Abtahi Firoozeh, Abdi Alireza, Jamshidi Saideh, Karimi Mehran, Babaei-Beigi Mohammad Ali, Attar Armin
Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Students' Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Cardiovasc Ultrasound. 2019 Nov 4;17(1):24. doi: 10.1186/s12947-019-0174-y.
Cardiac involvement due to iron overload is the most common cause of morbidity and mortality in patients with thalassemia, and many patients remain asymptomatic until the late stages. Therefore, early detection of heart problems in such patients at subclinical stages can improve the prognosis of these patients. We investigated the role of speckled tracking (SI) and tissue Doppler echocardiography (TDI) in early detection of iron overload in these patients.
52 thalassemic patients who were receiving regular blood transfusion with normal global LV function were examined by two- and three-dimensional echocardiography. Cardiac MRI was done and T2* images were considered as the non-invasive gold standard for evaluating cardiac iron deposition. Serum ferritin level was assessed and the relationships between serum ferritin levels and echo finding with cardiac MRI T was investigated.
No significant relationship was seen between serum ferritin levels and cardiac MRI T. Among the echocardiographic findings, septal systolic myocardial velocity (P = 0.002 and r = 0.43) and global strain (GLS) (P = 0.000 and r = 0.60) were significantly associated with T. A GLS < 19.5 could predict a T level below 20 by 82.14% sensitivity and 86.36% specificity (area under the curve = 0.87; p < 0.0001).
While serum ferritin level and ejection fraction are not useful candidates, GLS may be used as a valuable marker to screen thalassemia patients for myocardial iron deposition, using a cut off value below - 19.5. This approach may facilitate the cardiac follow up, reduce the costs, and contribute to preventing deterioration of cardiac function in countries with limited availability of cardiac MRI.
铁过载所致的心脏受累是地中海贫血患者发病和死亡的最常见原因，许多患者直到晚期仍无症状。因此，在此类患者亚临床阶段早期发现心脏问题可改善其预后。我们研究了斑点追踪（SI）和组织多普勒超声心动图（TDI）在此类患者铁过载早期检测中的作用。
对52例接受定期输血且左心室整体功能正常的地中海贫血患者进行二维和三维超声心动图检查。进行心脏磁共振成像（MRI）检查，T2*图像被视为评估心脏铁沉积的非侵入性金标准。评估血清铁蛋白水平，并研究血清铁蛋白水平与心脏MRI T的回声结果之间的关系。
血清铁蛋白水平与心脏MRI T之间未见显著关系。在超声心动图检查结果中，室间隔收缩期心肌速度（P = 0.002，r = 0.43）和整体应变（GLS）（P = 0.000，r = 0.60）与T显著相关。GLS < 19.5可预测T水平低于20，敏感性为82.14%，特异性为86.36%（曲线下面积 = 0.87；p < 0.0001）。
虽然血清铁蛋白水平和射血分数不是有用的指标，但GLS可作为一个有价值的标志物，采用低于 - 19.5的临界值来筛查地中海贫血患者的心肌铁沉积。这种方法可能有助于心脏随访，降低成本，并有助于在心脏MRI可用性有限的国家预防心脏功能恶化。
