Key result
Reduced LASr linked to ~16.2-fold higher adverse cardiovascular events in β-thalassemia major.
Why the study?
Cardiovascular diseases are the prominent cause of mortality in β-thalassemia major (β-TM) patients, and the CMR-derived T2 parameter is the only imaging index previously shown to have prognostic value in this population, prompting evaluation of the prognostic role of myocardial strain indices.
Does myocardial strain assessed by speckle tracking echocardiography predict adverse cardiovascular events and all-cause mortality in patients with β-thalassemia major?
Cohort (n=146)
Does myocardial strain assessed by speckle tracking echocardiography predict adverse cardiovascular events and all-cause mortality in patients with β-thalassemia major?
Reduced left atrial reservoir strain (LASr) measured by speckle tracking echocardiography independently predicts adverse cardiovascular events and mortality in β-thalassemia major patients, offering prognostic value beyond CMR T2.
LASr may refine prognostication in β-thalassemia major; leaves open whether strain imaging alters management beyond T2.
Introduction Cardiovascular diseases are the prominent cause of mortality in β-thalassemia major (β-TM) patients. T2* parameter derived from cardiac magnetic resonance (CMR) imaging is the only imaging index that has been shown to have prognostic value in this specific patient population. Purpose The aim of the present study is to evaluate the prognostic role of myocardial strain indices in β-TM. Methods A total of 110 patients with β-TM were initially evaluated, of which 96 were eventually enrolled in the study along with 50 healthy individuals. Speckle tracking echocardiography (STE) was implemented to assess the myocardial deformation of the left ventricle (LV-GLS), left atrium (LASr), and right ventricle (RVFWs). Additionally, they underwent CMR imaging to evaluate myocardial iron load by measuring the T2* parameter. Patients were monitored until the end of the study, with primary endpoints defined as the occurrence of atrial fibrillation or atrial flutter, hospitalization for heart failure and all-cause mortality. Results Median follow-up was 1486.5 [752.25 – 1850] days. In summary, primary endpoints were recorded in a total of 17 patients. All-cause death occurred in 4/96 patients (4.2%). Multivariate Cox proportional hazards models were performed to evaluate the prognostic value of LV-GLS, LASr, RVFWs, E/e’, LAVI and PASP for the primary endpoint, after adjustment for age, history of atrial fibrillation, left ventricular ejection fraction (LVEF), and myocardial T2* value. All tested echocardiographic parameters were dichotomized based on their median values. Among the evaluated parameters, only LASr (HR [95% CI]: 16.2 [2.0–135.6], p=0.009) emerged as an independent predictor of the primary endpoint (Figure 1), whereas the remaining conventional and speckle-tracking parameters were not statistically significant. Conclusion In β-TM patients, reduced LASr by STE independently predicted adverse cardiovascular events. These findings position LASr as a valuable non-invasive prognostic marker of early cardiac involvement in β-TM, potentially improving risk stratification beyond current standards.
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Patsourakos et al. (2026) conducted a cohort in β-thalassemia major (β-TM) (n=146). Reduced left atrial reservoir strain (LASr) on speckle tracking echocardiography (below median) vs. Higher left atrial reservoir strain (above median) and healthy individuals was evaluated on Composite of occurrence of atrial fibrillation or atrial flutter, hospitalization for heart failure, and all-cause mortality (HR 16.2, 95% CI 2.0-135.6, p=0.009). Reduced left atrial reservoir strain (LASr) independently predicted adverse cardiovascular events in β-thalassemia major patients (HR 16.2; 95% CI 2.0-135.6; p=0.009).
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