menoufia, Egypt.
Department of Clinical pathology, Faculty of Medicine, Menoufia University. Naser street, Shebeen El-koom, Menoufia, Egypt.
Mediterr J Hematol Infect Dis. 2015 Aug 24;7(1):e2015051. doi: 10.4084/MJHID.2015.051. eCollection 2015.
Cardiac iron toxicity is the leading cause of death among β-halassaemia major (TM) patients. Once heart failure becomes overt, it is difficult to reverse.
To investigate non-overt cardiac dysfunctions in TM patients using pulsed wave Tissue Doppler Imaging (TD I) and its relation to iron overload and brain natriuretic peptide (BNP).
Thorough clinical, conventional echo and pulsed wave TDI parameters were compared between asymptomatic 25 β-TM patients and 20 age and gender matched individuals. Serum ferritin and plasma BNP levels were assayed by ELISA.
TM patients had significant higher mitral inflow early diastolic (E) wave and non significant other conventional echo parameters. In the patient group, pulsed wave TDI revealed systolic dysfunctions, in the form of significant higher isovolumetric contraction time (ICT), and lower ejection time (E T), with diastolic dysfunction in the form of higher isovolumetric relaxation time (IRT), and lower mitral annulus early diastolic velocity E' (12.07 ±2.06 vs 15.04±2.65, P= 0.003) compared to the controls. Plasma BNP was higher in patients compared to the controls. Plasma BNP and serum ferritin had a significant correlation with each other and with pulsed wave conventional and TDI indices of systolic and diastolic functions. Patients with E/E' ≥ 8 had significant higher serum ferritin and plasma BNP levels compared to those with ratio < 8 without a difference in Hb levels.
Pulsed wave TDI is an important diagnostic tool for latent cardiac dysfunction in iron-loaded TM patients and is related to iron overload and BNP.
心脏铁中毒是重型β地中海贫血（TM）患者的主要死因。一旦心力衰竭明显出现，就难以逆转。
使用脉冲波组织多普勒成像（TDI）研究TM患者的隐匿性心脏功能障碍及其与铁过载和脑钠肽（BNP）的关系。
比较25例无症状β-TM患者与20例年龄和性别匹配的个体的全面临床、传统超声心动图和脉冲波TDI参数。采用酶联免疫吸附测定法检测血清铁蛋白和血浆BNP水平。
TM患者的二尖瓣舒张早期血流速度（E）波显著更高，其他传统超声心动图参数无显著差异。在患者组中，脉冲波TDI显示出收缩功能障碍，表现为等容收缩时间（ICT）显著延长，射血时间（ET）缩短，舒张功能障碍表现为等容舒张时间（IRT）延长，二尖瓣环舒张早期速度E'降低（12.07±2.06对15.04±2.65，P = 0.003）。与对照组相比，患者的血浆BNP更高。血浆BNP和血清铁蛋白彼此之间以及与收缩和舒张功能的脉冲波传统指标和TDI指标均有显著相关性。E/E'≥8的患者与比值<8的患者相比，血清铁蛋白和血浆BNP水平显著更高，血红蛋白水平无差异。
脉冲波TDI是诊断铁负荷TM患者潜在心脏功能障碍的重要工具，且与铁过载和BNP相关。
