Key result
Asymptomatic patients with beta-thalassemia major had a significantly reduced left atrial active emptying fraction compared to healthy controls (34.3% vs. 43.2%, p<0.05), indicating early left atrial dysfunction.
Why the study?
Does left atrial function, assessed by real-time three-dimensional echocardiography, differ in asymptomatic patients with b-thalassemia major compared to healthy controls?
Cross-Sectional (n=48)
No
Does left atrial function, assessed by real-time three-dimensional echocardiography, differ in asymptomatic patients with b-thalassemia major compared to healthy controls?
Absolute Event Rate: 34.3% vs 43.2%
p-value: p=<0.05
Real-time 3D echocardiography reveals that left atrial active emptying fraction is reduced in asymptomatic b-thalassemia major patients, serving as a potential early marker of myocardial dysfunction before LVEF declines.
May signal early LA dysfunction in beta-thalassemia; hypothesis-generating for 3D echo as preclinical marker before LVEF decline.
BACKGROUND: There is strong evidence that left atrial (LA) size is a prognostic marker in a variety of heart diseases. Recently, real-time three-dimensional echocardiography (RT3DE) has been reported as a useful tool for studying the phasic changes of the left atrial volumes. The aim of this study was to investigate the performance of the left atrium in beta-thalassemic patients with preserved left ventricular ejection fraction (EF) and no iron overload, using RT3DE. METHODS: Twenty-eight asymptomatic b-thalassemic patients (32.2 ± 4.3 years old, 17 men) who were on iron chelating therapy, as well as 20 age- and sex-matched healthy controls underwent transthoracic RT3DE. The patient group had normal echocardiographic systolic and diastolic indices, while there was no myocardial iron disposition according to MRI. Apical full volume data sets were obtained and LA volumes were measured at 3 time points of the cardiac cycle: (1) maximum volume (LAmax) at end-systole, just before mitral valve opening; (2) minimum volume (LAmin) at end-diastole, just before mitral valve closure; and (3) volume before atrial active contraction (LApreA) obtained from the last frame before mitral valve reopening or at time of the P wave on the surface electrocardiogram. From the derived values, left atrial active and passive emptying volumes, as well as the respective emptying fractions were calculated. RESULTS: Left ventricular EF (59.2 ± 2.5% patients vs. 60.1 ± 2.1% controls), E/A, E/E' were similar between the two groups. Differences in the LAmax, LAmin and LApreA between b-thalassemic patients and controls were non-significant, LAmax:(35.5 ± 13.4 vs 31.8 ± 9.8)cm3, LAmin:(16.0 ± 6.0 vs. 13.5 ± 4.2)cm3, and LApreA:(25.4 ± 9.8 vs. 24.3 ± 7.2)cm3. However, left atrial active emptying fraction was reduced in the patient group as compared to the healthy population (34.3 ± 16.4% vs. 43.2 ± 11.4%, p < 0.05). CONCLUSION: RT3DE may be a novel technique for the evaluation of LA function in asymptomatic patients with b-Thalassemia Major. Among three-dimensional volumes and indices, left atrial active emptying fraction may be an early index of LA dysfunction in the specific patient population.
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Aggeli et al. (2011) conducted a cross-sectional in beta-thalassemia major (n=48). Beta-thalassemia major vs. Healthy controls was evaluated on Left atrial active emptying fraction (AAEF) (p=<0.05). Asymptomatic patients with beta-thalassemia major had a significantly reduced left atrial active emptying fraction compared to healthy controls (34.3% vs. 43.2%, p<0.05), indicating early left atrial dysfunction.
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