Key result
Peak atrial 2D strain at a cutoff of 41.1 cm/s ruled out diastolic dysfunction in β-thalassemia major patients with an AUC of 0.66 (P<0.05), 90% sensitivity, and 81% specificity.
Why the study?
Does 2D strain imaging improve the detection of latent diastolic dysfunction compared to conventional methods in patients with beta-thalassemia major?
Cross-Sectional (n=88)
Does 2D strain imaging improve the detection of latent diastolic dysfunction compared to conventional methods in patients with beta-thalassemia major?
2D strain imaging, specifically peak atrial strain, is more accurate than traditional E/E' ratio for early detection of latent diastolic dysfunction in patients with beta-thalassemia major.
May aid ruling out diastolic dysfunction in β-thalassemia major; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: β-thalassemia major is a unique disease characterized by early severe diastolic dysfunction, due to iron myocardial deposition alone, while left ventricular systolic dysfunction and failure seem to be multifactorial in aitiology. OBJECTIVES: The purpose of this study was to investigate left ventricular diastolic dysfunction using a new echo index as speckle tracking in comparison with the conventional methods. MATERIAL AND METHODS: Eighty-eight consecutive patients (38 male, 50 female) aged 36 ± 8.2 yr with β-thalassemia major and preserved LV ejection fraction (LVEF>55%) were studied. Patients were divided into two groups according to the E mitral/E mitral annulus ratio (E/E'): group A patients with E/E' ratio ≤8 and group B patients with E/E' >8. Cutoff value of eight was used to separate patients with normal and abnormal diastolic function. All subjects were studied thoroughly by tissue Doppler echocardiography as also by 2D left ventricular and atrial strain imaging 2-4 d following blood transfusion. Blood samples were also taken for plasma BNP measurements at the same time. RESULTS: Left atrial volumes(LAV max, LAV min) as also left atrial index were significantly higher in patients with diastolic dysfunction compared with patients without diastolic dysfunction(LAV max: 57.6 ± 19.4 vs. 71.3 ± 22.9, P < 0.01,LAV min: 20.2 ± 11.4 vs. 33.9 ± 18, P < 0.01, LAVI: 37.66 ± 12.18 vs. 47.13 ± 14.77, P < 0.01). Radial 2D strain (RS) and peak atrial 2D strain (AS) were significantly reduced in patients with suspected diastolic dysfunction compared with patients without diastolic dysfunction (RS: 43.48 ± 13.92 vs. 35.58 ± 11.32, P < 0.05; AS: 36.36 ± 8.45 vs. 29.85 ± 9.25, P < 0.01). Using ROC analysis, peak atrial 2D strain at a cutoff of 41.1 cm/s was highly accurate (AUC: 0.66, P < 0.05 in ruling out diastolic dysfunction (E/E'<8) with a sensitivity of 90% and a specificity of 81%. CONCLUSIONS: B-thalassemic major patients with preserved left ventricular systolic function had impaired left atrial function at the longitudinal axis and left ventricular function at the radial axis. The new echo markers have better prognostic value than the traditional echo indexes in detecting latent diastolic dysfunction in β-thalassemia major, earlier than E/E' ratio.
No takes yet. Share an insight, caveat, or question.
Karamanou et al. (2013) conducted a cross-sectional in β-thalassemia major (n=88). 2D strain imaging (peak atrial 2D strain) vs. Conventional echocardiography (E/E' ratio) was evaluated on Diagnostic accuracy of peak atrial 2D strain for ruling out diastolic dysfunction (E/E'<8) (AUC 0.66, p=< 0.05). Peak atrial 2D strain at a cutoff of 41.1 cm/s ruled out diastolic dysfunction in β-thalassemia major patients with an AUC of 0.66 (P<0.05), 90% sensitivity, and 81% specificity.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: