Evaluation of heart rate variability in pediatric patients with beta thalassemia major: Cross-sectional study

doi:10.5409/wjcp.v15.i2.116098

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 15, Issue 2

This Article

(0) (0) (0)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (75)

All Articles published online

Item

Count

PDF

HTML

Figures (1-2)

Tables (1-6)

Sum=44

Publishing Process of This Article

Item

Count

Browse

Download

Sum=49

Jun 9, 2026 (publication date) through May 16, 2026

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Clinical Pediatrics

ISSN

2219-2808

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Pediatr. Jun 9, 2026; 15(2): 116098
Published online Jun 9, 2026. doi: 10.5409/wjcp.v15.i2.116098

Evaluation of heart rate variability in pediatric patients with beta thalassemia major: Cross-sectional study

Esraa A Sorour, Eman M Elaskary, Shimaa Basyoni Elnemr, Adel A Hagag, Nesma Ahmed Kassab, Mohammed Al-Beltagi

Esraa A Sorour, Eman M Elaskary, Shimaa Basyoni Elnemr, Adel A Hagag, Nesma Ahmed Kassab, Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt

Mohammed Al-Beltagi, Department of Paediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Manama, Bahrain

Co-first authors: Esraa A Sorour and Eman M Elaskary.

Author contributions: Sorour EA conceptualized and designed the study, coordinated data collection, performed the statistical analysis, interpreted the findings, and drafted the initial manuscript; Elaskary EM contributed to the study design, data acquisition, and critical revision of the manuscript; Sorour EA and Elaskary EM have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper; Elnemr SB participated in data interpretation, literature review, and manuscript editing; Hagag AA supervised the clinical evaluation of patients and reviewed the manuscript for important intellectual content; Kassab NA assisted in data entry, tabulation, and preliminary data analysis; Al-Beltagi M provided overall study supervision, critically revised the manuscript for intellectual and clinical accuracy, and approved the final version for publication; all authors have read and approved the final manuscript.

AI contribution statement: We did not use ChatGPT, DeepL, or any similar AI-based writing tools in the preparation of this manuscript. The only tool used was Grammarly, integrated within Microsoft Office, solely for basic grammar and language correction.

Institutional review board statement: The study was reviewed and approved by the Ethical Committee of the Faculty of Medicine, Tanta University, Egypt (No. 36264MS112/3/23). The study was conducted in accordance with the ethical standards of the institutional research committee and with the principles of the Declaration of Helsinki.

Informed consent statement: Written informed consent was obtained from the parents or legal guardians of all participating children prior to enrollment in the study.

Conflict-of-interest statement: The authors declare that they have no conflict of interest related to this study.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.

Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to ethical and privacy considerations related to patient confidentiality.

Corresponding author: Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, No. 1 Hassan Radwan Street, Tanta 31511, Algharbia, Egypt. mohamed.elbeltagi@med.tanta.edu.eg

Received: November 3, 2025
Revised: December 15, 2025
Accepted: January 29, 2026
Published online: June 9, 2026
Processing time: 192 Days and 11 Hours

Abstract

BACKGROUND

Cardiac complications are a significant cause of morbidity and mortality in patients with β-thalassemia major (TM). Early detection of subclinical cardiac involvement remains challenging, as conventional echocardiography and electrocardiography often fail to identify early dysfunction. Heart rate variability (HRV) reflects autonomic regulation of the heart and may serve as a sensitive marker for early cardiac impairment.

AIM

To evaluate HRV in children with β-TM without clinical cardiac manifestations.

METHODS

A cross-sectional study was conducted on 40 children with β-TM and 40 age- and sex-matched healthy controls. All participants underwent full clinical assessment, laboratory investigations, and 24-hour ambulatory Holter monitoring. HRV parameters were analyzed in both time and frequency domains using Cardioscan CS12 software. Statistical comparisons between groups and correlations with hemoglobin and serum ferritin levels were performed using SPSS version 27.

RESULTS

Children with β-TM showed significantly higher minimum and maximum heart rates and markedly lower HRV indices, including standard deviation of all normal-to-normal intervals (SDNN), standard deviation of the 5-minutes average normal-to-normal intervals, SDNN index, root mean square of successive differences, and percentage of normal-to-normal intervals differing by > 50 ms, compared with controls (P < 0.001). High-frequency (HF) power was significantly decreased, whereas the low-frequency/HF ratio was elevated (P < 0.001), indicating sympathetic predominance. Arrhythmias were recorded in 47.5% of patients, though HRV parameters did not differ significantly between those with and without arrhythmia. No correlation was found between HRV indices and hemoglobin or serum ferritin levels.

CONCLUSION

Children with β-TM demonstrate significant autonomic imbalance, reflecting early cardiac involvement even before the onset of clinical symptoms. Routine HRV assessment could provide a valuable, non-invasive tool for early detection and risk stratification in pediatric thalassemia management.

Keywords: β-thalassemia major; Heart rate variability; Autonomic dysfunction; Pediatric cardiology; Iron overload

Core Tip: Children with β-thalassemia major may develop cardiac dysfunction long before echocardiographic or clinical evidence appears. This study demonstrates that heart rate variability (HRV) analysis can detect early autonomic imbalance, reflecting subclinical cardiac involvement. Routine HRV monitoring in pediatric thalassemia patients offers a simple, non-invasive method to identify high-risk individuals and initiate preventive measures early, potentially improving cardiac outcomes and survival.