Role of tissue Doppler imaging in detection of diastolic dysfunction in children with transfusion dependent thalassemia

Background and aim
Transfusion dependent thalassemia (TDT) is a severe form of thalassemia in which patients require regular blood transfusions for life to survive which results in iron overload. Cardiomyopathy is the most serious complication of TDT which results from iron overload in the myocardium. Tissue Doppler imaging (TDI) is a relatively new echocardiographic modality which may help in the detection of subclinical diastolic dysfunction before the appearance of symptoms or signs of heart failure. This study aims to assess the role of conventional Doppler and TDI in the diagnosis of latent diastolic dysfunction in patients with TDT.


Patients and methods
A total of 60 children with TDT aging from 1 to 16 years old with no symptoms or signs of heart failure were included in this study. Serum ferritin levels were measured to all patients. They had echocardiographic examination with pulsed wave Doppler and TDI modalities. E/A ratio and E/e′ ratio were measured and results were evaluated to detect diastolic dysfunction.


Results
There was no abnormality in E/A ratio. E/e′ ratio was elevated. There was no correlation between serum ferritin level and E/A ratio. There was a highly significant positive correlation between serum ferritin level and E/e′ ratio.


Conclusion
There are latent diastolic dysfunction in children with TDT can not be detected by conventional echocardiographic modalities but with advanced modalities like TDI.