Correlation Between Serum Ferritin and Electrocardiographic and Echocardiographic Markers of Cardiac Dysfunction in Children With Transfusion-Dependent β-Thalassemia Major.
- 1Pediatrics and Neonatology, Baba Raghav Das Medical College, Gorakhpur, IND.
- 2Pediatrics, Baba Raghav Das Medical College, Gorakhpur, IND.
Abstract
Background
Cardiac complications resulting from iron overload remain the leading cause of morbidity and mortality in children with transfusion-dependent β-thalassemia major. Early identification of myocardial dysfunction using non-invasive markers is essential, particularly in resource-limited settings where cardiac magnetic resonance imaging (MRI) T2* is not readily available.Objectives
To evaluate the correlation between serum ferritin levels and electrocardiographic and echocardiographic markers of cardiac dysfunction in children with β-thalassemia major.Methods
This analytical cross-sectional study was conducted in the Department of Pediatrics, Baba Raghav Das Medical College, Gorakhpur, India, from January 2025 to December 2025. Eighty children aged two to 16 years with transfusion-dependent β-thalassemia major were enrolled and stratified into three groups according to serum ferritin levels: <2500 ng/mL, 2500-5000 ng/mL, and >5000 ng/mL. All participants underwent clinical evaluation, electrocardiography (ECG), conventional echocardiography, and tissue Doppler imaging. Pearson correlation and multivariate linear regression analyses were performed.Results
Higher serum ferritin levels were associated with significant prolongation of the corrected QT (QTc) interval and QT dispersion and associated with impairment of left ventricular systolic and diastolic function. Serum ferritin showed significant negative correlations with left ventricular ejection fraction (LVEF) (r = -0.684), E/A ratio (r = -0.582), lateral early diastolic mitral annular velocity (r = -0.658), and tricuspid annular plane systolic excursion (r = -0.512), and positive correlations with the ratio of early transmitral flow velocity to early diastolic mitral annular velocity (E/Ea ratio) (r = 0.726), QTc interval (r = 0.648), and myocardial performance index (r = 0.672) (all p < 0.001). Multivariate analysis identified serum ferritin as the strongest independent predictor of reduced LVEF (β = -0.562, p < 0.001).Conclusions
Elevated serum ferritin levels are significantly associated with subclinical and overt cardiac dysfunction in children with β-thalassemia major. Combined assessment using serum ferritin, ECG, and echocardiography may facilitate early detection of iron overload cardiomyopathy and help optimize chelation therapy, particularly in settings where advanced cardiac imaging is unavailable.
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BibTeX
@article{kasaudhan2026correlation,
title = {{Correlation Between Serum Ferritin and Electrocardiographic and Echocardiographic Markers of Cardiac Dysfunction in Children With Transfusion-Dependent β-Thalassemia Major.}},
author = {Vipin Kasaudhan and Vijay K Singh and Bhoopendra Sharma and Priyanka Singh and Kuldeep K Singh and Rachna Bhatnagar},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116573},
url = {https://europepmc.org/article/MED/42903318},
note = {CC BY},
}
RIS
TY - JOUR
TI - Correlation Between Serum Ferritin and Electrocardiographic and Echocardiographic Markers of Cardiac Dysfunction in Children With Transfusion-Dependent β-Thalassemia Major.
AU - Vipin Kasaudhan
AU - Vijay K Singh
AU - Bhoopendra Sharma
AU - Priyanka Singh
AU - Kuldeep K Singh
AU - Rachna Bhatnagar
PY - 2026
DA - 2026/09/20
JO - Cureus
DO - 10.7759/cureus.116573
UR - https://europepmc.org/article/MED/42903318
AB - Background Cardiac complications resulting from iron overload remain the leading cause of morbidity and mortality in children with transfusion-dependent β-thalassemia major. Early identification of myocardial dysfunction using non-invasive markers is essential, particularly in resource-limited settings where cardiac magnetic resonance imaging (MRI) T2* is not readily available.Objectives To evaluate the correlation between serum ferritin levels and electrocardiographic and echocardiographic markers of cardiac dysfunction in children with β-thalassemia major.Methods This analytical cross-sectional study was conducted in the Department of Pediatrics, Baba Raghav Das Medical College, Gorakhpur, India, from January 2025 to December 2025. Eighty children aged two to 16 years with transfusion-dependent β-thalassemia major were enrolled and stratified into three groups according to serum ferritin levels: <2500 ng/mL, 2500-5000 ng/mL, and >5000 ng/mL. All participants underwent clinical evaluation, electrocardiography (ECG), conventional echocardiography, and tissue Doppler imaging. Pearson correlation and multivariate linear regression analyses were performed.Results Higher serum ferritin levels were associated with significant prolongation of the corrected QT (QTc) interval and QT dispersion and associated with impairment of left ventricular systolic and diastolic function. Serum ferritin showed significant negative correlations with left ventricular ejection fraction (LVEF) (r = -0.684), E/A ratio (r = -0.582), lateral early diastolic mitral annular velocity (r = -0.658), and tricuspid annular plane systolic excursion (r = -0.512), and positive correlations with the ratio of early transmitral flow velocity to early diastolic mitral annular velocity (E/Ea ratio) (r = 0.726), QTc interval (r = 0.648), and myocardial performance index (r = 0.672) (all p < 0.001). Multivariate analysis identified serum ferritin as the strongest independent predictor of reduced LVEF (β = -0.562, p < 0.001).Conclusions Elevated serum ferritin levels are significantly associated with subclinical and overt cardiac dysfunction in children with β-thalassemia major. Combined assessment using serum ferritin, ECG, and echocardiography may facilitate early detection of iron overload cardiomyopathy and help optimize chelation therapy, particularly in settings where advanced cardiac imaging is unavailable.
SN - 2168-8184
ER -