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Evaluation of electrocardiographic markers of cardiac arrhythmic events and their correlation with cardiac iron overload in patients with β-thalassemia major

Published online by Cambridge University Press:  04 September 2020

Tulay Demircan Open the ORCID record for Tulay Demircan [Opens in a new window] ,
Zuhal Onder Sivis ,
Burçak Tatlı Güneş  and
Cem Karadeniz Open the ORCID record for Cem Karadeniz [Opens in a new window]
Tulay Demircan*
Affiliation:
Department of Pediatric Cardiology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
Zuhal Onder Sivis
Affiliation:
Department of Pediatric Hematology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
Burçak Tatlı Güneş
Affiliation:
Department of Pediatric Hematology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
Cem Karadeniz
Affiliation:
Department of Pediatric Cardiology Unit, Izmir Katip Celebi University, Izmir, Turkey
*
Author for correspondence: Tulay Demircan, Department of Pediatric Cardiology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey. Tel: +90 505 753 87 60; Fax: 0232 433 07 56. E-mail: tulay.sirin@hotmail.com
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Abstract

Iron overload is associated with an increased risk of atrial and ventricular arrhythmias. Data regarding the relationship between electrocardiographic parameters of atrial depolarisation and ventricular repolarisation with cardiac T2* MRI are scarce. Therefore, we aimed to investigate these electrocardiographic parameters and their relationship with cardiac T2* value in patients with β-thalassemia major. In this prospective study, 52 patients with β-thalassemia major and 52 age- and gender-matched healthy patients were included. Electrocardiographic measurements of QT, T peak to end interval, and P wave intervals were performed by one cardiologist who was blind to patients’ data. All patients underwent MRI for cardiac T2* evaluation. Cardiac T2* scores less than 20 ms were considered as iron overload. P wave dispersion, QTc interval, and the dispersions of QT and QTc were significantly prolonged in β-thalassemia major patients compared to controls. Interestingly, we found prolonged P waves, QT and T peak to end dispersions, T peak to end intervals, and increased T peak to end/QT ratios in patients with T2* greater than 20 ms. No significant correlation was observed between electrocardiographic parameters and cardiac T2* values and plasma ferritin levels. In conclusion, our study demonstrated that atrial depolarisation and ventricular repolarisation parameters are affected in β-thalassemia major patients and that these parameters are not correlated with cardiac iron load.

