Echocardiography in Transfusion Dependent Beta Thalassaemia Major Egyptian Children: Correlation with Thyroid Function Status and Ferritin LevelCorrespondence Address :
Dr. Hanan Mahmoud Fayed,
Mabber Elshababst Street, Qena-83523, Egypt.
Introduction: Iron-mediated cardiomyopathy is leading cause of death in ÃŸ-thalassaemia (ÃŸTM). Thyroid dysfunction maybe associated with cardiac dysfunctions. Early detection of cardiac-function impairment can help in preventing further cardiac damage by modifying disease progression and treatment.
Aim: To assess cardiac function and echocardiography indices in transfusion dependent ÃŸTM children in Qena, Egypt and correlate findings with thyroid status and serum ferritin levels.
Materials and Methods: This was a case-control study conducted on 40 transfusion dependent ÃŸTM cases aged from 6-12 years who were on regular follow-up in outpatient paediatric clinic in Qena university hospital between January 2016 and December 2016. Fifteen, age and sex-matched healthy children were included as a control group to investigate Left Ventricle (LV) diastolic and systolic function using echocardiography, and correlate findings with serum Thyroid Stimulating Hormone (TSH), free thyroxine (FT4), and serum ferritin. SPSS version 22 used for data analysis and Pearson correlation was used to explore the relationship between quantitative variables. All statistical tests were two tailed, and a p-value below 0.05 was considered statistically significant.
Results: In children with ÃŸTM had a mean age 9.51 years (SDÂ±3.26), (n=10, 25%) had hypothyroidism; primary (n=1, 2.5%), subclinical (n=5, 12.5%) and central (n=4, 10%). Cases had Left Ventricular Ejection Fraction percentage (LVEF%) of 67.68Â±7.04, ferritin level of 2617Â±1866 vs. 118Â±43 in control; (p-value=<0.001), Left Ventricular Dimensions at the End of Systole (LVESD) 40.63Â±6.17 vs. 36.53Â±4.82 in control; (p-value=0.025) and Left Ventricular Dimensions at the End of Diastole (LVEDD) was 25.40Â±4.83 vs. 22.60Â±3.54 in control; (p-value=0.046). Cases with impaired thyroid function had higher ferritin and lower EF%. Cases displayed left ventricular diastolic restrictive pattern with preserved left ventricular systolic function in echocardiogram. FT4 showed a negative correlation with TSH and myocardial performance index (LV Tei) while ferritin showed a positive correlation with TSH, LVEDD and LVESD.
Conclusion: Periodic evaluation of thyroid and cardiac functions and thyroxine replacement maybe considered in cases with iron overload, subclinical hypothyroidism and poor response to chelation therapy.
Beta-thalassaemia major, Diastolic function, Echocardiography, Ferritin, Tei index, Thyroid hormone
Date of Submission: Sep 21, 2017
Date of Peer Review: Nov 01, 2017
Date of Acceptance: Jan 23, 2018
Date of Publishing: Apr 01, 2018
FINANCIAL OR OTHER COMPETING INTERESTS: None.
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