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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; 40:1413-1421. [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] [MESH Headings] [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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d'Humières T, Bouvarel A, Boyer L, Savale L, Guillet H, Alassaad L, de Luna G, Berti E, Iles S, Pham Hung d'Alexandry d'Orengiani AL, Audureau E, Troupe MJ, Schlatter RC, Lamadieu A, Galactéros F, Derumeaux G, Messonnier LA, Bartolucci P. Cardiac diastolic maladaptation is associated with the severity of exercise intolerance in sickle cell anemia patients. Sci Rep 2024; 14:11095. [PMID: 38750085 PMCID: PMC11096405 DOI: 10.1038/s41598-024-61689-w] [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: 07/12/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
This pilot study focusing on Sickle Cell Anemia (SCA) patients offers a comprehensive and integrative evaluation of respiratory, cardiovascular, hemodynamic, and metabolic variables during exercise. Knowing that diastolic dysfunction is frequent in this population, we hypothesize that a lack of cardiac adaptation through exercise might lead to premature increase in blood lactate concentrations in SCA patients, a potential trigger for acute disease complication. SCA patients were prospectively included in PHYSIO-EXDRE study and underwent a comprehensive stress test with a standardized incremental exercise protocol up to 4 mmol L-1 blood lactate concentration (BL4). Gas exchange, capillary lactate concentration and echocardiography were performed at baseline, during stress test (at ∼ 2 mmol L-1) and BL4. The population was divided into two groups and compared according to the median value of percentage of theoretical peak oxygen uptake (%V ˙ O 2 p e a k t h ) at BL4. Twenty-nine patients were included (42 ± 12 years old, 48% of women). Most patients reached BL4 at low-intensity exercise [median value of predicted power output (W) was 37%], which corresponds to daily life activities. The median value of %V ˙ O 2 p e a k t h at BL4 was 39%. Interestingly, diastolic maladaptation using echocardiography during stress test along with hemoglobin concentration were independently associated to early occurrence of BL4. As BL4 occurs for low-intensity exercises, SCA patients may be subject to acidosis-related complications even during their daily life activities. Beyond assessing physical capacities, our study underlines that diastolic maladaptation during exercise is associated with an early increase in blood lactate concentration.
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Affiliation(s)
- Thomas d'Humières
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France.
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
- Sickle Cell Referral Center-UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP, Créteil, France.
| | - Antoine Bouvarel
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Laurent Boyer
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Laurent Savale
- Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Henri Guillet
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC/Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Sickle Cell Referral Center-UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP, Créteil, France
| | - Lara Alassaad
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Gonzalo de Luna
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC/Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Sickle Cell Referral Center-UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP, Créteil, France
| | - Enora Berti
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Sihem Iles
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | | | - Etienne Audureau
- Biostatistics Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- CEpiA IMRB U955, FHU SENEC, Université Paris Est (UPEC), Créteil, France
| | - Marie-Joelle Troupe
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Reine-Claude Schlatter
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Anaïs Lamadieu
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Frédéric Galactéros
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC/Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Sickle Cell Referral Center-UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP, Créteil, France
| | - Geneviève Derumeaux
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Laurent A Messonnier
- Inter-University Laboratory of Human Movement Sciences EA 7424, Université Savoie Mont Blanc, Chambéry, France
| | - Pablo Bartolucci
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC/Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Sickle Cell Referral Center-UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP, Créteil, France
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3
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Pinto DMR, do Sacramento MDS, Santos PHS, Silva WS, de Oliveira EC, Gardenghi G, Ladeia AMT, Petto J. Physical exercise in sickle cell anemia: a systematic review. Hematol Transfus Cell Ther 2020; 43:324-331. [PMID: 33032952 PMCID: PMC8446247 DOI: 10.1016/j.htct.2020.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Sickle cell anemia (SCA) is a genetic condition that alters the conformation of deoxygenated red blood cells, which results in their stiffening and the occurrence of vaso-occlusive crises, endothelium damage, organ dysfunction and systemic complications. Additionally, SCA limits the participation of individuals in physical and social activities. As we consider that physical exercise promotes the recovery of functional capacity and cardiorespiratory conditioning, we aim to verify the patterns of prescription, the effects and safety of exercise for individuals with SCA. METHODOLOGY We systematically reviewed the published literature focusing on clinical trials that correlated physical exercise with SCA patients and cross-sectional studies that applied the stress test. The data research was based on the PRISMA recommendations and the following databases were used: Medline by PubMed, Cochrane, PEDro, Scielo. RESULTS Six studies which were based on the evaluation of 212 patients aged between 13 and 40 years, were selected from 122 identified studies. Those studies associated the individual effort tolerance improvement, its inflammatory profile adjustment and the absence of alteration in the autonomic nervous system activity to physical exercise or stress test. CONCLUSION Low-to-moderate intensity physical exercise increased the SCA individual tolerance without causing vaso-occlusive crises, nor changes in the hemorheological and inflammatory profiles.
