Myocardial Dysfunction in Thalassemia Major: Comparison between Echocardiography and MRI

Background- Iron overload contributes to cardiac dysfunction in patients with beta thalassemia major. T2* magnetic resonance is the gold- standard test for detecting iron overload in myocardial cells. Tissue Doppler imaging (TDI) has been developed to evaluate ventricular function in beta thalassemic patients. Aim- We aimed to assess the efficacy of TDI in predicting myocardial iron load in beta thalassemic patients using T2* magnetic resonance imaging (MRI) as the gold standard test. Methods- During a period of one year (2011- 2012), 27 known beta thalassemic patients were included in the study to be evaluated by TDI and T2* MRI. Results- There were 15 females and 12 males at an age range of 18 to 39 years (23.89±5.19). Patients in the age group of 18-25 years old comprised 63% of the subjects. Serum ferritin level ?1500 ng/ml was observed in 20 (74%) cases. T2* MRI > 20 ms was detected in 22 (81.5%) patients. Abnormal T2*MRI (T2*? 20 ms) had a significant correlation with increased serum ferritin levels (P = 0.007), increased left ventricular end diastolic dimension (P = 0.039), decreased E/A filling ratio (P = 0.022), and decreased early and late diastolic myocardial velocities at the lateral left ventricular wall (P = 0.028, and P = 0.023, respectively). Conclusions- The present study findings suggested that even in a population of young, asymptomatic, and well-chelated thalassemic patients; impairment of myocardial function can be observed and this damage can be detected by echocardiographic techniques.