CARDIAC ABNORMALITIES IN TRANSFUSION DEPENDENT BETA THALASSEMIA CHILDREN

Dr. Vaibhav Kashinath Gode; Dr. Shakutala S Prabhu; Dr. Sumitra Venkatesh

Volume : VI, Issue : IX, September - 2017

CARDIAC ABNORMALITIES IN TRANSFUSION DEPENDENT BETA THALASSEMIA CHILDREN

Dr. Vaibhav Kashinath Gode, Dr. Shakutala S Prabhu, Dr. Sumitra Venkatesh

Abstract :

Objectives: To note spectrum of cardiac abnormalities in transfusion dependent β-thalassemia children by clinical and echocardiographic evaluation and to correlate its severity with serum ferritin levels.

Methods: 100 thalassemic children who received >50 blood transfusions and had serum ferritin level >2500 ng/ml were included. Detailed medical history, anthropometry, transfusion details, examination including cardiovascular system were noted. Echocardiogram, Colour Doppler and Tissue Doppler Imaging (TDI) were done to assess cardiac functions. Cardiac dimensions, functions, mass and index were assessed by standard Echocardiographic techniques and were compared to paediatric norms. TDI was performed to assess myocardial involvement.

Results: Cardiac symptoms were largely subclinical. 13 children had tachycardia and 10 were hypertensive. 8/100 had left ventricular dilatation. 85 children had diastolic dysfunction which was seen more in children with Hb <8 g/dL, increasing years of transfusion therapy and increasing ferritin levels (p value: 0.042). 13/100 children had systolic dysfunction. There was a significant correlation between age and systolic dysfunction (p value: 0.017). 32 children had a high cardiac output. There was a significant correlation between increasing serum ferritin levels and TDI abnormalities (p value: 0.006). 45 children had right ventricular dysfunction. There was significant correlation between age and right ventricle dysfunction (p value: 0.028).

Conclusion: Cardiovascular manifestations remain predominantly silent in thalassemic children. On Echocardiographic evaluation, LV dilatation, LV diastolic and systolic dysfunctions, impaired myocardial performance, increased cardiac output, moderate TR and RV dysfunction were the various findings. LV diastolic dysfunction was more common than systolic dysfunction and was noted more in children with longer duration of transfusion therapy and high serum ferritin levels. TDI complimented the conventional echocardiography in diagnosing diastolic dysfunction.