Subclinical Cardiac Dysfunction in Children with Iron Deficiency Anemia Assessed by Tissue Doppler and Speckle-Tracking Echocardiography

Objective: Iron deficiency is the leading cause of anemia in childhood and may induce cardiovascular adaptations, including increased heart rate, elevated cardiac output, plasma volume expansion, and myocardial remodeling. Beyond hematologic consequences, reduced iron availability may also affect myocardial structure and function. This study aimed to assess biventricular function in children with iron deficiency anemia using two-dimensional speckle-tracking echocardiography.
Method: This prospective case–control study included pre- and post-treatment evaluations. Forty children with iron deficiency anemia and 29 healthy controls were enrolled. Of the 40 patients, 24 were re-evaluated after treatment. Tissue Doppler imaging was used to measure myocardial velocities, isovolumic contraction time, isovolumic relaxation time, and ejection time at the interventricular septum and the basal segments of both ventricles. Speckle-tracking echocardiography was used to assess left ventricular longitudinal strain (LS) and strain rate, left ventricular circumferential strain and strain rate, as well as right ventricular global longitudinal strain and strain rate.
Results: Left and right ventricular LS values improved following treatment, indicating recovery of myocardial function. Tissue Doppler parameters also demonstrated improvement in both systolic and diastolic function.
Conclusion: Although significant improvement was observed after treatment, some echocardiographic parameters did not fully normalize, suggesting that subtle myocardial alterations may persist. These findings should be interpreted with caution due to the relatively small sample size and the predominance of mild-to-moderate anemia in the study population. Children with iron deficiency anemia may benefit from longer-term follow-up and post-treatment evaluation.

Keywords: Anemia, doppler tissue imaging, echocardiography, iron deficiency, speckle tracking, two-dimensional