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European Journal of Echocardiography Advance Access published online on August 7, 2007
European Journal of Echocardiography, doi:10.1016/j.euje.2007.06.003
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Tissue Doppler echocardiography reliably reflects severity of iron overload in pediatric patients with β thalassemia

Suchaya Silvilairat1,*, Rekwan Sittiwangkul1, Yupada Pongprot1, Pimlak Charoenkwan2 and Charlie Phornphutkul1

1 Division of Pediatric Cardiology, Chiang Mai University, Chiang Mai, Thailand
2 Division of Pediatric Hematology, Chiang Mai University, Chiang Mai, Thailand

Received 8 March 2007; accepted after revision 2 June 2007.

* Corresponding author. Department of Pediatrics, Chiang Mai University, Chiang Mai, 50200, Thailand. Tel: +66 89 761 2855; fax: +66 53 94 6461. E-mail address: ssamana{at}mail.med.cmu.ac.th (S. Silvilairat).


  Abstract

Aims: Tissue Doppler imaging has been recently used to evaluate ventricular function in patients with β thalassemia. In clinical practice, serum ferritin is commonly used to assess the severity of iron overload. The aim of this study was to determine which Doppler findings correlated with serum ferritin.

Methods and results: Thirty-one pediatric patients with transfusion-dependent β thalassemia with normal LVFS were evaluated. Seven patients with serum ferritin <2500 ng/ mL, 13 patients with serum ferritin 2500–5000 ng/mL, and 11 patients with serum ferritin >5000 ng/mL were studied. Diastolic dysfunction was absent in all patients with serum ferritin <2500 ng/mL, and was present in all patients with serum ferritin >5000 ng/mL. Deceleration time (DT) has a significant correlation with serum ferritin (r = –0.59, p < 0.0001). Difference of pulmonary vein atrial reversal flow and mitral valve A wave duration (PVAR – MVA) and early ventricular filling velocity to early diastolic myocardial velocity ratio (E/Em) significantly correlated with serum ferritin (r = 0.49, p = 0.006; r = 0.56, p = 0.001, respectively).

Conclusion: Decreased DT, increased PVAR-MVA duration, and increased E/Em ratio reliably reflected severe iron overload in pediatric patients with β thalassemia. Systolic and diastolic LV function is preserved in patients who have serum ferritin <2500 ng/mL.

Keywords: Tissue Doppler imaging; β Thalassemia; Diastolic dysfunction; Serum ferritin; Iron overload


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