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Roger G, Denormandie P, Gobe T, Azzolina D, Pham T, Chantalat C, Cuveillier D, Bouchachi A, Jourdain P, Lai C, Pavot A, Fage N, Domnariu P, Teboul JL, Monnet X. Left ventricular global longitudinal strain and acute myocardial injury in patients with sickle cell disease admitted to the intensive care unit for vaso-occlusive crisis. Br J Haematol 2024; 204:2007-2015. [PMID: 38471666 DOI: 10.1111/bjh.19394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
In patients with sickle cell disease (SCD), SCD-related cardiomyopathy may be partly due to repeated ischaemic events related to sickling during vaso-occlusive crises, but few clinical studies support this hypothesis. We evaluated the incidence of acute myocardial ischaemia during vaso-occlusive crises as assessed by the left ventricular global longitudinal strain (LVGLS) and high-sensitive cardiac troponin T (hs-cTnT). We included adult patients with SCD admitted to the intensive care unit (ICU) for vaso-occlusive crisis. We collected hs-cTnT and measured LVGLS with echocardiography at admission (day 1), day 2, day 3 and ICU discharge. Among 55 patients included, considering only the first hospitalization of patients admitted several times, 3 (5%) had elevated hs-cTnT at ≥1 time point of the ICU stay. It was ≤2 times the upper limit of normal in two of these patients. LVGLS was altered at ≥1 time point of the ICU stay in 13 (24%) patients. Both hs-cTnT and LVGLS were abnormal at ≥1 time point of the hospital stay in 2 (4%) patients. Acute myocardial injury as assessed by troponin elevation and LVGLS impairment was a rare event during vaso-occlusive crises.
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Affiliation(s)
- Guillaume Roger
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
- Sorbonne Université, Paris, France
| | - Pierre Denormandie
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Thibaut Gobe
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Danila Azzolina
- Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy
| | - Tài Pham
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Christelle Chantalat
- Service de Médecine Interne et Immunologie Clinique, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 7 Endocrinologie-Immunités-Inflammations-Cancer-Urgences, Le Kremlin-Bicêtre, France
| | - Daphnée Cuveillier
- Service de Médecine Interne et Immunologie Clinique, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 7 Endocrinologie-Immunités-Inflammations-Cancer-Urgences, Le Kremlin-Bicêtre, France
| | - Amir Bouchachi
- Service de Cardiologie, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Patrick Jourdain
- Service de Cardiologie, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Christopher Lai
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Arthur Pavot
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Nicolas Fage
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Paul Domnariu
- Service de Médecine Interne et Immunologie Clinique, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 7 Endocrinologie-Immunités-Inflammations-Cancer-Urgences, Le Kremlin-Bicêtre, France
| | - Jean-Louis Teboul
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
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Mansour MJ, De Marco C, Haddad K, Potter BJ, Argentin S, Bérubé L, Honos G, Le VV, Legault S, Nguyen TP, Salem R, Santagata P, Tournoux F, Cyr V, Romanelli G. Prognostic value of exercise longitudinal right ventricular free wall strain in patients with sickle cell disease. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03116-9. [PMID: 38689030 DOI: 10.1007/s10554-024-03116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
Longitudinal right ventricular free wall strain (RVFWS) has been identified as an independent prognostic marker in patients with pulmonary hypertension. Little is known however about the prognostic value of RVFWS in patients with sickle cell (SC) disease, particularly during exercise. We therefore examined the prognostic significance of RVFWS both at rest and with exercise in patients with SC disease and normal resting systolic pulmonary artery pressure (SPAP). Consecutive patients with SC disease referred for bicycle ergometer stress echocardiography (SE) were enrolled ftom July 2019 to January 2021. All patients had measurable tricuspid regurgitation velocity (TRV). Conventional echocardiography parameters, left ventricular global longitudinal strain (LVGLS), RVFWS, and ventriculoarterial coupling indices (TAPSE/SPAP and RVFWS/SPAP) were assessed at rest and peak exercise. Repeat SE was performed at a median follow-up of 2 years. The cohort consisted of 87 patients (mean age was 31 ± 11 years, 66% females). All patients had normal resting TRV < 2.8 m/s, RVFWS and LVGLS at baseline. There were 23 (26%) patients who had peak stress RVFWS < 20%. They had higher resting and peak stress TRV and SPAP, but lower resting and peak stress TAPSE/SPAP, RVFWS/SPAP, and LVGLS as well as lower peak stress cardiac output when compared to patients with peak stress RVFWS ≥ 20% (p < 0.05). Patients with baseline peak stress RVFWS < 20% had a significant decrease in exercise performance at follow-up (7.5 ± 2.7 min at baseline vs. 5.5 ± 2.8 min at follow-up, p < 0.001). In the multivariate analysis, baseline peak stress RVFWS was the only independent predictor of poorer exercise performance at follow-up [odds ratio 8.2 (1.2, 56.0), p = 0.033]. Among patients with SC disease who underwent bicycle ergometer SE, a decreased baseline value of RVFWS at peak stress predicted poorer exercise time at follow-up.