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Affiliation(s)
| | - Marvyn de Santana do Sacramento
- Actus Cordios Reabilitação Cardiovascular, Respiratória e Metabólica, Salvador, BA, Brazil; Centro Universitário Social da Bahia (UNISBA), Salvador, BA, Brazil.
| | - Pedro Henrique Silva Santos
- Fundação Estatal de Saúde da Família (FESF-SUS), Salvador, BA, Brazil; Fundação Oswaldo Cruz (Fiocruz Bahia - IGM), Salvador, BA, Brazil
| | | | | | - Giulliano Gardenghi
- Hospital Encore, Aparecida de Goiânia, Goiás, GO, Brazil; Faculdade Ceafi, Goiânia, GO, Brazil; Lifecare, Hugol, Unidade de Terapia Intensiva em Queimados, Goiânia, Go, Brazil; Hospital e Maternidade São Cristóvão, São Paulo, SP, Brazil
| | | | - Jefferson Petto
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil; Actus Cordios Reabilitação Cardiovascular, Respiratória e Metabólica, Salvador, BA, Brazil; Centro Universitário Social da Bahia (UNISBA), Salvador, BA, Brazil
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4
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Gellen B, Messonnier LA, Galactéros F, Audureau E, Merlet AN, Rupp T, Peyrot S, Martin C, Féasson L, Bartolucci P, Habibi A, Guillet E, Gellen-Dautremer J, Ribeil JA, Arlet JB, Mattioni S, Berkenou J, Delrieux N, Lionnet F, Grenot JF, Mira J, Peyrard A, Lacroix R, Garcin A, Di Liberto G, Hourdé C. Moderate-intensity endurance-exercise training in patients with sickle-cell disease without severe chronic complications (EXDRE): an open-label randomised controlled trial. LANCET HAEMATOLOGY 2018; 5:e554-e562. [PMID: 30389037 DOI: 10.1016/s2352-3026(18)30163-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 01/17/2023]
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Badawy SM, Payne AB, Rodeghier MJ, Liem RI. Exercise capacity and clinical outcomes in adults followed in the Cooperative Study of Sickle Cell Disease (CSSCD). Eur J Haematol 2018; 101:532-541. [PMID: 29999202 DOI: 10.1111/ejh.13140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine the factors associated with exercise capacity in adults with sickle cell disease (SCD) and its relationship to hospitalizations and mortality. METHODS A total of 223 participants in the Cooperative Study of Sickle Cell Disease (CSSCD) (64% female, 70% hemoglobin SS/Sβ0 thalassemia, mean age 43.3 ± 7.5 years) underwent maximal exercise testing using a treadmill protocol with a mean duration of 11.6 ± 5.2 minutes. RESULTS Female sex (β = -3.34, 95% CI [-1.80, -4.88], P < 0.001), older age (β = -0.14, 95% CI [-0.24, -0.04], P = 0.005), higher body mass index (β = -0.23, 95% CI [-0.37, -0.10]; P = 0.001), and lower hemoglobin (β = 0.56, 95% CI [0.08, 1.04], P = 0.02) were independently associated with lower fitness, while there was a trend with abnormal pulmonary function testing (β = -1.42, 95% CI [-2.92, 0.07]; P = 0.06). Lower percent-predicted forced expiratory volume in 1 second (FEV1 ) was independently associated with lower fitness (β = 0.08, 95% CI [0.03, 0.13], P = 0.001). Genotype and hospitalization rates for pain and acute chest syndrome (ACS) prior to testing were not associated with exercise capacity. Baseline exercise capacity predicted neither future pain or ACS nor survival in our cohort. Adults with SCD tolerated maximal exercise testing. CONCLUSIONS Prospective studies are needed to further evaluate the impact of regular exercise and improved fitness on clinical outcomes and mortality in SCD.
