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Preclinical cardiac dysfunction in transfusion-dependent children and young adults detected with low-dose dobutamine stress echocardiography

Journal of the American Society of Echocardiography
Publication Date
DOI: 10.1016/s0894-7317(98)70136-1


Abstract Transfusion-dependent (TD) patients develop cardiac iron overload that will eventually lead to cardiac pump failure. Low-dose dobutamine stress echocardiography may complement resting echocardiography and identify preclinical myocardial dysfunction caused by early cardiac hemosiderosis. Twenty-six iron-overloaded TD patients had stress echocardiography with 5 μg/kg per minute of dobutamine. Indexed left ventricular (LV) mass, LV dimensions, meridional wall stress, and cardiac index were significantly increased. TD patients had similar LV shortening fraction by M-mode (40.5% ± 5.6% vs 39.4% ± 4.5%) but had a lower mean LV ejection fraction (53.3% ± 3.9% vs 46.8% ± 6.9%, P < .002) and a subnormal increase in cardiac index during dobutamine stress (35% ± 20% vs 11% ± 16%, P < .0001). Impairment in LV relaxation was demonstrated by a prolonged isovolumetric relaxation time (0.060 ± 0.005 vs 0.088 ± 0.019 seconds, P < .0001), increased peak mitral E wave, and abnormal E/A ratio. Asymptomatic TD patients demonstrate decreased systolic functional reserve and abnormal left ventricular relaxation that may be caused by cardiac hemosiderosis. Low-dose dobutamine stress echocardiography may be useful for detecting and following cardiac dysfunction in patients at risk for cardiac hemosiderosis. (J Am Soc Echocardiogr 1998;11:948-56.)

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