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Affiliation(s)
- Mohamad Jihad Mansour
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1.
- Université de Montréal, Montréal, QC, Canada.
| | - Corrado De Marco
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Kevin Haddad
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Brian James Potter
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Stefania Argentin
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Lyne Bérubé
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - George Honos
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Vy-Van Le
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Sylvie Legault
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Tuong-Phong Nguyen
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Reda Salem
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Patrizia Santagata
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - François Tournoux
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Véronique Cyr
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Giovanni Romanelli
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
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Koster T, Boyer E, Clutterbuck DJ, Benhabib H, Herath J. Death due to sickle cell crisis: a case report. Forensic Sci Med Pathol 2024:10.1007/s12024-023-00774-4. [PMID: 38224421 DOI: 10.1007/s12024-023-00774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/16/2024]
Abstract
Sickle cell disease (SCD) is the most common hereditary hemoglobinopathy worldwide. It results in characteristic acute and chronic findings on postmortem computed tomography (PMCT), macroscopic and microscopic examinations. While the diagnostic imaging and macroscopic features are not specific for SCD on their own, when coupled with microscopic features such as sickled erythrocytes and evidence of chronic venous congestion (i.e., Gamna-Gandy bodies), these clues can help alert forensic pathologists to the presence of SCD. Despite the prevalence of the disease and the constellation of findings alluded to above, SCD is not often explored in forensic pathology literature. This case demonstrates classic acute and chronic features of SCD on PMCT, macroscopic and microscopic examinations. It explores the pathophysiology leading to sudden and unexpected death in a person with SCD and possible pitfalls in attribution of cause of death.
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Affiliation(s)
- Teaghan Koster
- Department of Pathology and Molecular Medicine, Queen's University, 76 Stuart St, Kingston, ON, K7L 2V7, Canada.
| | | | - David J Clutterbuck
- Provincial Forensic Pathology Unit, Ontario Forensic Pathology Service, 25 Morton Shulman Avenue, Toronto, ON, M3M 0B1, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Canada
- Division of Physician Assistant Education, University of Nebraska Medical Center, Omaha, USA
| | - Hadas Benhabib
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4th Floor, Toronto, ON, M5T 1W7, Canada
| | - Jayantha Herath
- Provincial Forensic Pathology Unit, Ontario Forensic Pathology Service, 25 Morton Shulman Avenue, Toronto, ON, M3M 0B1, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Canada
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Grützediek K, Fischer R, Kurio G, Böckelmann L, Bleeke M, Hagar RW, Tahir E, Grosse R, Weyhmiller M, Adam G, Bannas P, Schoennagel BP. Rapid MRI Assessment of Long-Axis Strain to Indicate Systolic Dysfunction in Patients With Sickle Cell Disease. J Magn Reson Imaging 2023; 58:1499-1506. [PMID: 36789724 DOI: 10.1002/jmri.28623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Patients with sickle cell disease (SCD) have a unique form of cardiomyopathy. However, left ventricular ejection fraction (LVEF) is often preserved. Monoplanar long-axis strain (LAS) can be assessed from MRI four-chamber views and may be better at detecting mild systolic dysfunction in these patients. PURPOSE To compare LAS (monoplanar and biplanar) with LVEF as a marker of systolic dysfunction in SCD patients. STUDY TYPE Retrospective. SUBJECTS A total of 20 patients with genetically proven SCD (35 MRI examinations), 39 healthy controls, and 124 patients with systemic iron overload (for validation purposes). FIELD STRENGTH/SEQUENCE 1.5 T/3 T. Cine balanced steady-state free-precession. ASSESSMENT Rapidly assessed biplanar LAS from four- and two-chamber views was correlated with age and compared to LVEF by