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Affiliation(s)
- Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School Medicine, Chicago, Illinois
| | - Amanda B Payne
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Robert I Liem
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School Medicine, Chicago, Illinois
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6
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Lopes AJ, Marinho CL, Alves UD, Gonçalves CEA, Silva PO, Botelho EC, Bedirian R, Soares AR, Maioli MCP. Relationship between ventilation heterogeneity and exercise intolerance in adults with sickle cell anemia. ACTA ACUST UNITED AC 2017; 50:e6512. [PMID: 28746470 PMCID: PMC5520223 DOI: 10.1590/1414-431x20176512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/09/2017] [Indexed: 12/18/2022]
Abstract
Sickle cell anemia (SCA) causes dysfunction of multiple organs, with pulmonary involvement as a major cause of mortality. Recently, there has been growing interest in the nitrogen single-breath washout (N2SBW) test, which is able to detect ventilation heterogeneity and small airway disease when the results of other pulmonary function tests (PFTs) are still normal. Thus, the objectives of the present study were to assess the heterogeneity in the ventilation distribution in adults with SCA and to determine the association between the ventilation distribution and the clinical, cardiovascular, and radiological findings. This cross-sectional study included 38 adults with SCA who underwent PFTs, echocardiography, computed tomography (CT), and 6-min walk test. To evaluate the ventilation heterogeneity, the patients were categorized according to the phase III slope of the N2SBW (SIIIN2). Compared with adults with lower SIIIN2 values, adults with higher SIIIN2 values showed lower hemoglobin levels (P=0.048), a history of acute chest syndrome (P=0.001), an elevated tricuspid regurgitation velocity (P=0.039), predominance of a reticular pattern in the CT (P=0.002), a shorter 6-min walking distance (6MWD) (P=0.002), and lower peripheral oxygen saturation (SpO2) after exercise (P=0.03). SIIIN2 values correlated significantly with hemoglobin (rs=-0.344; P=0.034), forced vital capacity (rs=-0.671; P<0.0001), diffusing capacity for carbon monoxide (rs=-0.376; P=0.019), 6MWD (rs=-0.554; P=0.0003), and SpO2 after exercise (P=0.040). Heterogeneity in the ventilation distribution is one of the most common pulmonary dysfunctions in adults with SCA. Moreover, relationships exist between ventilation heterogeneity, worsening of pulmonary structural damage, and reduced tolerance for exercise.
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Affiliation(s)
- A J Lopes
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil.,Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - C L Marinho
- Programa de Pós-Graduação em Fisiopatologia Clínica e Experimental, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - U D Alves
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - C E A Gonçalves
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - P O Silva
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - E C Botelho
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - R Bedirian
- Disciplina de Clínica Médica, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - A R Soares
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Disciplina de Hematologia e Hemoterapia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - M C P Maioli
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Disciplina de Hematologia e Hemoterapia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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7
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Farmakis D, Triposkiadis F, Lekakis J, Parissis J. Heart failure in haemoglobinopathies: pathophysiology, clinical phenotypes, and management. Eur J Heart Fail 2016; 19:479-489. [PMID: 28000341 DOI: 10.1002/ejhf.708] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/18/2016] [Accepted: 11/07/2016] [Indexed: 12/28/2022] Open
Abstract
Hereditary haemoglobinopathies, mainly beta-thalassemia and sickle cell disease, constitute the most common monogenic disorders in humans, and although once geographically confined, they are currently globally distributed. They are demanding clinical entities that require multidisciplinary medical management. Despite their genotypic and phenotypic heterogeneity, the haemoglobinopathies share several similarities in pathophysiology, clinical manifestations, therapeutic requirements, and complications, among which heart failure (HF) represents a leading cause of mortality and morbidity. However, haemoglobinopathies have generally been addressed in a rather fragmentary manner. A unifying approach focusing on the underlying similarities of HF attributes in the two main entities might contribute to their better understanding, characterization, and management. In the present review, we attempt such an approach to the pathophysiology, clinical phenotypes, and management of HF in haemoglobinopathies.
