Assessment of diastolic function in children and adolescents with beta thalassemia major by tissue Doppler imaging

Yıl 2011, , 26 - 32, 01.03.2011

Taner Yavuz Türkan Ertuğrul Zafer Şalcıoğlu Gönül Aydoğan

https://doi.org/10.4274/tpa.46.05

Öz

Aim: First degree relatives of patients who have had an acute myocardial infarction prior to age of 55 years have 2 7 times the risk that their peers have The aim of this study was to investigate some haemostatic and inflammatory markers in children whose parents had early onset lt;55 years coronary artery disease CAD and whether those markers were effective to show CAD risk

Anahtar Kelimeler

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Beta talasemi majorlu çocuk ve ergenlerde doku Doppler yöntemiyle diyastolik işlevlerin değerlendirilmesi

Öz

Amaç: Bu çal›flmada belirgin kardiyomiyopati tablosu geliflmemifl beta talasemi majorlu çocuk ve ergenlerde doku Doppler yöntemi ile miyokard›n diyastolik ifllevlerini incelemek ve bu verileri geleneksel Doppler verileri ile karfl›laflt›rmak amaçland›.

Gereç ve Yöntem: Sol ventrikül sistolik ifllevleri normal olan 61 beta talasemi major olgusu (4-20 yafl, ortalama: 10,7±4,1 y›l; 32 k›z, 29 erkek) ile yafl ve cinsiyet aç›s›ndan hasta grubu ile uyumlu 52 kontrol olgusu çal›flmaya al›nd›. Hasta ve kontrol grubunda M-mode ekokardiyografi, sol ventrikülün sistolik ifllevi ölçüldü; sa¤ ve sol ventrikülün diyastolik ifllevleri doku Doppler ve geleneksel Doppler tekni¤i ile de¤erlendirildi. ‹statistik analizler SPSS for Windows 13.0 program› kullan›larak yap›ld›, veriler student-t testi ile karfl›laflt›r›ld›. Bu çal›flma ‹stanbul T›p Fakültesi Etik Komitesi’nce onayland›.

Bulgular: Hasta grubunda vücut yüzey alan› (1,0±0,2 m2) kontrol grubundan (1,2±0,3 m2) daha küçük idi p<0,01). Hastalar›n trans-mitral erken ak›m zirve h›z› ve erken ak›m zirve h›z›n›n geç ak›m zirve h›z›na oran› kontrollerden anlaml› olarak yüksek saptand› (s›ras›yla p<0,01 ve p=0,039). Mitral kapak geç ak›m zirve h›z› ve tüm triküspit kapak Doppler ak›m h›zlar› gruplar aras›nda farkl›l›k göstermedi (p>0,05). Beta talasemi major hastalar›n›n miyokard erken diyastolik ak›m h›zlar› sa¤ ventrikül ve sol ventrikül bazalinde, sa¤ ventrikül, sol ventrikül ve interventrikül septumun orta segmentinde kontrolden yüksek bulundu (p<0,05). Geç diyastolik ak›m h›zlar› sa¤ ventrikül bazal ve orta segmentlerde, Erken ve geç diyastolik ak›m oran› ise sa¤ ventrikül bazal ve sa¤ ventrikül, sol ventrikül ve interventrikül orta segmentlerde kontrolden anlaml› yüksek bulundu (p<0,05).

Çıkarımlar: Normal ventrikül sistolik ifllevleri olan genç yafltaki beta talasemi major hastalar›ndan edinilen bu bulgular, gerçek ventrikül restriksiyonundan ziyade kronik anemiye ba¤l› hiperdinamik yan›t ve yüklenmeyi düflündürmektedir. Doku Doppler ile beta talasemi major hastalar›n›n uzun süreli izlemlerini içeren çal›flmalar›n yap›lmas› ile, doku Doppler görüntülemenin bu hasta grubunda kalbin erken etkilenmesini yans›tmadaki güvenilirli¤inin de¤erlendirilebilece¤i kan›s›nday›z. (Türk Ped Arfl 2011; 46: 26-32) 

Anahtar Kelimeler

Beta-talasemi, diyastolik kalp yetersizliği, doku Doppler görüntüleme, ekokardiyografi, kardiyomiyopati, konjestif kalp yetersizliği

