Left ventricular systolic dyssynchrony index and endothelial dysfunction parameters as subclinical predictors of cardiovascular involvement in patients with beta‐thalassemia major
Objective Cardiovascular iron load is the leading cause of morbidity and mortality in beta‐thalassemia major (β‐TM). However, many patients remain asymptomatic until the late stage. In this cross‐sectional study, we investigated the role of three‐dimensional (3D) echocardiography and endothelial dys...
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| Veröffentlicht in: | Echocardiography (Mount Kisco, N.Y.) N.Y.), 2021-06, Vol.38 (6), p.825-833 |
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| creator | Solmaz, Hatice Cabuk, Ali Kemal Altin, Zeynep Albudak Ozcan, Esin Ozdogan, Oner |
| description | Objective
Cardiovascular iron load is the leading cause of morbidity and mortality in beta‐thalassemia major (β‐TM). However, many patients remain asymptomatic until the late stage. In this cross‐sectional study, we investigated the role of three‐dimensional (3D) echocardiography and endothelial dysfunction parameters in asymptomatic β‐TM patients, and the relationship between these parameters and cardiac magnetic resonance imaging (MRI) T2* value.
Methods
A total of 51 asymptomatic β‐TM patients receiving regular blood transfusions were divided into two groups based on cardiac MRI‐T2* values (MRI‐T2* |
| doi_str_mv | 10.1111/echo.15067 |
| format | Article |
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Cardiovascular iron load is the leading cause of morbidity and mortality in beta‐thalassemia major (β‐TM). However, many patients remain asymptomatic until the late stage. In this cross‐sectional study, we investigated the role of three‐dimensional (3D) echocardiography and endothelial dysfunction parameters in asymptomatic β‐TM patients, and the relationship between these parameters and cardiac magnetic resonance imaging (MRI) T2* value.
Methods
A total of 51 asymptomatic β‐TM patients receiving regular blood transfusions were divided into two groups based on cardiac MRI‐T2* values (MRI‐T2*<20 ms and ≥20 ms), which MRI‐T2*<20 ms determines myocardial iron load and evaluated by two‐dimensional (2D) and 3D‐echocardiography including endothelial dysfunction parameters. The relationships between ferritin levels, 2D and 3D‐echocardiography measurements, endothelial dysfunction parameters, and cardiac MRI‐T2* values were investigated.
Results
All left ventricle ejection fraction (LVEF) obtained by 2D‐echocardiography were normal (≥50%). LVEF‐3D (53.25 ± 2.33 vs. 58.81 + 1.02), SDI12 (6.53 ± 0.56 vs. 2.85 + 0.48), and SDI16 (7.65 ± 0.75 vs. 3.26 + 0.49) were significantly different and negatively correlated between groups with MRI‐T2*<20 ms and ≥20 ms, respectively. Flow‐mediated dilatation (FMD) (6.08% ± 0.34% vs. 14.46% ± 1.12), aortic strain (7.79% ± 2.19% vs. 12.76% ± 4.19), ferritin levels were significantly different and negatively correlated between groups with MRI‐T2*<20 ms and ≥20 ms, respectively. Higher ferritin, SDI12/16 were significant independent predictors of MR‐T2* < 20 ms. SDI16 > 5.5, SDI12 > 4.3 predicted MRI‐T2*<20ms with a sensitivity of 92%, specificity of 81% (AUC 0.85, P < .001), and sensitivity of 92%, specificity of 78% (AUC 0.83, P < .001), respectively.
Conclusion
SDI12/16 calculated by 3D‐echocardiography may be a promising predictors of cardiovascular iron load and, decreased LVEF‐3D, FMD, and aortic strain might be good indicators of subclinical cardiovascular involvement of β‐TM.]]></description><identifier>ISSN: 0742-2822</identifier><identifier>EISSN: 1540-8175</identifier><identifier>DOI: 10.1111/echo.15067</identifier><identifier>PMID: 33945174</identifier><language>eng</language><publisher>United States</publisher><subject>3D‐echocardiography ; beta‐thalassemia major ; cardiovascular involvement ; endothelial dysfunction parameters ; left ventricular systolic dyssynchrony index</subject><ispartof>Echocardiography (Mount Kisco, N.Y.), 2021-06, Vol.38 (6), p.825-833</ispartof><rights>2021 Wiley Periodicals LLC</rights><rights>2021 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3297-9693d9a487998effc218d509b9738c6285cc3efee76438c7325f6bb0a6dc7ed63</citedby><cites>FETCH-LOGICAL-c3297-9693d9a487998effc218d509b9738c6285cc3efee76438c7325f6bb0a6dc7ed63</cites><orcidid>0000-0002-8474-1214 ; 0000-0001-5549-3744 ; 0000-0003-3682-1479 ; 0000-0003-3205-6917 ; 0000-0002-0867-1752</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fecho.15067$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fecho.15067$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33945174$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Solmaz, Hatice</creatorcontrib><creatorcontrib>Cabuk, Ali Kemal</creatorcontrib><creatorcontrib>Altin, Zeynep</creatorcontrib><creatorcontrib>Albudak Ozcan, Esin</creatorcontrib><creatorcontrib>Ozdogan, Oner</creatorcontrib><title>Left ventricular systolic dyssynchrony index and endothelial dysfunction parameters as subclinical predictors of cardiovascular involvement in patients with beta‐thalassemia major</title><title>Echocardiography (Mount Kisco, N.Y.)</title><addtitle>Echocardiography</addtitle><description><![CDATA[Objective
Cardiovascular iron load is the leading cause of morbidity and mortality in beta‐thalassemia major (β‐TM). However, many patients remain asymptomatic until the late stage. In this cross‐sectional study, we investigated the role of three‐dimensional (3D) echocardiography and endothelial dysfunction parameters in asymptomatic β‐TM patients, and the relationship between these parameters and cardiac magnetic resonance imaging (MRI) T2* value.
