Monte IP, Buccheri S, Leggio S. (May 2015). Echocardiographic predictors of adverse cardiac events in asymptomatic beta thalassemic patients. Jour of Med Sc & Tech; 4(2); Page No: 108 – 116. J Med. Sci. Tech. Volume 4. Issue 2 ISSN: 1694-1217 JMST. An open access journal © RA Publications Page108 Journal of Medical Science & Technology Original Article Open Access Echocardiographic predictors of adverse cardiac events in asymptomatic beta- thalassemic patients Ines Paola Monte 1 , Sergio Buccheri 2 , Stefano Leggio 3 . University of Catania, Catania. Abstract Aim of study was to identify echocardiographic parameters related to the development of future adverse events (AEs) in asymptomatic thalassemic patients (TM). A total of 74 TM patients (TM group) and 22 healthy subjects (HS group) were included in the study. All subjects underwent standard echocardiography with Tissue Doppler Imaging (TDI). The follow up was for 974 ± 275 days. When compared to HS, TM showed a significant increase of LV Mass index (LVMi), diastolic (LVEDV) and systolic (LVESV) volume (p=0.001, p=0.001 and p=0.023, respectively). TDI analysis identified a significant impairment of S’, E’ and A’ wave mean values (p<0.001, p<0.001 and p=0.002 respectively). Left atrial volume index and the E/E’ ratio were significantly increased in TM (p<0.001). LV ejection fraction was preserved. At follow up, 10 AEs were observed in TM: one death from cardiac cause, 6 patients developing heart failure, 3 new detected supra-ventricular arrhythmias. In TM, ROC curve analysis identified LVEDV>122 ml, LVESV >46 ml, LVMi >82.1 g/m 2 , E/A ratio>2.09, S’ wave< 6.2 cm/sec, E’ wave< 10 cm/sec, A’ wave< 5 cm/sec and E/E’ ratio >7.82 as cut off-values differentiating TM patients with AEs. On multivariate logistic regression analysis, the E/E’ ratio (Exp (B) = 1.623, p=0.038) and the A’ velocity (Exp (B)=0.509, p=0.044) were independent predictors of AEs at follow up. The TDI derived parameters are useful for the prognostic stratification of asymptomatic TM and easy to use. Early identification of subclinical myocardial dysfunction based on these parameters could be useful for the optimization of therapeutic strategies and correct risk stratification. Keywords: Beta-thalassemic patients; Cardiac dysfunction; Tissue Doppler *Corresponding Author: Prof. Ines Monte, Clinical Echocardiography, A.O.U. Policlinic VE – PO G.Rodolico, Via Santa Sofia 78 – 95100 Catania. Telephone: +39 095 3781308, Email: inemonte@unict.it Received: February 2, 2014 Accepted: February 28, 2015. Published: May 20, 2015. This is an open- access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Beta-thalassemia is an inherited blood disorder characterized by a combination of ineffective erythropoiesis and haemolytic anaemia secondary to impaired haemoglobin beta-chain output [1]. These features are responsible for a severe anaemic status incompatible with life and for this reason patients require periodic blood transfusions. Each transfusion is responsible for an estimated iron over-load of 0.3-0.5 mg/kg/d 2 that combined with increased iron absorption in the intestinal tract lead to secondary hemochromatosis [2]. This process can affect different organs including the liver, pancreas, gonads and hypothesis but cardiac dysfunction secondary to chronic iron overload and high output state actually represents the leading cause of mortality and morbidity in thalassemic patients [3]. Echocardiography is a fundamental tool for the close follow up that this group of patients requires. Even if quantification if myocardial iron overload by means of cardiac magnetic resonance imaging (MRI) represents the gold standard for the identification of myocardial iron burden. However, the risk of gadolinium contrast reactions using MRI and against low costs and the wide availability of echocardiography, are features favouring echocardiography routinely clinical use.