Ahmed Rana Adnan, Salih Aso Faeq, Omer Shirwan Hamasalih, Rahman Heshu Sulaiman, Rasool Luqman Khalid
Department of Physiology, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq.
Department of Pediatrics, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq.
Ther Clin Risk Manag. 2022 Mar 22;18:259-271. doi: 10.2147/TCRM.S354574. eCollection 2022.
Lifelong blood transfusion is recommended for patients with transfusion-dependent thalassemia (TDT) that lead to iron overload and results in cardiomyopathy (CM).
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.
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.
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.
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.
对于依赖输血的地中海贫血（TDT）患者，建议进行终身输血，这会导致铁过载并引发心肌病（CM）。
评估心律失常高危患者的几种心电图（ECG）数据的准确性，利用心电图和超声心动图（二维、M型超声心动图以及多普勒研究）早期检测左心房和心室的结构及功能变化，并观察TDT患者血浆B型利钠肽（BNP）/血清铁蛋白与心电图以及多普勒和超声心动图变化之间的相关性。
当前的前瞻性病例对照研究纳入了75例TDT患者和74例对照者，平均年龄分别为9.55岁和9.93岁。对参与者进行社会人口统计学、体格检查、血清铁蛋白、血浆BNP、心电图、二维超声心动图以及组织/脉搏波多普勒检查。
病例组的血清铁蛋白和血浆BNP平均值（分别为1475.19 ng/mL和47.63 pg/mL）显著高于对照组（分别为41.3 ng/mL和BNP 23.37 pg/mL）（p<0.001）。心电图结果显示，病例组的P波离散度、QRS时限、QT时限及离散度和JTc离散度显著高于对照组。超声心动图结果显示，地中海贫血病例存在射血分数（EF）保留的舒张功能障碍，且病例组的左心室（LV）质量、收缩期和舒张期左心室内径（LVIDs和d）以及舒张期左心室后壁厚度（LVPWd）显著高于对照组（p<0.05）。此外，患者的BNP与QT离散度之间存在显著相关性（p<0.05）。
这些发现表明心电图、二维超声心动图、多普勒研究和血浆BNP在检测TDT患者早期心脏变化方面有用，而血清铁蛋白水平在这方面无显著有益作用。