Methods
A total of 51 asymptomatic β‐TM patients receiving regular blood transfusions were divided into two groups based on cardiac MRI‐T2* values (MRI‐T2*<20 ms and ≥20 ms), which MRI‐T2*<20 ms determines myocardial iron load and evaluated by two‐dimensional (2D) and 3D‐echocardiography including endothelial dysfunction parameters. The relationships between ferritin levels, 2D and 3D‐echocardiography measurements, endothelial dysfunction parameters, and cardiac MRI‐T2* values were investigated.
Results
All left ventricle ejection fraction (LVEF) obtained by 2D‐echocardiography were normal (≥50%). LVEF‐3D (53.25 ± 2.33 vs. 58.81 + 1.02), SDI12 (6.53 ± 0.56 vs. 2.85 + 0.48), and SDI16 (7.65 ± 0.75 vs. 3.26 + 0.49) were significantly different and negatively correlated between groups with MRI‐T2*<20 ms and ≥20 ms, respectively. Flow‐mediated dilatation (FMD) (6.08% ± 0.34% vs. 14.46% ± 1.12), aortic strain (7.79% ± 2.19% vs. 12.76% ± 4.19), ferritin levels were significantly different and negatively correlated between groups with MRI‐T2*<20 ms and ≥20 ms, respectively. Higher ferritin, SDI12/16 were significant independent predictors of MR‐T2* < 20 ms. SDI16 > 5.5, SDI12 > 4.3 predicted MRI‐T2*<20ms with a sensitivity of 92%, specificity of 81% (AUC 0.85, P < .001), and sensitivity of 92%, specificity of 78% (AUC 0.83, P < .001), respectively.
Conclusion
SDI12/16 calculated by 3D‐echocardiography may be a promising predictors of cardiovascular iron load and, decreased LVEF‐3D, FMD, and aortic strain might be good indicators of subclinical cardiovascular involvement of β‐TM.]]></description><subject>3D‐echocardiography</subject><subject>beta‐thalassemia major</subject><subject>cardiovascular involvement</subject><subject>endothelial dysfunction parameters</subject><subject>left ventricular systolic dyssynchrony index</subject><issn>0742-2822</issn><issn>1540-8175</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kc1u1DAURi0EokNhwwMgLxFSin-SOF6iUaFII3UD68ixbxRXjj3YzpTs-gi8DC_Ek-AhhSXe-JN9dO6VPoReU3JFy3kPegpXtCGteIJ2tKlJ1VHRPEU7ImpWsY6xC_QipTtCiKC0fo4uOJd1Q0W9Qz8PMGZ8Ap-j1YtTEac15eCsxmZNafV6isGv2HoD37HyBoM3IU_grHJnZFy8zjZ4fFRRzZAhJqwSTsugnfVWF-oYwVidQ_kJI9YqGhtOKm3jrD8Fd4K5bFBysWRbYsL3Nk94gKx-PfzIk3IqJZitwrO6C_ElejYql-DV432Jvn68_rK_qQ63nz7vPxwqzZkUlWwlN1LVnZCyg3HUjHamIXKQgne6ZV2jNYcRQLR1eRCcNWM7DES1RgswLb9EbzfvMYZvC6TczzZpcE55CEvqWcMY72RNeUHfbaiOIaUIY3-MdlZx7SnpzzX155r6PzUV-M2jdxlmMP_Qv70UgG7AvXWw_kfVX-9vbjfpb1y6pRk</recordid><startdate>202106</startdate><enddate>202106</enddate><creator>Solmaz, Hatice</creator><creator>Cabuk, Ali Kemal</creator><creator>Altin, Zeynep</creator><creator>Albudak Ozcan, Esin</creator><creator>Ozdogan, Oner</creator><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8474-1214</orcidid><orcidid>https://orcid.org/0000-0001-5549-3744</orcidid><orcidid>https://orcid.org/0000-0003-3682-1479</orcidid><orcidid>https://orcid.org/0000-0003-3205-6917</orcidid><orcidid>https://orcid.org/0000-0002-0867-1752</orcidid></search><sort><creationdate>202106</creationdate><title>Left ventricular systolic dyssynchrony index and endothelial dysfunction parameters as subclinical predictors of cardiovascular involvement in patients with beta‐thalassemia major</title><author>Solmaz, Hatice ; Cabuk, Ali Kemal ; Altin, Zeynep ; Albudak Ozcan, Esin ; Ozdogan, Oner</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3297-9693d9a487998effc218d509b9738c6285cc3efee76438c7325f6bb0a6dc7ed63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>3D‐echocardiography</topic><topic>beta‐thalassemia major</topic><topic>cardiovascular involvement</topic><topic>endothelial dysfunction parameters</topic><topic>left ventricular systolic dyssynchrony index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Solmaz, Hatice</creatorcontrib><creatorcontrib>Cabuk, Ali