Diastolic Function in Young Patients with Beta‐Thalassemia Major: An Echocardiographic Study

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Abstract
Objective: We aimed to evaluate myocardial diastolic function in patients with beta‐thalassemia major (β‐TM) using pulsed‐tissue Doppler imaging (TDI) and flow propagation (VP), in relation to BNP levels. Methods: We enrolled 192 consecutive patients with β‐TM (88 men (25 ± 6 years) and 104 women (26 ± 6 years), with normal left ventricular (LV) systolic function. By TDI, diastolic myocardial velocities were sampled at the lateral section of the mitral annulus (Smv, Emv, Amv). From the apical four‐chamber view diastolic transmitral flow velocities, including measures of E‐ and A‐waves were performed. The propagation velocity of early flow into the LV cavity was measured by color M‐mode Doppler. Plasma BNP levels were measured in all patients. Results: A nonlinear relationship was found between BNP levels and E/A ratio (beta coefficient for the second‐order term = 1.4 ± 0.4, P = 0.001). We also found a positive association of BNP levels with Amv (r = 0.28, P = 0.023), and a reverse with Smv (r =−0.59, P = 0.01) and Emv/Amv (r =−0.36, P = 0.019). Moreover, an inverse relationship was observed between BNP and Vp (r =−0.43, P = 0.012) levels. Finally, a strong positive linear relationship was found between E/Vp ratio and BNP levels (r = 0.76, P < 0.001). Conclusion: A U‐curved association of E/A ratio of transmitral Doppler velocity was revealed with BNP levels, while the tissue Doppler of the Emv/Amv of the mitral annulus movement showed a negative linear association with BNP levels.

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