two operators. For validation, biplanar LAS was compared to global longitudinal strain (GLS) using MRI feature-tracking in 124 patients with systemic iron overload. STATISTICAL TESTS Bland-Altman analysis. Wilcoxon-Mann-Whitney test and Spearman-rank correlation (correlation coefficient, rS ). Receiver-operating-characteristic (ROC) curve analysis (area under the curve, AUC). Bivariate discriminant analysis. Significance level: P < 0.01. RESULTS There was strong correlation between biplanar LAS and GLS using feature tracking (rS = 0.73). Interoperator agreement showed nonsignificant bias for biplanar LAS (-0.02%; ±95%-agreement interval -2.2%/2.2%, P = 0.9). Biplanar LAS increased significantly with age in controls (rS = 0.70). In SCD patients, biplanar LAS was better correlated with age than monoplanar LAS (r2 = 0.53, standard error of estimate, SEE = 1.4% vs. r2 = 0.37;SEE = 2.0%). ROC analysis of LVEF, biplanar LAS, and age-adjusted Z-scores Z (LAS(age)) showed AUCs of 0.69, 0.75, and 0.86 for differentiation between SCD patients and controls. Bivariate discriminant analysis of biplanar Z (LAS(age)) and LVEF revealed a sensitivity of 63% and a specificity of 95%. DATA CONCLUSION Rapidly assessed biplanar LAS demonstrated high diagnostic accuracy and was an indicator of mild systolic dysfunction in patients with SCD. Biplanar LAS provided more precise measurements than monoplanar, and normalization to age increased diagnostic accuracy. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Katharina Grützediek
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Roland Fischer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
- UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Gregory Kurio
- UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Lukas Böckelmann
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Matthias Bleeke
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | | | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Regine Grosse
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | | | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
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Longitudinal analysis of cardiac abnormalities in pediatric patients with sickle cell anemia and effect of hydroxyurea therapy. Blood Adv 2021; 5:4406-4412. [PMID: 34529023 PMCID: PMC8579269 DOI: 10.1182/bloodadvances.2021005076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/04/2021] [Indexed: 01/26/2023] Open
Abstract
Cardiac abnormalities in children and young adults with sickle cell anemia are common. Timely initiation of treatment with hydroxyurea may lead to reverse cardiac remodeling and improvement in these cardiac abnormalities.
Cardiac abnormalities such as left ventricular hypertrophy, left ventricular dilation, and pulmonary hypertension in sickle cell anemia have been previously described. Hydroxyurea, a disease-modifying therapy for sickle cell anemia, has been used for several decades. Longitudinal assessment of echocardiographic abnormalities in children and young adults with sickle cell anemia receiving hydroxyurea therapy is lacking. The goal of this retrospective study was to determine the prevalence of echocardiographic abnormalities in children and young adults with sickle cell anemia and to examine the effects of hydroxyurea on reverse cardiac remodeling. We reviewed the records of patients with sickle cell anemia who underwent routine cardiac screening at Cohen Children’s Medical Center between 2010 and 2017, followed by retrospective longitudinal analysis of echocardiograms performed on patients receiving treatment with hydroxyurea. Data on a total of 100 patients with sickle cell anemia were analyzed; 60 (60%) were being treated with hydroxyurea. Twenty-five (41.6%) of the patients on hydroxyurea had been treated for <1 year; these patients had a significantly greater prevalence of left ventricular dilation compared with those who had been on treatment for >1 year. Serial echocardiograms of patients receiving hydroxyurea were then analyzed. Left ventricular dilation and hypertrophy improved significantly with hydroxyurea treatment. In addition, the left ventricular volume and mass correlated negatively with duration of treatment with hydroxyurea. Our study provides evidence that prolonged hydroxyurea therapy may lead to reverse cardiac remodeling. Future studies should attempt to follow up this patient cohort for a longer duration.
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