Kaynakça

• Zurlo MG, De Stefano P, Borgna-Pignatti C, et al. Survival and causes of death in thalassaemia major. Lancet 1989; 2: 27-30. (Abstract) / (PDF)
• Aldouri MA, Hoffbrand AV, Flynn DM, et al. High incidence of cardiomyopathy in beta-thalassaemia patients receiving regu- lar transfusion and iron chelation: reversal by intensified chela- tion. Acta Haematol 1990; 84: 113-7. (Abstract)
• Nienhuis AW, Griffith P, Strawczynski H, et al. Evaluation of cardiac function in patients with thalassaemia major. Ann N Y Acad Sci 1980; 344: 384-96. (Abstract) / (PDF)
• Fitchett DH, Coltart DJ, Littler WA, et al. Cardiac involvement in secondary haemochromatosis: a catheter biopsy study and analysis of myocardium. Cardiovasc Res 1980; 14: 719-24. (Abstract)
• Oki T, Tabata T, Yamada H, et al. Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation. Am J Cardiol 1997; 79: 921-8. (Abstract) / (Full Text) / (PDF)
• Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiog- raphy applications for the study of diastolic function. J Am Coll Cardiol 1998; 32: 865-75. (Abstract) / (PDF)
• Koyama J, Ray-Sequin PA, Davidoff R, Falk RH. Usefulness of pulsed tissue Doppler imaging for evaluating systolic and diastolic left ventricular function in patients with AL (primary) amyloidosis. Am J Cardiol 2002; 89: 1067-71. (Abstract) / (Full Text) / (PDF)
• Tekten T, Onbasılı AO, Ceyhan C, Unal S, Discigil B. Value of measuring myocardial performance index by tissue Doppler echocardiography in normal and diseased heart. Jpn Heart J 2003; 44: 403-16. (Abstract
• Yılmaz M, Erol MK, Acikel M, Sevimli S, Alp N. Pulsed Doppler tissue imaging can help to identify patients with right ventricular infarction. Heart Vessels 2003; 18: 112-6. (Abstract) / (PDF)
• Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 1989; 2: 358-67. (Abstract)
• Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7: 79-108. (Abstract)
• Lai WW, Geva T, Shirali GS, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the task of the pediatric council of the American Society of Echocardiography. J Am Soc Echocardiogr 2006; 19: 1413-30. (Abstract) / (Full Text) / (PDF)
• Kapusta L, Thijssen JM, Cuypers MHM, Peer PGM, Daniels O. Assessment of myocardial velocities in healthy children using tissues Doppler imaging. Ultrasound Med Biol 2000; 26: 229-37. (Abstract) / (Full Text) / (PDF)
• Engle MA, Erlandson M, Smith CH. Late cardiac complications of chronic, severe refractory anemia with hemochromatosis. Circulation 1964; 30: 698-705. (Abstract)
• Kremastinos DT, Tsetsos GA, Tsiapras DP, Karavolias GK, Ladis VA, Kattamis CA. Heart failure in beta-thalassemia: a 5-year follow-up study. Am J Med 2001; 111: 349-54. (Abstract) / (Full Text) / (PDF)
• Cohen AR, Galanello R, Pennell DJ, Cunningham MJ, Vichinsky E. Thalassemia. Hematology Am Soc Hematol Educ Program 2004; 14-34.
• Davis BA, O’Sullivan C, Jarritt PH, Porter JB. Value of sequential monitoring of left ventricular ejection fraction in the management of thalassemia major. Blood 2004; 104: 263-9. (Abstract)
• Vogel M, Anderson LJ, Holden S, Deanfield JE, Pennell DJ, Walker JM. Tissue Doppler echocardiography in patients with thalassaemia detects early myocardial dysfunction related to myocardial iron overload. Eur Heart J 2003; 24: 113-9. (Abstract) / (Full Text) / (PDF)
• Magri D, Sciomer S, Fedele F, et al. Early impairment of myocardial function in young patients with beta thalassemia major. Eur J Haematol 2008; 80: 515-22. (Abstract) / (PDF)
• Hamdy AM, Zein El-Abdin MY, Abdel-Hafez MA. Right ventricular function in patients with beta thalassemia: relation to serum ferritin level. Echocardiography 2007; 24: 795-801. (Abstract) / (PDF)
