Does Iron Deficiency Affect the Heart in Children?
Journal
Journal of pediatric hematology/oncology
ISSN: 1536-3678
Titre abrégé: J Pediatr Hematol Oncol
Pays: United States
ID NLM: 9505928
Informations de publication
Date de publication:
01 Apr 2022
01 Apr 2022
Historique:
received:
18
01
2021
accepted:
04
03
2021
pubmed:
13
4
2021
medline:
20
4
2022
entrez:
12
4
2021
Statut:
ppublish
Résumé
It is well known that serum iron parameters are closely related to cardiovascular health. Iron deficiency may lead to significant cardiac problems, such as atrioventricular conduction abnormalities, and systolic and/or diastolic dysfunction. Studies related to the effect of iron deficiency on cardiac functions are limited in children. Therefore, the aim of this study was to evaluate the effect of low iron stores on cardiac repolarization parameters which are used to predict arrhythmia and cardiac functions. Onehundred thirty-five children 2 to 18 years of age without structural heart disease who were referred to the Pediatric Cardiology Department for various reasons such as chest pain, heart murmur, or evaluation before sports participation were evaluated prospectively. The cases were separated into 3 groups according to ferritin levels (group 1: ferritin <15 ng/mL [n=48], group 2: ferritin 15 to 25 ng/mL [n=51], and group 3: ferritin >25 ng/mL [n=36]). Evaluations were made with detailed 12-lead surface electrocardiography (ECG) and transthoracic echocardiogram. Cardiac repolarization parameters were measured from surface ECG and systolic functions, left ventricular wall diameters were evaluated from transthoracic echocardiogram. Eighty-four (62.2%) girls and 51 (37.8%) boys are included in the study. The average age of the groups was similar. In children with low ferritin levels (group 1); Pw, Pw max, and Pw dis; QT, QTc, and QTc dis; Tp-Te, Tp-Te dis, Tp-Te/QT, and Tp-Te/QTc were significantly longer compared with the group 3 (P<0.05). There was a negative correlation between ferritin level and Pw, P max, and Pw dis; QT, QT dis, QTc, and QTc dis; Tp-Te, Tp-Te dis, Tp-Te/QT, and Tp-Te/QTc (P<0.05). No correlation was found between ferritin level and Pw min. There was no difference between the groups in respect of ejection phase indices, heart wall measurements, and end-diastolic diameter measurements. Iron deficiency may be related to the tendency of arrhythmias in children without structural heart disease. Therefore, careful evaluation of ECG parameters of healthy children with low iron stores, and follow up with intermittent monitoring is highly important.
Identifiants
pubmed: 33843814
doi: 10.1097/MPH.0000000000002170
pii: 00043426-202204000-00003
doi:
Substances chimiques
Ferritins
9007-73-2
Iron
E1UOL152H7
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
84-88Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Yurdakök K, İnce OT. Çocuklarda demir eksikliği anemisini önleme yaklaşimlari [Strategies for prevention of iron deficiency anemia in children]. Çocuk Sağliği ve Hastaliklari Dergisi. 2009;52:224–231.
Dhamangaonkar MP, Desmukh D. Electrocardiographic abnormalities in severe anaemia and its reversibility after correction of anaemia. Natl J Basic Med Sci. 2017;7:188–191.
Metivier F, Marchais SJ, Guerin AP. Pathophysiology of anaemia: focus on the heart and blood vessels. Nephrol Dial Transplant. 15(suppl 3)2000:14–18.
Hedge NR, Michael W, Gayomali C. The cardiomyopathy of iron deficiency. Tex Heart Inst J. 2006;33:340–344.
Pereira AA, Sarnak MJ. Anemia as a risk factor for cardiovascular disease: management of comorbidities in kidney disease in the 21st century: anemia and bone disease. Kidney Int. 2003;64:S32–S39.
Karaagac K, Yildiz A, Yontar O, et al. Relationship between fibroblast growth factor and arrhythmogenesis in normotensive patients with polycystic kidney disease. Eur Res J. 2015;1:106–112.
Karaagac K, Yontar OC, Emul A, et al. Tp-Te interval and Tp-Te/QT ratio in polycystic ovary syndrome. J Clin Anal Med. 2015;6:5–8.
Simsek H, Gunes Y, Demir C, et al. The effects of iron deficiency anemia on p wave duration and dispersion. Clinics. 2010;65:1067–1071.
Karadeniz C, Ozdemir R, Demir F, et al. Increased P-wave and QT dispersions necessitate long-term follow-up evaluation of Down syndrome patients with congenitally normal hearts. Pediatr Cardiol. 2014;35:1344–1348.
Kilicaslan F, Tokatli A, Ozdag F, et al. Tp‐e interval, Tp‐e/QT ratio, and Tp‐e/QTc ratio are prolonged in patients with moderate and severe obstructive sleep apnea. Pacing Clin Electrophysiol. 2012;35:966–972.
Kayali S, Yildirim FT. Echocardiographic assessment of children participating in regular sports training. North Clin Istanb. 2019;6:236–241.
Rothman J Behrman RE, Kliegman RM, Jenson HB. Iron deficiency. Nelson Textbook of Pediatrics, 20th ed. Philadelphia, PA: WB Saunders Company; 2007:1387–1389.
Shahriari V, Taheri F, Salehi Abarghouei F. The effect of iron replacement therapy on electrocardiographic consequences in pediatric patients. Int J Pediatr. 2019;7:10299–10309.
Şimşek H, Gümrükçüoğlu HA, Kaya Y, et al. Demir eksikliği anemisi ve tedavisinin P dalga süreleri ve diyastolik fonksiyon parametreleri üzerine etkileri [The effects of iron deficiency anemia and its treatment on P wave durations and parameters of diastolic function]. J Clin Exp Investig. 2010;1:187–194.
Tse G, Gong M, Wong WT, et al. The Tpeak−Tend interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: a systematic review and meta-analysis. Heart Rhythm. 2017;14:1131–1137.
Gaber R, Kotb NA, Ghazy M, et al. Tissue doppler and strain rate imaging detect improvement of myocardial function in iron deficient patients with congestive heart failure after iron replacement therapy. Echocardiography. 2012;29:13–18.
Karadeniz C, Özdemir R, Demirol M, et al. Low iron stores in otherwise healthy children affect electrocardiographic markers of important cardiac events. Pediatr Cardiol. 2017;38:909–914.
Hünük B, Çağaç Ö, Erdoğan O, et al. The impact of anemia on QT interval: a population based study. J Am Coll Cardiol. 2013;62(suppl 2):C146.
Cho IJ, Mun YC, Kwon KH, et al. Effect of anemia correction on left ventricular structure and filling pressure in anemic patients without overt heart disease. Korean J Intern Med. 2014;29:445–453.
Zhou Q, Shen J, Liu Y, et al. Assessment of left ventricular systolic function in patients with iron deficiency anemia by three-dimensional speckle-tracking echocardiography. Anatol J Cardiol. 2017;18:194–199.
Mozos I, Serban C, Mihaescu R, et al. Anemia and the QT interval in hypertensive patients. Int J Collab Res Intern Med Public Health. 2012;4:2084–2091.
Okin PM, Devereux RB, Howard BV, et al. Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians: The Strong Heart Study. Circulation. 2000;101:61–66.
Odemis E, Catal F, Karadag A. Assessment of cardiac function in iron-deficient children without anemia. J Pediatr Hematol Oncol. 2006;28:88–90.