P-Wave and QT Dispersion in Children With βeta-Thalassemia

Main Article Content

Marwa Salama
Shimaa El-Nemr
Ibrahim Badraia
Amr Zoair

Abstract

Aim: This study aimed at assessing P-wave and QT interval dispersion in children with β-thalassemia and to correlate them with various laboratory and echocardiographic data.

Methodology: Subjects comprised of 30   children with β-thalassemia major as the patient group. 30 healthy children matched for age and sex served as the control group. All patients were evaluated clinically as well as by echocardiography and 12 leads ECG. The type of study is prospective case control study.

Results: There was a statistically significant increase of Interventricular Septal end diastole (IVSd), Interventricular Septal end systole (IVSs), Left Ventricular Internal Diameter end diastole (LVIDd), Left Ventricular Internal Diameter end systole (LVIDs) and Left Ventricular Posterior Wall end diastole (LVPWd) in patients as compared to controls (Mean ±SD = 0.950±0.166, 0.863±0.103, 3.983±0.456, 2.947±0.535a nd 0.797±0.165 respectively) (P < 0.05). Moreover, there were a significant increase of LV mass (Mean ±SD = 107.267±26.736, P= 0.002) and LV mass index of the studied patients (Mean ±SD = 106.900±22.651, P = 0.005) compared to the controls. There were significant decrease of ejection fraction (EF%)( Mean ±SD = 60.373 ± 8.088,  P = 0.032)and fractional shortening (FS%) (Mean ±SD = 29.495 ± 4.171, P = 0.026) of the studied patients compared to control group.  Both P wave dispersion (PWd) (Mean ±SD = 33.667 ± 13.767, P =     0.029) and QT dispersion (QTd) (Mean ±SD = 53.000 ± 18.411, P = 0.001) were significantly higher in patients compared to controls.  There was a significant positive correlation between PWd and serum ferritin (r =0.551, P-value= 0.002), LVIDd (r =0.406, P-value= 0.026), LVPWd (r =0.461, P-value= 0.010), LV mass (r =0.412, P-value= 0.024), and LV mass index(r = 0.379, P-value= 0.039). While, there were a significant positive correlations between QTd and serum ferritin (r =0.654, P-value <0.001), LVIDd (r = 0.388, P-value = 0.034), LV mass (r = 0.454, P-value = 0.012) and LV mass index (r = 0.456, P-value = 0.011).

Conclusion: P wave dispersion and QT dispersion were prolonged in children with β-thalassemia major denoting cardiac autonomic dysfunction with homogeneity disorders of atrial conduction and ventricular repolarization in these patients. 

Keywords:
Beta-thalassemia major, QT dispersion, P wave dispersion.

Article Details

How to Cite
Salama, M., El-Nemr, S., Badraia, I., & Zoair, A. (2020). P-Wave and QT Dispersion in Children With βeta-Thalassemia. Journal of Advances in Medicine and Medical Research, 32(1), 38-45. https://doi.org/10.9734/jammr/2020/v32i130348
Section
Original Research Article

References

Hatti J. Genetic counselling in anemia and thalassemia. Acta Medica International 2015;2(2):100.

Ehlers KH, Levin AR, Markenson AL, Marcus JR, Klein AA, Hilgartner MW, et al. Longitudinal study of cardiac function in thalassemia major. Ann N Y Acad Sci. 1980;344:397–404.

Cassinerio E, Roghi A, Orofino N, et al. A 5-year follow-up in deferasirox treatment: Improvement of cardiac and hepatic iron overload and amelioration in cardiac function in thalassemia major patients. Annals of Hematology. 2015;94(6):939- 945.

Murphy CJ and Oudit GY. Iron-overload cardiomyopathy: Pathophysiology, diagnosis and treatment. J Card Fail. 2010;16(11):888-900.

Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, et al. Pwave dispersion: An update. Indian Pacing and Electro-physiology Journal. 2016;16(4):126- 133.

Magnani JW, Mazzini MJ, Sullivan LM, et al. P‐wave indices, distribution and quality control assessment (from the Framingham Heart Study). Ann Noninvasive Electrocardiol. 2010;15(1):77-84.

