Heart involvement in transfusion-dependent beta-thalassemia with conventional echocardiography

Background: The most important prognostic factor in transfusion-dependent beta-thalassemia is cardiac involvement which is usually evaluated with echocardiography. Methods: In this cross-sectional study (April 2011 to April 2012), conventional echocardiography was used to assess myocardial performance and valvular involvement (through transvalvular Doppler study) for right and left heart abnormalities in transfusion-dependent beta-thalassemia. Results: Among the 60 patients, 43 cases had heart problems, 26 (43.3%) of them had left myocardial dysfunction and 11 ( 18.3%) of them had right myocardial dysfunction, 3 cases had both RV and LV myocardial dysfunction, (based on LVMPI & RVMPI, respectively). In patients with right myocardial dysfunction, 4 cases had pulmonary hypertension (PH) and 3 had both sided myocardial dysfunction. LVMPI and RVMPI significantly increased in patients with cardiac involvement (p<0.001). Serum ferritin levels in patients with and without cardiac involvement were 2427 +/- 1788 ng/ml and 1573 +/- 592 ng/ml, respectively (P=0.008). All 4 patients who had PH, had been splenectomized. In splenectomized and non-splenectomized patients, LVMPI was 0.37 +/- 0.11 and 0.38 +/- 0.1 (P=0.589), RVMPI was 0.3 +/- 0.07 and 0.25 +/- 0.39 (P=0.004), and TR gradient (TRG) was 28 +/- 11.8 mmHg and 19.7 +/- 5.2 mmHg (P=0.033), respectively. Mean ferritin level in patients with a history of splenectomy (n=31), was 2525 +/- 1968 ng/ml and in patients without the history of splenectomy ( n=29) was 1821 +/- 947 ng/ml (P=0.082). Conclusion: In addition to left-sided heart involvement, conventional echocardiography revealed right-sided heart involvement in transfusion-dependent thalassemia patients which did not correlate with serum ferritin level in splenectomized patients.