Left Atrial Strain Identifies Increased Atrial Ectopy in Patients with Beta-Thalassemia Major

Maria Vlachou; Vasileios Kamperidis; Efthymia Vlachaki; Georgios Tziatzios; Despoina Pantelidou; Afroditi Boutou; Chrysa Apostolou; Despoina Papadopoulou; George Giannakoulas; Haralambos Karvounis

doi:10.3390/diagnostics11010001

Left Atrial Strain Identifies Increased Atrial Ectopy in Patients with Beta-Thalassemia Major

Diagnostics (Basel). 2020 Dec 22;11(1):1. doi: 10.3390/diagnostics11010001.

Affiliations

¹ 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece.
² Thalassaemia Unit, Ippokratio University Hospital, 54642 Thessaloniki, Greece.
³ Thalassaemia Unit, AHEPA University Hospital, 54621 Thessaloniki, Greece.
⁴ Pulmonary Department, Papanikolaou Hospital, 57010 Thessaloniki, Greece.

Abstract

Patients with beta-thalassemia major (β-ΤΜ) may develop cardiac arrhythmias through a multifactorial mechanism. The current study evaluated the association of cardiac structure and function on echocardiography with atrial ectopic burden on 24-hour tape recording in β-ΤΜ patients. This prospective study included consecutive β-ΤΜ patients. Demographic, laboratory, echocardiographic, cardiac magnetic resonance (CMR) T2* and 24-hour tape recording data were prospectively collected. The patients were classified according to the median value of premature atrial contractions (PACs) on 24-hour tape. In total, 50 β-TM patients (37.6 ± 9.1 years old, 50% male) were divided in 2 groups; PACs ≤ 24/day and > 24/day. Patients with PACs > 24/day were treated with blood transfusion for a longer period of time (39.0 ± 8.6 vs. 32.0 ± 8.9 years, p < 0.007), compared to their counterparts. Older age (OR: 1.121, 95% CI: 1.032-1.217, p = 0.007), longer duration of blood transfusion (OR:1.101, 95% CI:1.019-1.188, p = 0.014), larger LV end-diastolic diameter (OR: 4.522, 95% CI:1.009-20.280, p = 0.049), higher values of LA peak systolic strain (OR: 0.869, 95% CI: 0.783-0.964, p = 0.008), higher MV E/E' average (OR: 1.407, 95% CI: 1.028-1.926, p = 0.033) and higher right ventricular systolic pressure (OR: 1.147, 95% CI: 1.039-1.266, p = 0.006) were univariably associated with PACs > 24/day. LA peak systolic strain remained significantly associated with PACs > 24/day after adjusting for the duration of blood transfusions or for CMR T2*. The multivariable model including blood transfusion duration and LA peak systolic strain was the most closely associated with PACs > 24/day. Receiver operating characteristic curve analysis identified a left atrial peak systolic strain of 31.5%, as the best cut-off value (83% sensitivity, 68% specificity) for prediction of PACs > 24/day. In β-TM patients, LA peak systolic strain was associated with the atrial arrhythmia burden independently to the duration of blood transfusions and CMR T2*.

Keywords: arrhythmia; beta-thalassemia major; left atrial strain; premature atrial contractions.