Why the study?
Heart disease is a major cause of morbidity and mortality in β-thalassemia major, but conventional echocardiography fails to identify early myocardial dysfunction.
Does speckle tracking echocardiography identify early myocardial dysfunction in patients with β-thalassemia major compared to controls?
Does speckle tracking echocardiography identify early myocardial dysfunction in patients with β-thalassemia major compared to controls?
Speckle tracking echocardiography can identify early myocardial dysfunction in β-thalassemia major patients and is recommended as a supplementary tool to conventional echocardiography.
Speckle tracking may detect subclinical dysfunction in β-thalassemia; supports adjunctive role but leaves open prospective validation.
Heart disease is among the primary causes of morbidity and mortality in β-thalassemia major (β-TM). Conventional echocardiography has failed to identify myocardial dysfunction at an early stage among these patients, thus speckle tracking echocardiography (STE) has been lately used. The objectives of this review were to 1) identify all published studies having evaluated myocardial strain among β-TM patients, 2) gather their results, 3) compare their findings and 4) propose recommendations based on these data. Literature search was conducted in PubMed, SCOPUS and Cohrane Library. Data regarding left ventricular global longitudinal (LV-GLS), circumferential (LV-GCS) and radial strain (LV-GRS), right ventricular longitudinal strain (RV-GLS), left and right atrial strain were extracted. Thirty-five studies (34 original articles and 1 meta-analysis) have met the inclusion criteria. LV-GLS has been reported being worse in patients compared to controls in 13 of 21 studies, LV-GCS in 7 of 11 studies, LV-GRS in 6 of 7 studies, RV-GLS in 2 of 3 studies and left atrial strain in all case-control studies. Myocardial iron overload (MIO) patient subgroups had worse LV-GLS in 6 of 15 studies, LV-GCS in 2 of 7 studies and LV-GRS in none of 7 studies. A small number of studies suggest left atrial strain correlation with electrical atrial ectopy and atrial fibrillation. It is suggested that STE should be applied supplementary to conventional echocardiography for early identification of myocardial dysfunction among β-TM patients. Potential myocardial strain utilities could be screening for myocardial iron overload, left ventricular diastolic dysfunction and atrial fibrillation.
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Patsourakos et al. (2023) studied this question.
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