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Echocardiographic evaluation of left atrial strain for predicting iron overload in pediatric patients with β-thalassemia with preserved ejection fraction

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Abstract

Pediatric patients with β-thalassemia (β-TM) with preserved ejection fraction may experience early myocardial damage. This prospective study aimed to investigate left atrial (LA) function restructure in pediatric patients with β-TM by two-dimensional speckle tracking echocardiography (2D-STE) and evaluate the value of LA strain for predicting myocardial iron overload (MIO). We recruited 50 β-TM pediatric patients and 30 healthy children aged 3–14 years. The patients were assigned to a normal left ventricular (LV) lesion group (n = 20) and an enlarged LV lesion group (n = 30). Subjects all underwent echocardiography to measure conventional cardiac function parameters and LA strain parameters. The results displayed that LA reservoir strain (LASr), conduit strain (LAScd), contractile strain (LASct) and strain rate were significantly reduced in pediatric patients with β-TM with preserved ejection fraction. LASr, LAScd, and LASct were negatively correlated with the E/e′ ratio, of which LASr had the most significant correlation (r = − 0.69, P < 0.001). LASr and LASct correlated positively with T2* (r = 0.70 and 0.62, respectively, all P < 0.001). In the multiple regression, LASr and LASct were independent predictors for T2*. The areas under the curve for LASr and LASct were 0.87 (P < 0.001) and 0.78 (P = 0.004), respectively. Our results demonstrated that LA strains were dramatically impaired in pediatric patients with β-TM, and LASr is an efficient indicator for detecting LV early diastolic dysfunction in β-TM pediatric patients and reflects early myocardial damage. LASr and LASct were independently predictive of MIO, but LASr was a more sensitive predictor.

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Acknowledgements

The authors would like to thank the study staff and the participants involved with the project.

Funding

This project was supported by a scholarship from the National Natural Science Foundation of China (Grant No. 82060051), the Project of Medical and Health Appropriate Technology Development and Promotion Application of Guangxi (Grant No. S2020030), the Precision Medicine Foundation of Guangxi Key Laboratory in Cardio-cerebrovascular Disease (Grant No. GXXNXG202001), the “139” Program for Training High-level Backbone Talents of Guangxi Medical (Grant No. G201903053) and the Training Project for One Thousand Young and Middle-aged Backbone Teachers in Guangxi.

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Authors and Affiliations

  1. Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China

    Shao-Lin Luo, Yan Deng, Wei-Fang Lan, Yi-Hong Yang & Ping Dai

  2. Department of Echocardiography of Cardiovascular Disease Institute, The First Affiliated Hospital of Guangxi Medical University, 6 Shuang yong Road, 530021, Nanning, China

    Yan Deng

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Contributions

S-LL and YD designed the research. S-LL, W-FL, Y-HY and PD collected the data. S-LL conducted the data analyses and composed the thesis.

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Correspondence to Yan Deng.

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All study projects were completed with informed consent from all participants and their parents, and this protocol was authorized by the Human Research Ethics Committee of Guangxi Medical University.

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Luo, SL., Deng, Y., Lan, WF. et al. Echocardiographic evaluation of left atrial strain for predicting iron overload in pediatric patients with β-thalassemia with preserved ejection fraction. Int J Cardiovasc Imaging 39, 895–906 (2023). https://doi.org/10.1007/s10554-022-02788-5

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