Keywords

Thalassemiairon overloadred blood cellselectrocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 11 , November 2020 , pp. 1666 - 1671
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Flint, J, Harding, RM, Boyce, AJ, Clegg, JB. The population genetics of the haemoglobinopathies. Baillieres Clin Haematol 1998; 11: 1–51.CrossRefGoogle ScholarPubMed
Olivieri, NF. The beta-thalassemias. N Engl J Med 1999; 341: 99–109.CrossRefGoogle ScholarPubMed
Kyriacou, K, Michaelides, Y, Senkus, R, Simamonian, K, et al. Ultrastructural pathology of the heart in patients with beta-thalassaemia major. Ultrastruct Pathol 2000; 24: 75–81.CrossRefGoogle ScholarPubMed
Modell, B, Khan, M, Darlison, M. Survival in beta-thalassaemia major in the UK: data from the UK Thalassaemia Register. Lancet 2000; 355: 2051–2052.CrossRefGoogle ScholarPubMed
Russo, V, Rago, A, Pannone, B, et al. Dispersion of repolarization and beta-thalassemia major: the prognostic role of QT and JT dispersion for identifying the high-risk patients for sudden death. Eur J Haematol 2011; 86: 324–331.CrossRefGoogle ScholarPubMed
Russo, V, Rago, A, Pannone, B, et al. Early electrocardiographic evaluation of atrial fibrillation risk in beta-thalassemia major patients. Int J Hematol. 2011;93: 446–451 CrossRefGoogle ScholarPubMed
Dilaveris, PE, Gialafos, EJ, Sideris, SK ,et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998; 135 (Pt 1): 733–738.CrossRefGoogle ScholarPubMed
Gupta, P, Patel, C, Patel, H, et al. T(p-e)/QT ratio as an index of arrhythmo-genesis. J Electrocardiol. 2008; 41: 567–574.CrossRefGoogle Scholar
Anderson, LJ, 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 (23): 2171–2179.CrossRefGoogle ScholarPubMed
Westwood, MA, Wonke, B, Maceira, AM, et al. Left ventricular diastolic function compared with T2* cardiovascular magnetic resonance for early detection of myocardial iron overload in thalassemia major. J Magn Reson Imag 2005; 22: 229–233.CrossRefGoogle Scholar
Kayrak, M, Acar, K, Gul, EE, et al. The association between myocardial iron load and ventricular repolarization parameters in asymptomatic beta-thalassemia patients. Advances in Hematology 2012; 5: 15.Google Scholar
Karadeniz, C, Özdemir, R, Demirol, M, et al. Low iron stores in otherwise healthy children affect electrocardiographic markers of important cardiac events. Pediatr Cardiol 2017; 38: 909–914.CrossRefGoogle ScholarPubMed
Bazett, H. An analysis of the time-relations of electrocardio-grams. Heart 1920; 7: 353–370.Google Scholar
Rudski, LG, Lai, WW, Afilalo, J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23: 685–713.CrossRefGoogle Scholar
Teichholz, LE, Cohen, MV, Sonnenblick, EH, Gorlin, R. Study of left ventricular geometry and function by B scan ultrasonography in patients with and without asynergy. N Engl J Med 1974; 291 (23): 1220–1226.CrossRefGoogle Scholar
Murphy, CJ, Oudit, GY. Iron-overload cardiomyopathy: pathophysiology, diagnosis, and treatment. J Card Fail 2010; 16: 888–900.CrossRefGoogle ScholarPubMed
Ulger, Z, Aydinok, Y, Levent, E, Gurses, D, Ozyurek, AR. Evaluation of QT dispersion in beta thalassemia major patients. Am J Hematol 2006; 81 (12): 901–906.CrossRefGoogle Scholar
Schellhammer, PF, Engle, MA, Hagstrom, JW. Histochemical studies of the myocardium and conduction system in acquired iron-storage disease. Circulation 1967; 35: 631–637.CrossRefGoogle ScholarPubMed
Kuryshev, YA, Brittenham, GM, Fujioka, H, et al. Decreased sodium and increased transient outward potassium currents in iron-loaded cardiac myocytes. Implications for the arrhythmogenesis of human siderotic heart disease. Circulation 1999; 100: 675–683.CrossRefGoogle ScholarPubMed
Ozer, N, Aytemir, K, Atalar, E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000; 23: 1109–1112.CrossRefGoogle ScholarPubMed
Acar, K, Kayrak, M, Gul, EE, Abdulhalikov, T, Özbek, O, Uçar, R. Cardiac iron load and novel P-Wave measurements in patients with Thalassemia Major. Eur J Gen Med 2012; 9: 45–51.Google Scholar
Magrì, D, Sciomer, S, Fedele, F, et al. Increased QT variability in young asymptomatic patients with beta-thalassemia major. Eur J Haematol 2007; 79: 322–329.CrossRefGoogle ScholarPubMed
Garadah, TS, Kassab, S, Mahdi, N, Abu-Taleb, A, Jamsheer, A. QTc Interval and QT dispersion in patients with Thalassemia Major: electrocardiographic (EKG) and Echocardiographic Evaluation. Clin Med Insights Cardiol 2010; 4: 31–37.CrossRefGoogle ScholarPubMed
Kors, JA, Ritsema, HJ, Van Herpen, G The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol 2008; 41: 575–580.CrossRefGoogle ScholarPubMed
Castro Hevia, J, Antzelevitch, C, Tornés Bárzaga, F, et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol 2006; 47: 1828–1834.CrossRefGoogle ScholarPubMed
Shimizu, M, Ino, H, Okeie, K, et al. T-peak to T-end interval may be a better predictor of high-risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clin Cardiol 2002; 25: 335–339.CrossRefGoogle ScholarPubMed