Circulation, Vol 88, 1127-1135, Copyright © 1993 by American Heart Association
DT Kremastinos, DP Tsiapras, GA Tsetsos, EI Rentoukas, HP Vretou and PK Toutouzas
BACKGROUND. Diastolic left ventricular function expressed by diastolic
Doppler characteristics of the left ventricle has never been properly
investigated. METHODS AND RESULTS. Left ventricular inflow and pulmonary
vein flow patterns were assessed by Doppler echocardiography in 88
beta-thalassemia major patients with normal left ventricular systolic
function; 34 were young (age, 15.1 +/- 3.2 years) and 54 were adults (age,
25.1 +/- 3.6 years). The findings were compared with those obtained from 22
young (age, 13.8 +/- 2.4 years) and 24 adult (age, 25.3 +/- 4.1 years)
normal individuals. In both groups of patients, peak flow velocities in
early (E) and late (A) diastole were higher than in the control subjects
(young E: P < .01; adult E: P < .001; young A: P < .05; adult A: P
< .05), whereas no difference was found in the E/A ratio, deceleration
time, or isovolumic relaxation time. Pulmonary vein systolic (S) and
diastolic (D) velocities were also higher in beta-thalassemia major
patients compared with the control subjects (young S: P < .05; adult S:
P < .05; young D: P < .05; adult D: P < .05). Restrictive left
ventricular abnormalities were only found in 7 patients who were among the
oldest beta-thalassemia major population of the adult group (P < .01)
with highly elevated mean serum ferritin. In comparison to the remaining
adult patients, interventricular septum and left ventricular posterior wall
thickness were increased (P < .01 and P < .01, respectively). The
left atrium and right ventricle were dilated (P < .05 and P < .01,
respectively). CONCLUSIONS. Doppler diastolic indexes in beta-thalassemia
major patients with normal left ventricular systolic function are similar
to those seen in conditions with an increased preload, probably because of
chronic anemia. Only severe iron loading and deposition in the myocardium
leads to the restrictive abnormalities of left ventricular filling.
ARTICLES
Left ventricular diastolic Doppler characteristics in beta-thalassemia major
Cardiology Department, Athens General Hospital, University of Athens Greece Medical School.
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