Key result
Asymptomatic pediatric β-thalassemia major is linked to ~58-ms lower SDNN versus healthy controls.
Why the study?
Early detection of subclinical cardiac involvement in beta-thalassemia major remains challenging because conventional echocardiography and electrocardiography often miss early dysfunction, while heart rate variability may serve as a sensitive marker.
Does heart rate variability reveal early subclinical autonomic and cardiac dysfunction in pediatric patients with beta-thalassemia major compared to healthy controls?
Cross-Sectional (n=80)
Single-blind
No
Does heart rate variability reveal early subclinical autonomic and cardiac dysfunction in pediatric patients with beta-thalassemia major compared to healthy controls?
Children with beta-thalassemia major demonstrate significant autonomic imbalance and reduced heart rate variability, highlighting the utility of HRV monitoring as a non-invasive tool for early detection of subclinical cardiac involvement.
Answers are grounded in this paper and cite their sources.
HRV may flag subclinical autonomic imbalance in asymptomatic pediatric β-thalassemia; hypothesis-generating for risk stratification, needs prospective validation.
BACKGROUND Cardiac complications are a significant cause of morbidity and mortality in patients with β-thalassemia major (TM). Early detection of subclinical cardiac involvement remains challenging, as conventional echocardiography and electrocardiography often fail to identify early dysfunction. Heart rate variability (HRV) reflects autonomic regulation of the heart and may serve as a sensitive marker for early cardiac impairment. AIM To evaluate HRV in children with β-TM without clinical cardiac manifestations. METHODS A cross-sectional study was conducted on 40 children with β-TM and 40 age- and sex-matched healthy controls. All participants underwent full clinical assessment, laboratory investigations, and 24-hour ambulatory Holter monitoring. HRV parameters were analyzed in both time and frequency domains using Cardioscan CS12 software. Statistical comparisons between groups and correlations with hemoglobin and serum ferritin levels were performed using SPSS version 27. RESULTS Children with β-TM showed significantly higher minimum and maximum heart rates and markedly lower HRV indices, including standard deviation of all normal-to-normal intervals (SDNN), standard deviation of the 5-minutes average normal-to-normal intervals, SDNN index, root mean square of successive differences, and percentage of normal-to-normal intervals differing by > 50 ms, compared with controls (P < 0.001). High-frequency (HF) power was significantly decreased, whereas the low-frequency/HF ratio was elevated (P < 0.001), indicating sympathetic predominance. Arrhythmias were recorded in 47.5% of patients, though HRV parameters did not differ significantly between those with and without arrhythmia. No correlation was found between HRV indices and hemoglobin or serum ferritin levels. CONCLUSION Children with β-TM demonstrate significant autonomic imbalance, reflecting early cardiac involvement even before the onset of clinical symptoms. Routine HRV assessment could provide a valuable, non-invasive tool for early detection and risk stratification in pediatric thalassemia management.
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Sorour et al. (2026) conducted a cross-sectional in β-thalassemia major (n=80). β-thalassemia major vs. Healthy controls was evaluated on Heart rate variability (Standard deviation of all normal-to-normal intervals [SDNN] in milliseconds) (p=<0.001). Children with asymptomatic β-thalassemia major exhibited significantly reduced overall heart rate variability (SDNN 79.18 vs 137.2 ms) compared to healthy controls, reflecting early autonomic imbalance.
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