Evaluation of the Correlation Between Electrocardiographic Abnormalities, Cardiac Iron Overload, and Magnetic Resonance T2* Values in Patients with Beta Thalassemia Major

Amir Farjam Fazelifar; Mehran  Khosh-Fetrat; Mozhgan  Parsaee; Sedigheh Saedi

doi:10.18502/jimc.v7i2.15046

Amir Farjam Fazelifar Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Mehran Khosh-Fetrat Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Mozhgan Parsaee Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Sedigheh Saedi Congenital Heart Disease Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jimc.v7i2.15046

Keywords: Beta thalassemia major, Electrocardiography, Iron overload, Magnetic resonance imaging

Abstract

Background: Beta thalassemia major (β-TM) is an inherited blood disorder. Affected patients require frequent blood transfusions, leading to iron deposition and end organ damage, particularly myocardial dysfunction. A 12-lead ECG is a readily available tool that could be used to screen for conduction abnormalities and arrhythmias as a marker of worsening myocardial function.

Methods: A total of 108 β-TM patients were evaluated for correlation between abnormal findings on the surface ECG and severity of myocardial iron deposition in magnetic resonance imaging as measured by T2* levels.

Results: Patients with T2* below 20 msec had significantly longer PR intervals, P wave durations, and QTc intervals. Patients with T2* below 10 msec had the longest QRS duration and QRS activation times. Atrial fibrillation was more prevalent in patients with lower T2* levels. With a decrease in T2*, the probability of notching of QRS in the limb and precordial leads increased.

Conclusion: Abnormal ECG is prevalent in β-TM patients, and the frequency of changes increases with the severity of iron overload. A 12-lead ECG is a valuable and readily available tool for the early assessment of myocardial damage and the implementation of a timely and appropriate management strategy.