Tissue doppler imaging in thalassemia major patients: correlation between systolic and diastolic function with serum ferritin level

Syarif Rohimi; Najib Advani; Sudigdo Sastroasmoro; Bambang Mardiyono; Sukman Tulus Putra; Mulyadi M. Djer; Fajar Subroto

doi:10.14238/pi52.4.2012.187-93

Syarif Rohimi Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo Hospital, Jakarta
Najib Advani Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo Hospital, Jakarta
Sudigdo Sastroasmoro Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo Hospital, Jakarta
Bambang Mardiyono Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo Hospital, Jakarta
Sukman Tulus Putra Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo Hospital, Jakarta
Mulyadi M. Djer Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo Hospital, Jakarta
Fajar Subroto Department of Child Health, Harapan Kita Women's and Children's Hospita, Jakarta

DOI: https://doi.org/10.14238/pi52.4.2012.187-93

Keywords: tissue doppler imaging, echocardiography, systolic function, diastolic function, ferritin, betathalassemia major

Abstract

Background Thalassemia is a major public health problem in
Indonesia. Cardiac diseases remain as the main cause of death in
these patients due to iron overload. Although the T2* magnetic
resonance imaging has been considered as the gold standard for
assessing cardiac iron overload but it has limited availability.
The tissue doppler imaging (TDI) echocardiography, a fairly new
and easy method that is suggested, can detect early abnormal
myocardial iron overload.
Objective To assess myocardial systolic and diastolic function
of thalassemic patients using TDI and examine their correlation
with serum ferritin level.
Methods A crossô€Œsectional study was conducted from January to
March 2011 at the Harapan Kita Women and Children Hospital.
We performed clinical examination, serum ferritin level, as well
as conventional and tissue doppler echocardiography on all
subjects.
Results We included 34 regularlyô€Œtranfused patients, of which
17 were boys. The mean age of the subjects was 11.6 (SD 4.7
years, range 2.6 ô€Œ 20 years). Mean pulse rate and blood pressure
were within normal range. Hemoglobin level at inclusion ranged
from 5.8 to 6 g/dL. Almost all patients did not receive regular
chelation therapy. Median serum ferritin level was 6275 ng/mL
(range 2151 - 17,646 ng/mL). Conventional echocardiography
showed normal systolic function, but some diastolic dysfunctions
were found including E wave abnormalites in 4 patients, A wave
abnormalites in 3, and E/A ratio abnormalites found in 3. The
TDI showed decreased systolic function (Sa wave abnormality) in
9 patients and diastolic dysfunctions (Ea wave abnormality in 11
patients and Aa wave abnormaly in 2). No abnormality was found
in Ea/Aa and ElEa ratios. There was a weak negative correlation
between ferritin level and Sa wave and Ea wave respectively and
a moderately negative correlation between ferritin level and Ea/

Aa ratio. There was no correlation between serum ferritin and
Aa wave or ElEa ratio.
Conclusion TDI identifies a greater number of patients Mth
systolic and diastolic myocardial dysfunction than was revealed
by conventional echocardiography. There was a weak negative
correlation between serum ferritin to Sa wave and Ea wave, and a
moderately negative correlation between ferritin and Ea/Aa ratio.
There was no correlation between serum ferritin and Aa wave or
ElEa ratio. [paediatr Indones. 2012;52:187,93].

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