• Silvilairat S, Sittiwangkul R, Pongprot Y, Charoenkwan P, Phornphutkul C. Tissue Doppler echocardiography reliably reflects severity of iron overload in pediatric patients with beta thalassemia. Eur J Echocardiogr 2008; 9: 368-72. (Abstract) / (Full Text) / (PDF)
• Iarussi D, Di Salvo G, Pergola V, et al. Pulsed Doppler tissue imaging and myocardial function in thalassemia major. Heart Vessels 2003; 18: 1-6. (Abstract) / (PDF)
• Anderson L, Holden S, Davis B, et al. Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J 2001; 22: 2171-9. (Abstract) / (PDF)
• Spirito P, Lupi G, Melevendi C, Vecchio C. Restrictive diastolic abnormalities identified by Doppler echocardiog- raphy in patients with thalassemia major. Circulation 1990; 82: 88-94. (Abstract) / (PDF)
• Karvounis HI, Zaglavara TA, Parharidis GE, et al. An angiotensin- converting enzyme inhibitors improve left ventricular systolic and diastolic in transfusion-dependent patients with beta-thalassemia major. Am Heart J 2001; 141: 281. (Abstract) / (Full Text) / (PDF)
• Hahalis G, Manolis AS, Apostolopoulos D, Alexopoulos D, Vagenakis AG, Zoumbos NC. Right ventricular cardiomyo- pathy in beta-thalassemia major. Eur Heart J 2002; 23: 147-56. (Abstract)
• Kremastinos DT, Tsiapras DP, Tsetsos GA, Rentoukas EI, Vretou HP, Toutouzas PK. Left ventricular diastolic Doppler characteristics in beta-thalassemia major. Circulation 1993; 88: 1127-35. (Abstract) / (PDF)
• Cheung YF, Chan GC, Ha SY. Arterial stiffness and endoth elial function in patients with beta-thalassemia major. Circula- tion 2002; 106: 2561-6.(Abstract) / (Full Text) / (PDF)
• Kremastinos DT, Rentoukas E, Mavrogeni S, Kyriakides ZS, Politis C, Toutouzas P. Left ventricular filling pattern in beta- thalassaemia major-a Doppler echocardiographic study. Eur Heart J 1993; 14: 351-7. (Abstract) / (PDF)
• Sohn DW, Chai IH, Lee DJ, et al. Assesment of mitral annulus velocity by Doppler tissue imaging in the evaluatin of left ventricular diastolic function. J Am Coll Cardiol 1997; 30: 474-80. (Abstract) / (PDF)
• Anand IS, Chandrashekhar Y, Ferrari R, Poole-Wilson PA, Haris PC. Pathogenesis of oedema in chronic severe anaemia: studies of body water and sodium, renal function, haemodynamic variables, and plasma hormones. Br Heart J 1993; 70: 352-62. (Abstract)
• Hahalis G, Manolis AS, Gerasimidou I, et al. Right ventricular diastolic function in beta-thalassemia major: echocardiograp- hic and clinical correlates. Am Heart J 2001; 141: 428-34. (Abstract) / (Full Text) / (PDF)
• Grisaru D, Rachmilewitz EA, Mosseri M, et al. Cardiopulmonary assessment in beta-thalassemia major. Chest 1990; 98: 1138-42. (Abstract) / (PDF)
• Du ZD, Roguin N, Milgram E, Saab K, Koren A. Pulmonary hypertension in patients with thalassemia major. Am Heart J 1997; 134: 532-7. (Abstract) / (Full Text) / (PDF)
• Olson LJ, Edwards WD, McCall JT, Ilstrup DM, Gersh BJ. Cardiac iron deposition in idiopathic hemochromatosis: histo- logic and analytic assessment of 14 hearts from autopsy. J Am Coll Cardiol 1987; 10: 1239-43. (Abstract)
• Mishiro Y, Oki T, Yamada H, et al. Use of angiotensin II stress pulsed tissue Doppler imaging to evaluate regional left ventricular contractility in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 2000; 13: 1065-73. (Abstract) / (Full Text) / (PDF)
• Yilmaz R, Baykan M, Erdol C. Pulsed wave doku Doppler ekokardiyografi. Anadolu Kardiyol Derg 2003; 3: 54-9. (PDF)
• Galiuto L, Ignone G, DeMaria AN. Contraction and relaxation velocities of the normal left ventricle using pulsed-wave tissue Doppler echocardiography. Am J Cardi0ol 1998; 81: 609-14. (Abstract) / (Full Text