{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:33:29Z","timestamp":1786649609101,"version":"build-2736575974"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Transfusion-dependent thalassemia (TDT) is a major health problem across the thalassemia belt. Although regular transfusions extend survival, they cause cardiac iron overload (CIO). Cardiac magnetic resonance imaging T2-star (MRI T2*) is the gold standard for detecting myocardial siderosis, but it remains costly and has limited availability. QT and corrected QT (QTc) intervals have been proposed as simple, inexpensive alternatives, yet pediatric evidence is limited. This systematic review aims to assess the association between QT and QTc prolongation and CIO in pediatric TDT. We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines (PROSPERO ID: CRD420251051029). Searches were performed in PubMed, EBSCO, Scopus, ProQuest, ScienceDirect, and Google Scholar for studies published between January 2015 and January 2025. Keywords included \u201c\u03b2-thalassemia,\u201d \u201ctransfusion-dependent thalassemia,\u201d \u201cpediatric,\u201d, \u201ciron overload,\u201d \u201cQT interval,\u201d \u201cQTc interval,\u201d \u201ccardiac MRI T2*,\u201d and \u201cserum ferritin.\u201d Eligible studies reported QT\/QTc intervals in pediatric TDT with CIO confirmed by MRI T2* and\/or serum ferritin. Study quality was evaluated using the Newcastle\u2013Ottawa Scale. Data were pooled using a random-effects model, with subgroup and sensitivity analyses. Seven studies involving 619 children were included; six provided data for meta-analysis. Both QT (mean difference [MD] 18.23 ms; 95% confidence interval [CI] 12.05\u201324.41; P &lt; 0.00001) and QTc intervals (MD 21.15 ms; 95% CI 15.88\u201326.42; P &lt; 0.00001) were significantly prolonged in the CIO group. Subgroup analyses confirmed consistent findings with low heterogeneity. QT and QTc prolongation are strongly associated with CIO in pediatric TDT.<\/jats:p>","DOI":"10.4103\/apc.apc_227_25","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T07:00:21Z","timestamp":1776236421000},"page":"62-67","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["QT and corrected QT prolongation as early markers of cardiac iron overload in pediatric transfusion-dependent thalassemia: A systematic review and meta-analysis"],"prefix":"10.4103","volume":"19","author":[{"given":"Monica","family":"Oktaviana","sequence":"first","affiliation":[{"name":"School of Medicine and Health Sciences, Atma Jaya Catholic University, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimas Tri","family":"Anantyo","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine, Diponegoro University, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven Yulius","family":"Usman","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Sciences, Atma Jaya Catholic University, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghea","family":"Mangkuliguna","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Sciences, Atma Jaya Catholic University, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"R1-20260420","doi-asserted-by":"crossref","first-page":"102619","DOI":"10.1016\/j.eclinm.2024.102619","article-title":"Global, regional, and national burden of thalassemia, 1990\u20132021: A systematic analysis for the global burden of disease study 2021","volume":"72","author":"Tuo","year":"2024","journal-title":"EClinicalMedicine"},{"key":"R2-20260420","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1080\/03630269.2021.2023565","article-title":"Thalassemia in Indonesia","volume":"46","author":"Wahidiyat","year":"2022","journal-title":"Hemoglobin"},{"key":"R3-20260420","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4103\/ijri.IJRI_395_18","article-title":"Cardiac T2* magnetic resonance analysis of membranous interventricular septum in assessment of cardiac iron overload in pediatric thalassemia patients: A pilot study","volume":"29","author":"Kumar","year":"2019","journal-title":"Indian J Radiol Imaging"},{"key":"R4-20260420","doi-asserted-by":"crossref","first-page":"e85379","DOI":"10.1371\/journal.pone.0085379","article-title":"How early can myocardial iron overload occur in beta thalassemia major? Xu X, editor","volume":"9","author":"Yang","year":"2014","journal-title":"PLoS ONE"},{"key":"R7-20260420","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1111\/bjh.14099","article-title":"Increased iron stores prolong the QT interval \u2013 A general population study including 20 261 individuals and meta-analysis of thalassaemia major","volume":"174","author":"Henriksen","year":"2016","journal-title":"Br J Haematol"},{"key":"R8-20260420","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1182\/asheducation-2017.1.265","article-title":"Iron overload in thalassemia: Different organs at different rates","volume":"2017","author":"Taher","year":"2017","journal-title":"Hematology Am Soc Hematol Educ Program"},{"key":"R9-20260420","doi-asserted-by":"crossref","first-page":"267","DOI":"10.24953\/turkjped.2020.02.013","article-title":"The corrected QT interval prolongation in adolescents with cardiac iron overload \u03b2-thalassemia 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