Early detection of cardiac dysfunction in thalassemic patients by radionuclide angiography and heart rate variability analysis

Benedetta De Chiara, Wilma Crivellaro, Roberto Sara, Livia Ruffini, Marina Parolini, Vlasta Fesslovà, Vittorio Carnelli, Cesare Fiorentini, Oberdan Parodi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Cardiac dysfunction remains the major cause of death in beta-thalassemia. Aim of this study was to assess early myocardial damage in thalassemic patients with no symptoms or echocardiographic evidence of dysfunction at routine monitoring. Methods: Twenty patients (seven females; median 25 yr [first quartile 22, third quartile 28]) with beta-thalassemia underwent radionuclide angiography (RNA) at rest and during low-dose dobutamine infusion (5-10 γ/kg/min). Right and left ventricular ejection fractions (EF) were determined by first-pass method and gated equilibrium acquisition, respectively. Twenty-four-hour Holter monitoring with time-domain heart rate variability (HRV) assessment and echocardiographic follow-up (21 months [5,27]) were performed. Results: Eleven patients showed regional wall motion abnormalities at RNA; left ventricular EF, HR and diastolic measurements significantly increased after dobutamine infusion. Patients with abnormal RNA right ventricular EF (n = 8, <0.45) showed lower echocardiographic left ventricular EF at the enrolment (0.54 [0.50,0.61] vs. 0.62 [0.56,0.67], P = 0.02) than those with a normal right ventricular EF. Patients with reduced standard deviation of the averages of RR intervals in all 5-minute periods of entire recording (SDANN) (n = 6, <100 ms), a measure of HRV, had lower echocardiographic left ventricular EF (0.53 [0.49,0.62] vs. 0.62 [0.56,0.66], P = 0.03) and lower fractional shortening (0.28 [0.25,0.32] vs. 0.36 [0.30,0.39], P = 0.003) at the enrolment than those with normal SDANN. No significant association was found between RNA and HRV measurements and follow-up left ventricular function. Conclusions: Right ventricular dysfunction and abnormal HRV may represent the early features of cardiac disease in thalassemic patients with no evidence of ventricular dysfunction at routine evaluation.

Original languageEnglish
Pages (from-to)517-522
Number of pages6
JournalEuropean Journal of Haematology
Volume74
Issue number6
DOIs
Publication statusPublished - Jun 2005

Keywords

  • Beta-thalassemia
  • Heart rate variability
  • Iron overload
  • Radionuclide angiography

ASJC Scopus subject areas

  • Hematology

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