VALUE OF SPECKLE TRACKING ECHOCARDIOGRAPHY IN ASSESSMENT OF LEFT VENTRICULAR FUNCTION IN B-THALASSEMIC PATIENTS | ||||
| Al-Azhar Journal of Pediatrics | ||||
| Article 5, Volume 24, Issue 1, January 2021, Page 1614-1632 PDF (327.63 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/azjp.2021.194402 | ||||
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| Abstract | ||||
| Introduction: Beta-thalassemia is a genetic disease with different clinical aspects, over the last years; growing interest has been reported for biomarkers that may help in the diagnosis, staging and prognosis of heart disease at an early stage, in patients with beta thalassemia (Maria et al., 2020). Speckle tracking echocardiography has recently emerged as a quantitative ultrasound technique for accurately evaluating myocardial function by analyzing the motion of speckles identified on routine two dimensional sonograms. It provides non Doppler, angle independent and objective quantification of myocardial deformation and LV systolic and diastolic dynamics. By tracking the displacement of the speckles during the cardiac cycle, strain and the strain rate (SR) can be rapidly measured offline after adequate image acquisition (Ahmed et al., 2020). Aim of the work: Assessment of left ventricular function in B- Thalassemia patients using different echocardiographic modalities and determine the value of Speckle Tracking Echocardiography (STE) in early detection of myocardial affection. Methodology: a cross-sectional study that included 62 patients aged from 7 to 18 years ( 31 known Beta thalassemia Major child from hematology outpatient clinic & 31 control apparently healthy child) from pediatric Cardiology and Hematology units , Al Hussein University Hospital, Faculty of Medicine, Al Azhar University from September 2018 to October 2020 using different echocardiographic modalities. Results: the mean age was 10.32± 3.13 (range 7.0 to 16.0 ys), mean body surface area (BSA) 1.15 ± 0.26 m2 (range 0.70 to1.68 m2) with females representing 22.6% and males 77.4%. There was no affection in EF as the EF of the beta thalassemia group and control group were within normal ranges with mean EF in patients 65.32 ± 7.74% and mean EF 70.05 ± 5.8% in controls. There was a highly significant difference in Mitral E/A ratio with p value 0.003 between beta thalassemia group and control group also there was a highly significant difference between two groups regarding Myocardial performance index (Tei Index) with p value 0.013 using tissue Doppler imaging technique (TDI) denoting diastolic affection in beta thalassemia group. By performing 2D speckle tracking technique the global longitudinal strain (GLS) mean of the beta thalassemia was -17.72 ± 4.14 and the controls was -20.80 ± 2.69 with a highly significant difference between them with a p value 0.001 and the global circumferential strain (GCS) mean for the beta thalassemia group was -19.96 ± 6.20 and the mean of the control group was -23.42±6.15 with a highly significant difference between them with a p value 0.032 denoting early myocardial systolic and diastolic affection detection despite of the normal EF values. There was no significant correlation between serum ferritin level and EF, on the other hand there was highly significant correlation between serum ferritin with GLS with a p value 0.013and a highly significant correlation between serum ferritin and GCS with a p value 0.01, but there was no significant difference between patients that had serum ferritin <1500ng/ml and patients that had serum ferritin >1500ng/ml with GLS and GCS values indicating that all patient groups has GLS affection with different serum ferritin values making GLS calculation in all patient group is very important to be estimated for early detection of LV affection regardless the serum ferritin value. | ||||
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