Speckle tracking echocardiography and & beta;-thalassemia major. A systematic review

Heart disease is among the primary causes of morbidity and mortality in & beta;-thalassemia major (& beta;-TM). Conventional echocardiography has failed to identify myocardial dysfunction at an early stage among these patients, thus speckle tracking echocardiography (STE) has been lately used. The objectives of this review were to 1) identify all published studies having evaluated myocardial strain among & beta;-TM patients, 2) gather their results, 3) compare their findings and 4) propose recommendations based on these data. Literature search was conducted in PubMed, SCOPUS and Cohrane Library. Data regarding left ventricular global longitudinal (LV-GLS), circumferential (LV-GCS) and radial strain (LV-GRS), right ventricular longitudinal strain (RV-GLS), left and right atrial strain were extracted. Thirty-five studies (34 original articles and 1 meta-analysis) have met the inclusion criteria. LV-GLS has been reported being worse in patients compared to controls in 13 of 21 studies, LV-GCS in 7 of 11 studies, LV-GRS in 6 of 7 studies, RV-GLS in 2 of 3 studies and left atrial strain in all case-control studies. Myocardial iron overload (MIO) patient subgroups had worse LV-GLS in 6 of 15 studies, LV-GCS in 2 of 7 studies and LV-GRS in none of 7 studies. A small number of studies suggest left atrial strain correlation with electrical atrial ectopy and atrial fibrillation. It is suggested that STE should be applied supplementary to conventional echocardiography for early identification of myocardial dysfunction among & beta;-TM patients. Potential myocardial strain utilities could be screening for myocardial iron overload, left ventricular diastolic dysfunction and atrial fibrillation.

Automated summary

Heart disease is a leading cause of morbidity and mortality in β-thalassemia major (β-TM) patients. Speckle tracking echocardiography (STE) has been used to identify myocardial dysfunction at an early stage. This review aims to gather and compare results from published studies evaluating myocardial strain in β-TM patients and propose recommendations based on these data. Thirty-five studies met the inclusion criteria and showed that myocardial strain was worse in β-TM patients compared to controls, indicating the potential utility of STE in early identification of myocardial dysfunction and screening for other cardiac conditions in β-TM patients.