Subclinical cardiac dysfunction in transfusion-dependent beta-thalassemia children, an experience from central India: A comparative cross-sectional study.

Abstract

Background: Cardiac complications are the leading cause of mortality in children with transfusion-dependent beta-thalassemia (TDT). Tissue Doppler imaging (TDI) is a readily available, noninvasive technique used to detect subclinical cardiac dysfunction by deriving the Tei index.

Objective: The objective of this study was to determine subclinical cardiac dysfunction in children with TDT and correlate findings with serum ferritin levels.

Materials and methods: This comparative cross-sectional study was conducted at a tertiary care institute in Central India. The study included 50 children with TDT (aged 2-18 years) as cases and 50 age-and sex-matched outpatient children with minor illnesses as controls, selected via simple random sampling over 1 year. Demographic, clinical, transfusion, and anthropometric data were collected. Hematological and biochemical investigations, along with electrocardiography, were performed. Conventional two dimensional echocardiography and TDI were conducted using an ALPINION 5 color Doppler system. M-mode, B-mode, and Doppler parameters were measured per American Society of Echocardiography guidelines. Statistical analysis utilized Chi-square, independent t-tests, and Pearson correlation coefficients (P < 0.05 was considered significant).

Results: Demographic variables were comparable between groups. However, the body mass index was significantly lower, and systolic blood pressure was significantly higher in cases than in controls. While 36% of cases were sero-reactive to Hepatitis C, all participants were negative for hepatitis B surface antigen and human immunodeficiency virus. Hemoglobin was significantly lower, whereas serum ferritin and cardiothoracic ratios were significantly higher in cases. Conventional echocardiography revealed significantly larger left ventricular internal diameter at end-diastole, mitral annular plane systolic excursion, and left atrial diameters in cases. Notably, both left and right ventricular Tei indices were significantly higher in cases compared to controls (P < 0.0001). Serum ferritin (r = 0.32) and systolic blood pressure (r = 0.29) had significant positive correlation with left ventricular Tei index.

Conclusion: Children with TDT exhibit latent systolic and diastolic dysfunction as evidenced by TDI. This highlights the critical importance of identifying asymptomatic cardiac dysfunction in children and adolescents to prevent cardiac-related mortality.