Research Information System
European Journal of Pediatrics, vol.185, no.5, 2026 (SCI-Expanded, Scopus)
Cardiac iron deposition remains a leading cause of morbidity and mortality in patients with beta-thalassemia major (β-TM). Early myocardial involvement may be difficult to detect using conventional echocardiography before overt systolic dysfunction develops. We aimed to evaluate early cardiac involvement in children with β-TM using electrocardiographic indices—P-wave dispersion (PWD) and QT dispersion (QTD)—and to examine their associations with markers of iron load. This retrospective study included 85 children with β-TM aged 6–17 years and 85 age-matched and sex-matched healthy controls. All participants underwent 12-lead electrocardiography and comprehensive echocardiography. PWD and QTD were measured manually from surface ECG recordings. Iron load was assessed using serum ferritin levels and cardiac magnetic resonance (CMR) T2* measurements; patients were stratified according to ferritin (< 2500 vs ≥ 2500 ng/mL) and T2* (> 20 ms vs ≤ 20 ms). Children with β-TM had significantly higher PWD, QTD, and corrected QT dispersion (QTcD) than controls (all p < 0.001), despite preserved left ventricular systolic function. Echocardiography demonstrated increased ventricular wall thickness, chamber dimensions, myocardial performance indices, and altered diastolic parameters in the β-TM group. PWD showed a positive correlation with left ventricular mass index (r = 0.295, p = 0.006) and a negative correlation with the tissue Doppler E/A ratio (r = − 0.252, p = 0.020). QTD correlated negatively with both mitral inflow E/A and tissue Doppler E/A ratios (r = − 0.247, p = 0.020). No significant correlations were observed between ECG dispersion indices and serum ferritin or CMR T2* values. Conclusion: PWD and QTD are significantly prolonged in children with β-TM even in the absence of clinical heart failure or overt systolic dysfunction, indicating early subclinical cardiac involvement. Given their simplicity, low cost, and noninvasive nature, these ECG indices may serve as practical and accessible tools for early cardiac screening in this population.