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Early detection of cardiac involvement in beta-thalassemia children.

BACKGROUND
Beta-thalassemia major and beta-thalassemia/HbE are the important causes of chronic hemolytic anemia in Thailand. The objectives of the study were to determine variables associated with cardiac involvement in asymptomatic beta-thalassemia patients.


PATIENTS AND METHOD
The authors studied beta-thalassemia major and beta-thalassemia/HbE patients who came to the clinic between July 1st 1999 and July 31st 2000. There were 211 asymptomatic patients included in study. Their ages ranged from 2.6 to 18.2 years. Previous clinical history including blood transfusion and iron chelation were recorded. All patients received a thorough physical examination, chest X-ray, electrocardiogram and echocardiogram. Patients who had abnormal systolic or diastolic function detected by echocardiogram were identified as having cardiac involvement.


RESULTS
Cardiac involvement was found in 26 patients (12.3%). There was no difference in physical examination between patients who had and did not have cardiac involvement. Abnormal chest X-Ray defined as cardiothoracic (CT) ratio>0.55 and electrocardiogram (ECG) findings of left or right ventricular hypertrophy were associated with cardiac involvement. Other associated findings were older age and lower average pretransfusion hematocrit (23 +/- 6.6%).


CONCLUSIONS
In asymptomatic beta-thalassemia children, chest X-ray and ECG should be used for screening patients for the detection of cardiac involvement.