Background: Thalassemia is a common disease in Thailand. Most patients with thalassemia receive regular blood transfusion, resulting in iron accumulation in the body. Ferritin levels are associated with iron accumulation in vital organs of patients with thalassemia. The relationship between the ferritin levels and left ventricular (LV) function in these patients showed no relationship in most data, but all data were measured by conventional echocardiography. Currently, LV function can be measured by more advanced methods, such as the speckle tracking echocardiography, which demonstrates high accuracy in detecting early-stage LV dysfunction.

Objective: To investigate the association between the serum ferritin level and LV function by speckle tracking echocardiography in patients with thalassemia.

Materials and Methods: The present study was a cross-sectional analytic study that enrolled patients with thalassemia in the Faculty of Medicine, Vajira Hospital, between January and December 2019. Each participants provided an informed consent. Serum ferritin, conventional echocardiography, and speckle tracking echocardiography using global longitudinal strain [GLS] parameters were collected.

Results: Among 45 participants, 33 had transfusion-dependent thalassemia (TDT), and 12 had non-transfusion-dependent thalassemia (NTDT). Female participants accounted for 64.4% with 29 patients. The mean age was 35.51±13.81 years, and participants had no other systemic diseases. The median serum ferritin was 1,159 ng/dL with a range of 638 to 1,983. The mean values for GLS and LVEF by biplane were −22.97±2.20% and 63.90±7.62%, respectively. Serum ferritin was not significantly related to GLS (Spearman’s rho 0.164, 95% CI −0.136 to 0.437, p=0.280). In the TDT group, ferritin was significantly related to GLS (Spearman’s rho 0.405, 95% CI 0.072 to 0.657, p=0.019), whereas in the NTDT group, such relationship was insignificant (Spearman’s rho −0.394, 95% CI 0.790 to 0.232, p=0.205).

Conclusion: Serum ferritin and speckle tracking echocardiography in patients with thalassemia are not significantly associated. Therefore, serum ferritin should not be a single candidate for detecting early-stage LV dysfunction. As a result, using various measurements remains the best option.

Keywords: Ferritin; Speckle tracking echocardiography; Thalassemia; Echocardiography

DOI: doi.org/10.35755/jmedassocthai.2021.09.12096

Received 12 October 2020 | Revised 29 January 2021 | Accepted 15 February 2021