Nussinovitch U. Meta‐analysis of P‐wave dispersion values in healthy individuals: The influence of clinical characteristics. Ann Noninvasive Electrocardiol. 2012; 17(1):28-35.

Donoiu I, Târtea GC, Chávez-González E. Is there a utility for QRS dispersion in clinical practice? Journal of Mind and Medical Sciences. 2017;4(2):132-141.

Kayrak M, Acar K, Gul EE, et al. The association between myocardial iron load and ventricular repolarization parameters in asymptomatic beta-thalassemia patients. Adv Hematol. 2012;170510s.

Nussinovitch U. Meta‐analysis of P‐wave dispersion values in healthy individuals: The influence of clinical characteristics. Ann Noninvasive Electrocardiol. 2012; 17(1):28-35.

Kautzner J, Malik M. QT interval dispersion and its clinical utility. Pacing and Clinical Electrophysiology. 1997;20(10):2625- 2640.

Weidemann F, Kowalski M, D'hooge J, et al. Doppler myocardial imaging. A new tool to assess regional inhomogeneity in cardiac function. Basic Res Cardiol. 2001; 96(6):595-605.

Bosi G, Crepaz R, Gamberini MR, et al. Left ventricular remodelling and systolic and diastolic function in young adults with β thalassemia major: A Doppler echocardiographic assessment and correlation with hematological data. Heart. 2003;89(7):762-766.

Kremastinos DT, Tsiapras DP, Tsetsos GA, et al. Left ventricular diastolic doppler characteristics in beta-thalassemia major. Circulation. 1993;88(3):1127-1135.

Vaccari M, Crepaz R, Fortini M, et al. Left ventricular remodeling, systolic function and diastolic function in young adults with β-thalassemia intermedia: A doppler echocardiography study. Chest. 2002; 121(2):506-512.

Iarussi D, Di Salvo G, Pergola V, et al. Pulsed doppler tissue imaging and myocardial function in thalassemia major. Heart Vessels. 2003;18:1–6.

Russo V, Rago A, Pannone B, et al. Early electrocardiographic evaluation of atrial fibrillation risk in beta-thalassemia major patients. International Journal of Hematology. 2011;93(4):446451.

Oliveira M, da Silva N, Cunha P, et al. Effects of acute autonomic modulation on atrial conduction delay and local electrograms duration in paroxysmal atrial fibrillation. Int J Cardiol. 2011;149(3):290-295.

Kocharian A, Dalir Rooyfard M, aghanouri R. Prolonged dispersion of QT and QTc in thalassemia major patients. Acta Medica Iranica. 2003;41:233–7.

Mittal SR. QT interval–Its measurement and clinical significance. Journal of Clinical and Preventive Cardiology. 2019; 8(2):71.

Noori NM, Mahjoubifard M, Mohammadi M, Jahangiri Fard A, Abassi A, Farzanegan B. Comparison of QT dispersion with left ventricular mass index in early diagnosis of cardiac dysfunction in patients with β-thalassemia major. Iran Red Crescent Med J. 2014;16(5):e11698.

Garadah TS, Kassab S, Mahdi N, et al. QTc interval and QT dispersion in patients with thalassemia major: Electrocardio-graphic (EKG) and echocardiographic evaluation. Clin Med Insights Cardiol. 2010;4:31-37.

Ghadiri A, Ghiliyan R, Rezaeian G. P-wave dispersion in patients with major thalassemia. Iran J Ped Hematol and Oncol. 2012;2(2):67-71.

Faruqi A, Ahmad SI, Ahmed ST. Evaluation of QT parameters in patients of thalassemia major with iron over- load. J Pak Med Assoc. 2016;66:799- 802.

Azarkeivan A, Mehrvar A, Faranoush M, et al. Cardiac involvement in patients with transfusion dependent β-thalassemia. Research Journal of Biological Sciences. 2009;4(2):195-199.

Ulger Z, Aydinok Y, Levent E, et al. Evaluation of QT dispersion in β thalassemia major patients. Am J Hematol. 2006;81(12):901-906.