The hyperdynamic paradox: 3D speckle-tracking unmasks subclinical RV dysfunction in pediatric transfusion-dependent beta-thalassemia

Abstract Background To comprehensively evaluate right ventricular function in children with transfusion-dependent beta-thalassemia (TDßT) using advanced echocardiographic techniques and to determine the diagnostic value of three-dimensional speckle-tracking strain compared to conventional parameters in detecting subclinical myocardial dysfunction. Results TDßT patients exhibited a hyperdynamic RV state with significantly higher fractional area change (FAC: 61.20% vs. 44.30%, p < 0.001) and 3D RV ejection fraction (RVEF: 64.16% vs. 52.39%, p < 0.001). However, 3D-STE revealed significant impairment in RV longitudinal strain (Global RV4CSL: -22.13% vs. -28.69%, p < 0.001). Strain parameters showed superior diagnostic performance (AUC for Global RV4CSL = 0.949, sensitivity 88.6%, specificity 97.1%) compared to conventional parameters like tricuspid annular plane systolic excursion (TAPSE, AUC = 0.627). No significant correlation was observed between RV function and serum ferritin levels or transfusion duration. Conclusion Children with TDßT develop early subclinical RV myocardial dysfunction detectable by 3DE and STE despite preserved conventional systolic indices. These advanced echocardiographic techniques should be integrated into routine cardiac surveillance to enable timely intervention and potentially improve long-term outcomes.