Introduction Despite standardized transfusion and chelation therapy, children with transfusion-dependent β -thalassemia (TDT) remain at high risk for cardiac dysfunction due to iron overload. Conventional ejection fraction assessment lacks sensitivity for early injury. This study evaluated multimodal indicators to develop a robust early-warning model. Methods A prospective cohort of 128 TDT children (3–16 years) underwent cardiac magnetic resonance (CMR) T2* imaging, echocardiography with global longitudinal strain (GLS), and measurement of circulating biomarkers including high-sensitivity cardiac troponin I (hs-cTnI), B-type natriuretic peptide (BNP), interleukin-6, and tumor necrosis factor-α. Children were classified into dysfunction and normal groups based on LVEF and GLS. Logistic regression identified predictors, and ROC analysis validated the integrated model. Results The dysfunction group demonstrated reduced GLS, ventricular remodeling, elevated hs-cTnI and BNP, and significantly shorter T2* values compared with controls ( p 0.001). Inflammatory cytokines were also upregulated. Multivariate analysis identified hs-cTnI, BNP, and T2* as independent predictors. The combined three-factor model achieved excellent discrimination (AUC 0.914), outperforming single markers, with preserved calibration following bootstrap validation. Conclusion By linking iron overload, myocardial injury, inflammation, and structural dysfunction, this study proposes a clinically feasible integrated model for early cardiac risk detection in pediatric TDT. The approach supports precision monitoring and prevention of heart failure.
Zhou et al. (Wed,) studied this question.