Kemal</creatorcontrib><creatorcontrib>Altin, Zeynep</creatorcontrib><creatorcontrib>Albudak Ozcan, Esin</creatorcontrib><creatorcontrib>Ozdogan, Oner</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Echocardiography (Mount Kisco, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Solmaz, Hatice</au><au>Cabuk, Ali Kemal</au><au>Altin, Zeynep</au><au>Albudak Ozcan, Esin</au><au>Ozdogan, Oner</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Left ventricular systolic dyssynchrony index and endothelial dysfunction parameters as subclinical predictors of cardiovascular involvement in patients with beta‐thalassemia major</atitle><jtitle>Echocardiography (Mount Kisco, N.Y.)</jtitle><addtitle>Echocardiography</addtitle><date>2021-06</date><risdate>2021</risdate><volume>38</volume><issue>6</issue><spage>825</spage><epage>833</epage><pages>825-833</pages><issn>0742-2822</issn><eissn>1540-8175</eissn><abstract><![CDATA[Objective
Cardiovascular iron load is the leading cause of morbidity and mortality in beta‐thalassemia major (β‐TM). However, many patients remain asymptomatic until the late stage. In this cross‐sectional study, we investigated the role of three‐dimensional (3D) echocardiography and endothelial dysfunction parameters in asymptomatic β‐TM patients, and the relationship between these parameters and cardiac magnetic resonance imaging (MRI) T2* value.
Methods
A total of 51 asymptomatic β‐TM patients receiving regular blood transfusions were divided into two groups based on cardiac MRI‐T2* values (MRI‐T2*<20 ms and ≥20 ms), which MRI‐T2*<20 ms determines myocardial iron load and evaluated by two‐dimensional (2D) and 3D‐echocardiography including endothelial dysfunction parameters. The relationships between ferritin levels, 2D and 3D‐echocardiography measurements, endothelial dysfunction parameters, and cardiac MRI‐T2* values were investigated.
Results
All left ventricle ejection fraction (LVEF) obtained by 2D‐echocardiography were normal (≥50%). LVEF‐3D (53.25 ± 2.33 vs. 58.81 + 1.02), SDI12 (6.53 ± 0.56 vs. 2.85 + 0.48), and SDI16 (7.65 ± 0.75 vs. 3.26 + 0.49) were significantly different and negatively correlated between groups with MRI‐T2*<20 ms and ≥20 ms, respectively. Flow‐mediated dilatation (FMD) (6.08% ± 0.34% vs. 14.46% ± 1.12), aortic strain (7.79% ± 2.19% vs. 12.76% ± 4.19), ferritin levels were significantly different and negatively correlated between groups with MRI‐T2*<20 ms and ≥20 ms, respectively. Higher ferritin, SDI12/16 were significant independent predictors of MR‐T2* < 20 ms. SDI16 > 5.5, SDI12 > 4.3 predicted MRI‐T2*<20ms with a sensitivity of 92%, specificity of 81% (AUC 0.85, P < .001), and sensitivity of 92%, specificity of 78% (AUC 0.83, P < .001), respectively.
Conclusion
SDI12/16 calculated by 3D‐echocardiography may be a promising predictors of cardiovascular iron load and, decreased LVEF‐3D, FMD, and aortic strain might be good indicators of subclinical cardiovascular involvement of β‐TM.]]></abstract><cop>United States</cop><pmid>33945174</pmid><doi>10.1111/echo.15067</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-8474-1214</orcidid><orcidid>https://orcid.org/0000-0001-5549-3744</orcidid><orcidid>https://orcid.org/0000-0003-3682-1479</orcidid><orcidid>https://orcid.org/0000-0003-3205-6917</orcidid><orcidid>https://orcid.org/0000-0002-0867-1752</orcidid></addata></record> |
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| subjects | 3D‐echocardiography beta‐thalassemia major cardiovascular involvement endothelial dysfunction parameters left ventricular systolic dyssynchrony index |
| title | Left ventricular systolic dyssynchrony index and endothelial dysfunction parameters as subclinical predictors of cardiovascular involvement in patients with beta‐thalassemia major |
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