Echocardiographic evaluation of R and L venticular diastolic function in thalassemia major

ABSTRACT

Beta thalassemia major [BTM] is a hereditary severe and fatal hemolytic anemia associated with organ failure and iron overload. Cardiac complications are the major cause of morbidity and death in BTM. The purpose of this study was to assess early diagnosis of cardiac involvement by echocardiography. This is a case-control study on 80 patients with BTM and 80 age and sex matched healthy children as control group from September 2002 to December 2003 in AliAsghar hospital of Zahedan, Complete echocardiographic study was done and diastolic function indices compared with control group statistically. From 80 patients 42 patients were males. The mean age was 14.3 +/- 2.3 years. In comparison with control group The mean of E/A Ratio of left ventricle [LV] and right ventricle [RV] was 1.81 +/- 0.35 and 1.33 +/- 0.33 respectively that increased significantly [p< 0.05]. The mean of deceleration time [DT] of mitral and tricuspid valves was 144.67 +/- 23, 134/87 +/- 25 msec respectively that decreased only significantly in RV. [P<0.05] Isovolumic relaxation time [IVRT] was the most frequent abnormal diastolic index increased significantly in both ventricles [p< 0.05]. The mean of pre ejection period / Ejection time [PEP/ET] ratio of LV and RV was 0.33 +/- 0.06 and 0.31 +/- 0.06 respectively. Although increased significantly in both ventricles [p<0.05] but abnormal PEP/ ET was more frequent in RV. Only 9 patients had LV systolic dysfunction. In patients with BTM, diastolic dysfunction especially in RV was more frequent and begun earlier than LV systolic dysfunction. Increased IVRT, PEP/ET ratio and decreased DT had more sensitivity in early diagnosis especially in RV. Therefore assessment of diastolic function in addition to LV systolic function is mandatory and leads to early diagnosis of cardiac dysfunction