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Affiliation(s)
- Dimitrios Farmakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - John Lekakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Parissis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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8
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1191-1229. [DOI: 10.1093/ehjci/jew190] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/20/2022] Open
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9
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Pathophysiology and treatment of pulmonary hypertension in sickle cell disease. Blood 2016; 127:820-8. [PMID: 26758918 DOI: 10.1182/blood-2015-08-618561] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/21/2015] [Indexed: 12/11/2022] Open
Abstract
Pulmonary hypertension affects ∼10% of adult patients with sickle cell disease (SCD), particularly those with the homozygous genotype. An increase in pulmonary artery systolic pressure, estimated noninvasively by echocardiography, helps identify SCD patients at risk for pulmonary hypertension, but definitive diagnosis requires right-heart catheterization. About half of SCD-related pulmonary hypertension patients have precapillary pulmonary hypertension with potential etiologies of (1) a nitric oxide deficiency state and vasculopathy consequent to intravascular hemolysis, (2) chronic pulmonary thromboembolism, or (3) upregulated hypoxic responses secondary to anemia, low O2 saturation, and microvascular obstruction. The remainder have postcapillary pulmonary hypertension secondary to left ventricular dysfunction. Although the pulmonary artery pressure in SCD patients with pulmonary hypertension is only moderately elevated, they have a markedly higher risk of death than patients without pulmonary hypertension. Guidelines for diagnosis and management of SCD-related pulmonary hypertension were published recently by the American Thoracic Society. Management of adults with sickle-related pulmonary hypertension is based on anticoagulation for those with thromboembolism; oxygen therapy for those with low oxygen saturation; treatment of left ventricular failure in those with postcapillary pulmonary hypertension; and hydroxyurea or transfusions to raise the hemoglobin concentration, reduce hemolysis, and prevent vaso-occlusive events that cause additional increases in pulmonary pressure. Randomized trials have not identified drugs to lower pulmonary pressure in SCD patients with precapillary pulmonary hypertension. Patients with hemodynamics of pulmonary arterial hypertension should be referred to specialized centers and considered for treatments known to be effective in other forms of pulmonary arterial hypertension. There have been reports that some of these treatments improve SCD-related pulmonary hypertension.
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Tewari S, Brousse V, Piel FB, Menzel S, Rees DC. Environmental determinants of severity in sickle cell disease. Haematologica 2015; 100:1108-16. [PMID: 26341524 PMCID: PMC4800688 DOI: 10.3324/haematol.2014.120030] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/05/2015] [Indexed: 12/13/2022] Open
Abstract
Sickle cell disease causes acute and chronic illness, and median life expectancy is reduced by at least 30 years in all countries, with greater reductions in low-income countries. There is a wide spectrum of severity, with some patients having no symptoms and others suffering frequent, life-changing complications. Much of this variability is unexplained, despite increasingly sophisticated genetic studies. Environmental factors, including climate, air quality, socio-economics, exercise and infection, are likely to be important, as demonstrated by the stark differences in outcomes between patients in Africa and USA/Europe. The effects of weather vary with geography, although most studies show that exposure to cold or wind increases hospital attendance with acute pain. Most of the different air pollutants are closely intercorrelated, and increasing overall levels seem to correlate with increased hospital attendance, although higher concentrations of atmospheric carbon monoxide may offer some benefit for patients with sickle cell disease. Exercise causes some adverse physiological changes, although this may be off-set by improvements in cardiovascular health. Most sickle cell disease patients live in low-income countries and socioeconomic factors are undoubtedly important, but little studied beyond documenting that sickle cell disease is associated with decreases in some measures of social status. Infections cause many of the differences in outcomes seen across the world, but again these effects are relatively poorly understood. All the above factors are likely to account for much of the pathology and variability of sickle cell disease, and large prospective studies are needed to understand these effects better.
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Affiliation(s)
- Sanjay Tewari
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, London, England
| | - Valentine Brousse
- Reference Centre for Sickle Cell Disease, Pediatric Department, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris; Université Paris Descartes, France
| | | | - Stephan Menzel
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, London, England
| | - David C Rees
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, London, England
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