Echocardiographic predictors of adverse cardiac events in asymptomatic beta thalassemic patients.
Journal Title: Journal of Medical Science and Technology - Year 2015, Vol 4, Issue 2
Abstract
Aim of study was to identify echocardiographic parameters related to the development of future adverse events (AEs) in asymptomatic thalassemic patients (TM). A total of 74 TM patients (TM group) and 22 healthy subjects (HS group) were included in the study. All subjects underwent standard echocardiography with Tissue Doppler Imaging (TDI). The follow up was for 974 ± 275 days. When compared to HS, TM showed a significant increase of LV Mass index (LVMi), diastolic (LVEDV) and systolic (LVESV) volume (p=0.001, p=0.001 and p=0.023, respectively). TDI analysis identified a significant impairment of S’, E’ and A’ wave mean values (p<0.001, p<0.001 and p=0.002 respectively). Left atrial volume index and the E/E’ ratio were significantly increased in TM (p<0.001). LV ejection fraction was preserved. At follow up, 10 AEs were observed in TM: one death from cardiac cause, 6 patients developing heart failure, 3 new detected supra-ventricular arrhythmias. In TM, ROC curve analysis identified LVEDV>122 ml, LVESV >46 ml, LVMi >82.1 g/m2, E/A ratio>2.09, S’ wave<6.2 cm/sec, E’ wave<10 cm/sec, A’ wave<5 cm/sec and E/E’ ratio >7.82 as cut off-values differentiating TM patients with AEs. On multivariate logistic regression analysis, the E/E’ ratio (Exp (B) = 1.623, p=0.038) and the A’ velocity (Exp (B)=0.509, p=0.044) were independent predictors of AEs at follow up. The TDI derived parameters are useful for the prognostic stratification of asymptomatic TM and easy to use. Early identification of subclinical myocardial dysfunction based on these parameters could be useful for the optimization of therapeutic strategies and correct risk stratification.
Authors and Affiliations
Ines Monte, Sergio Buccheri, Stefano Leggio
Keywords
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