What does this research mean for the field?

Persistent serum ferritin levels greater than 2500 mcg/ml are significantly correlated with electrocardiographic and echocardiographic abnormalities, and can assist in predicting the development of cardiac disease in patients with beta-thalassemia major. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to evaluate the correlation between serum ferritin levels and electrocardiographic and echocardiographic changes in patients with beta-thalassemia major.

May 18, 2026Open Access

Correlation between serum ferritin levels and electrocardiography and echocardiography changes in patients of beta thalassemia

Key Points

The study aims to evaluate the correlation between serum ferritin levels and electrocardiographic and echocardiographic changes in patients with beta-thalassemia major.
Cross-sectional study conducted over 2 years involving 60 beta-thalassemia major patients.
Evaluated serum ferritin levels in relation to echocardiographic and electrocardiographic parameters.
Assessed myocardial changes through measures like QT interval, septal thickness, and ejection fraction.
Group C showed significantly prolonged QTc and QTd compared to Groups A and B (p2: 0.00).
Significant correlations found between serum ferritin and septal thickness in Groups A, B, and C (p1: 0.00).
Ejection fraction showed significant correlation with serum ferritin levels in Groups A and B (p1: 0.00).

Abstract

Abstract: BACKGROUND: Thalassemia is the most common type of haemoglobinopathy characterized by decreased synthesis of one of the two types of polypeptide chains (α or β) that form the normal adult hemoglobin, with significant morbidity and mortality. The leading cause of death in transfusion dependent thalassemia patients is myocardial hemosiderosis. Echocardiographic estimation of left ventricular function may reveal abnormalities before there is any clinical evidence of cardiac disease and may help to prevent further cardiac damage by applying intense chelating regimens and combination therapy. Iron deposition in the heart muscle tissues caused heterogeneity of myocardium that made it susceptible to arrhythmias and QT prolongation, ECG can help in predicting patients who are at risk of developing arrythmias. The aim of this study the correlation between serum ferritin, ECG and echocardiography changes in patients of beta-thalassemia major. METHODS: This was a cross-sectional study which was conducted on 60 diagnosed cases of beta-thalassemia major (β-TM) attending our tertiary care centre for the period of 2 years. The relationship between serum ferritin and echocardiographic parameters transmitral E/A ration, Declaration time, septal thickness and ejection fraction and ECG QTc and QTd was measured. RESULTS: The patients were grouped into 3 based on their serum ferritin levels. Group A n =32 had a mean age of 12.22±3.02 years, Group B n =20 had a mean age of 12.80±3.43, Group C n =8 had a mean age of 12.75±3.58 years. Out of them, 14 23.33% were female and 46 76.67% were male and 52 86.67% were born to non-consanguineous marriage and 8 13.33% were to consanguineous marriage. Group A was receiving chelation therapy for a mean of 8.23±2.86 years, Group B for 7.55±3.28 years, Group C for 5.63±2.50 years. In electrocardiographic evaluation, Group A had a mean QTc of 358.16±28.86 ms. Group B had a mean QTc of 370.78±16.25 ms. Group C had a mean QTc of 432.38±11.91 ms. There was no statistically significant correlation between serum ferritin and QTc in Group A and Group B (p1: 0.08). However, there was a statistically significant correlation between serum ferritin and QTc in Group A and Group C (p2: 0.00). Patients in Group A had a mean QTd of 34.29±5.63 ms. Group B had a mean QTd of 38.65±6.37 ms. Group C had a mean QTd of 48.65±1.93 ms. There was a statistically significant correlation between serum ferritin and QTd in Group A and Group B (p1: 0.01) and between Group A and Group C (p2: 0.00). The mean septal value thickness in Group A, Group B and Group C were 6.08±1.08 mm, 8.85±3.86 mm and 9.35±2.25 mm, respectively. There was a statistically significant correlation between serum ferritin levels and septal wall thickness in Group A and Group B (p1: 0.00) and between Group A and Group C (p2: 0.00). While comparing systolic parameters, there was no statistically significant correlation between serum ferritin levels and ejection fraction between Group A and Group B (p1: 0.91) and between Group A and Group C (p2: 0.17). There was a statistically significant correlation between serum ferritin levels and ejection fraction between Group A and Group B (p1: 0.00). However, there was no statistically significant correlation between and between Group A and Group C (p2: 0.09). While evaluating diastolic parameters, the mean Mitral E/A ratio in group A, group B and group C were 1.65±0.16, 1.86±0.18 and 2.06±0.33, respectively. There was a statistically significant correlation between serum ferritin levels and Mitral E/A ratio between Group A and Group B (p1: 0.00) and between Group A and Group C (p2: 0.00). The mean declaration time in Group A, Group B and Group C were 146.30±17.78 ms, 138.01±8.62 ms and 127.83±21.48 ms respectively. There was no statistically significant correlation between serum ferritin levels and declaration time between Group A and Group B (p1: 0.06). However, there was a statistically significant correlation between Group A and Group C (p2: 0.02). CONCLUSIONS: Persistent ferritin levels greater than 2500 mcg/ml and assessment of annual blood requirement can assist in prediction of development of cardiac disease. Thus, regular monitoring for cardiac dysfunction and arrhythmias with annual echocardiogram and ECG is extremely important.

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