Key result
Elevated serum ferritin linked to reduced LVEF and cardiac dysfunction in pediatric β-thalassemia major.
Why the study?
Cardiac complications from iron overload are the leading cause of morbidity and mortality in children with transfusion-dependent β-thalassemia major, and early identification of myocardial dysfunction using non-invasive markers is essential, especially where cardiac MRI T2 is unavailable.
Do elevated serum ferritin levels correlate with electrocardiographic and echocardiographic markers of cardiac dysfunction in children with transfusion-dependent β-thalassemia major?
Cross-Sectional (n=80)
No
Do elevated serum ferritin levels correlate with electrocardiographic and echocardiographic markers of cardiac dysfunction in children with transfusion-dependent β-thalassemia major?
Effect estimate: r = -0.684
p-value: p=<0.001
Elevated serum ferritin levels are significantly correlated with electrocardiographic and echocardiographic evidence of cardiac dysfunction in children with transfusion-dependent β-thalassemia major, supporting its utility for early screening where advanced imaging is unavailable.
Serum ferritin was associated with reduced LVEF in cross-sectional pediatric data; leaves open its role for noninvasive screening in resource-limited settings.
Background: Cardiac complications resulting from iron overload remain the leading cause of morbidity and mortality in children with transfusion-dependent β-thalassemia major.Early identification of myocardial dysfunction using non-invasive markers is essential, particularly in resource-limited settings where cardiac magnetic resonance imaging (MRI) T2* is not readily available.Objectives: To evaluate the correlation between serum ferritin levels and electrocardiographic and echocardiographic markers of cardiac dysfunction in children with β-thalassemia major.Methods: This analytical cross-sectional study was conducted in the Department of Pediatrics, Baba Raghav Das Medical College, Gorakhpur, India, from January 2025 to December 2025.Eighty children aged two to 16 years with transfusion-dependent β-thalassemia major were enrolled and stratified into three groups according to serum ferritin levels: <2500 ng/mL, 2500-5000 ng/mL, and >5000 ng/mL.All participants underwent clinical evaluation, electrocardiography (ECG), conventional echocardiography, and tissue Doppler imaging.Pearson correlation and multivariate linear regression analyses were performed.Results: Higher serum ferritin levels were associated with significant prolongation of the corrected QT (QTc) interval and QT dispersion and associated with impairment of left ventricular systolic and diastolic function.Serum ferritin showed significant negative correlations with left ventricular ejection fraction (LVEF) (r = -0.684),E/A ratio (r = -0.582),lateral early diastolic mitral annular velocity (r = -0.658),and tricuspid annular plane systolic excursion (r = -0.512),and positive correlations with the ratio of early transmitral flow velocity to early diastolic mitral annular velocity (E/Ea ratio) (r = 0.726), QTc interval (r = 0.648), and myocardial performance index (r = 0.672) (all p < 0.001).Multivariate analysis identified serum ferritin as the strongest independent predictor of reduced LVEF (β = -0.562,p < 0.001).Conclusions: Elevated serum ferritin levels are significantly associated with subclinical and overt cardiac dysfunction in children with β-thalassemia major.Combined assessment using serum ferritin, ECG, and echocardiography may facilitate early detection of iron overload cardiomyopathy and help optimize chelation therapy, particularly in settings where advanced cardiac imaging is unavailable.
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Kasaudhan et al. (2026) conducted a cross-sectional in Transfusion-dependent β-thalassemia major (n=80). Elevated serum ferritin levels vs. Lower serum ferritin levels (<2500 ng/mL) was evaluated on Correlation of serum ferritin with left ventricular ejection fraction (LVEF) (r = -0.684, p=<0.001). Elevated serum ferritin independently predicted reduced left ventricular ejection fraction (β = -0.562) and significantly correlated with cardiac dysfunction in children with β-thalassemia major.
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