Heart rate variability as an alternative indicator for identifying cardiac iron status in non-transfusion dependent thalassemia patients

© 2015 Wijarnpreecha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: Iron-overload cardiomyop...

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Main Authors: Karn Wijarnpreecha, Natthaphat Siri-Angkul, Krekwit Shinlapawittayatorn, Pimlak Charoenkwan, Suchaya Silvilairat, Chate Siwasomboon, Pannee Visarutratna, Somdet Srichairatanakool, Adisak Tantiworawit, Arintaya Phrommintikul, Siriporn C. Chattipakorn, Nipon Chattipakorn
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Published: 2018
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spelling th-cmuir.6653943832-540002018-09-04T10:08:11Z Heart rate variability as an alternative indicator for identifying cardiac iron status in non-transfusion dependent thalassemia patients Karn Wijarnpreecha Natthaphat Siri-Angkul Krekwit Shinlapawittayatorn Pimlak Charoenkwan Suchaya Silvilairat Chate Siwasomboon Pannee Visarutratna Somdet Srichairatanakool Adisak Tantiworawit Arintaya Phrommintikul Siriporn C. Chattipakorn Nipon Chattipakorn Agricultural and Biological Sciences Biochemistry, Genetics and Molecular Biology © 2015 Wijarnpreecha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: Iron-overload cardiomyopathy is a major cause of death in thalassemia patients due to the lack of an early detection strategy. Although cardiac magnetic resonance (CMR) T2∗ is used for early detection of cardiac iron accumulation, its availability is limited. Heart rate variability (HRV) has been used to evaluate cardiac autonomic function and found to be depressed in thalassemia. However, its direct correlation with cardiac iron accumulation has never been investigated. We investigated whether HRV can be used as an alternative indicator for early identification of cardiac iron deposition in thalassemia patients. Methods: Ninety-nine non-transfusion dependent thalassemia patients (23.00 (17.00, 32.75) years, 35 male) were enrolled. The correlation between HRV recorded using 24-hour Holter monitoring and non-transferrin bound iron (NTBI), hemoglobin (Hb), serum ferritin, LV ejection fraction (LVEF), and CMR-T2∗ were determined. Results: The median NTBI value was 3.15 (1.11, 6.59) μM. Both time and frequency domains of HRV showed a significant correlation with the NTBI level, supporting HRV as a marker of iron overload. Moreover, the LF/HF ratio showed a significant correlation with CMR-T2∗ with the receiver operating characteristic (ROC) curve of 0.684±0.063, suggesting that it could represent the cardiac iron deposit in thalassemia patients. HRV was also significantly correlated with serum ferritin and Hb. Conclusions: This novel finding regarding the correlation between HRV and CMR-T2∗ indicates that HRV could be a potential marker in identifying early cardiac iron deposition prior to the development of LV dysfunction, and may be used as an alternative to CMR-T2∗ for screening cardiac iron status in thalassemia patients. 2018-09-04T10:06:26Z 2018-09-04T10:06:26Z 2015-06-17 Journal 19326203 2-s2.0-84939250843 10.1371/journal.pone.0130837 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84939250843&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/54000
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Agricultural and Biological Sciences
Biochemistry, Genetics and Molecular Biology
spellingShingle Agricultural and Biological Sciences
Biochemistry, Genetics and Molecular Biology
Karn Wijarnpreecha
Natthaphat Siri-Angkul
Krekwit Shinlapawittayatorn
Pimlak Charoenkwan
Suchaya Silvilairat
Chate Siwasomboon
Pannee Visarutratna
Somdet Srichairatanakool
Adisak Tantiworawit
Arintaya Phrommintikul
Siriporn C. Chattipakorn
Nipon Chattipakorn
Heart rate variability as an alternative indicator for identifying cardiac iron status in non-transfusion dependent thalassemia patients
description © 2015 Wijarnpreecha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: Iron-overload cardiomyopathy is a major cause of death in thalassemia patients due to the lack of an early detection strategy. Although cardiac magnetic resonance (CMR) T2∗ is used for early detection of cardiac iron accumulation, its availability is limited. Heart rate variability (HRV) has been used to evaluate cardiac autonomic function and found to be depressed in thalassemia. However, its direct correlation with cardiac iron accumulation has never been investigated. We investigated whether HRV can be used as an alternative indicator for early identification of cardiac iron deposition in thalassemia patients. Methods: Ninety-nine non-transfusion dependent thalassemia patients (23.00 (17.00, 32.75) years, 35 male) were enrolled. The correlation between HRV recorded using 24-hour Holter monitoring and non-transferrin bound iron (NTBI), hemoglobin (Hb), serum ferritin, LV ejection fraction (LVEF), and CMR-T2∗ were determined. Results: The median NTBI value was 3.15 (1.11, 6.59) μM. Both time and frequency domains of HRV showed a significant correlation with the NTBI level, supporting HRV as a marker of iron overload. Moreover, the LF/HF ratio showed a significant correlation with CMR-T2∗ with the receiver operating characteristic (ROC) curve of 0.684±0.063, suggesting that it could represent the cardiac iron deposit in thalassemia patients. HRV was also significantly correlated with serum ferritin and Hb. Conclusions: This novel finding regarding the correlation between HRV and CMR-T2∗ indicates that HRV could be a potential marker in identifying early cardiac iron deposition prior to the development of LV dysfunction, and may be used as an alternative to CMR-T2∗ for screening cardiac iron status in thalassemia patients.
format Journal
author Karn Wijarnpreecha
Natthaphat Siri-Angkul
Krekwit Shinlapawittayatorn
Pimlak Charoenkwan
Suchaya Silvilairat
Chate Siwasomboon
Pannee Visarutratna
Somdet Srichairatanakool
Adisak Tantiworawit
Arintaya Phrommintikul
Siriporn C. Chattipakorn
Nipon Chattipakorn
author_facet Karn Wijarnpreecha
Natthaphat Siri-Angkul
Krekwit Shinlapawittayatorn
Pimlak Charoenkwan
Suchaya Silvilairat
Chate Siwasomboon
Pannee Visarutratna
Somdet Srichairatanakool
Adisak Tantiworawit
Arintaya Phrommintikul
Siriporn C. Chattipakorn
Nipon Chattipakorn
author_sort Karn Wijarnpreecha
title Heart rate variability as an alternative indicator for identifying cardiac iron status in non-transfusion dependent thalassemia patients
title_short Heart rate variability as an alternative indicator for identifying cardiac iron status in non-transfusion dependent thalassemia patients
title_full Heart rate variability as an alternative indicator for identifying cardiac iron status in non-transfusion dependent thalassemia patients
title_fullStr Heart rate variability as an alternative indicator for identifying cardiac iron status in non-transfusion dependent thalassemia patients
title_full_unstemmed Heart rate variability as an alternative indicator for identifying cardiac iron status in non-transfusion dependent thalassemia patients
title_sort heart rate variability as an alternative indicator for identifying cardiac iron status in non-transfusion dependent thalassemia patients
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84939250843&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/54000
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