Cardiac Structural and Functional Changes Evaluated by Transthoracic and Tissue Doppler Echocardiography in Adult Patients with Sickle Cell Disease

Left ventricular geometry and electrocardiographic criteria in assessing left ventricular hypertrophy in sickle cell anemia patients

BACKGROUND

Left ventricular hypertrophy (LVH) is recognized as a cardiovascular risk factor and is a known consequence of sickle cell anemia (SCA). Abnormal left ventricular geometric patterns have been described but the determinants have not been well elucidated.

METHOD

Electrocardiography (ECG) and Echocardiography (ECHO) was done on subjects with SCA and hemoglobin A(HBA). Those with systemic hypertension were excluded. Voltages, durations, and intervals were measured as appropriate and recorded in a standard proforma. Analysis was made using a standard statistical software.

RESULTS

Eighty four people with SCA and 91 with HBA were recruited as cases and controls respectively. Subjects with SCA have more abnormal LV geometric patterns than those with HBA(p=0.000). Eccentric LVH(p=0.000) was more in SCA subjects while concentric LVH(p=0.054) and concentric remodeling(p=0.319) were not. Forty-one and fifty-two subjects with SCA and HBA respectively did ECGs. . Subjects with eccentric LVH had lower hip circumference, higher left atrial diameter, right atrial area, higher sokolow-lyon voltage sum, stroke volume and cardiac output. The Sokolow-Lyon voltage criteria at the traditional cut off point was not different between those with and without eccentric LVH. However, Sokolow-Lyon voltage criteria at a cut-off of ≥4.7mV detected eccentric LVH with a sensitivity of 60% and specificity of 83.3%.While Sokolow-Lyon voltage sum, stroke volume, right atrial area, and left atrial diameter correlated positively, pulse rate and hip circumference correlated inversely with eccentric LVH. Sokolow Lyon voltage sum was the independent determinant of eccentric LVH in this study.

CONCLUSION

Sickle cell anemia predisposes to abnormal LV geometric patterns, especially eccentric LVH. There may be a need to review the electrocardiographic cut off points for defining eccentric LVH in the SCA populace.

Myocardial Performance Index Among Patients of Sickle Cell Disorder in Rural Teaching Hospital: A Case-Control Study

OBJECTIVE

To evaluate the myocardial performance index (MPI) in sickle cell disease (SCD) patients, and to compare MPI in healthy individuals.

METHODS

In this case-controlled study, patients of SCD and age- and sex-matched controls were included. MPI was determined using echocardiographic Doppler-derived parameters. MPI according to disease type, sickle cell crisis, and in the presence of co-morbidities was compared.  Results: Between October 2018 and September 2020, we enrolled 100 SCD patients and 100 age and sex-matched controls. The MPI was significantly higher in SCD than in the control group (0.411±0.028 vs. 0.387±0.015, respectively; p<0.0001). There was no difference in MPI according to disease type as SS or AS (p=0.903). In patients with sickle cell crisis, mean MPI was significantly higher than those without sickle cell crisis (0.443±0.003 vs. 0.403±0.025, respectively; p<0.0001). In patients with comorbidities, mean MPI was significantly higher than those without any comorbidity (0.432±0.021 vs. 0.404±0.026, respectively; p<0.0001).

CONCLUSION

MPI can be a non-invasive tool for assessing subclinical cardiac dysfunction and should be considered for evaluating patients with SCD.

Evaluation of Cardiac Function in Patients with Sickle Cell Disease with Left Ventricular Global Longitudinal Strain

Background and Objectives

The importance of myocardial dysfunction in sickle cell disease (SCD) is currently debated. It is difficult to find a reliable index of function in patients with chronic overload as in SCD. Speckle tracking echocardiography, a new mean of evaluating cardiac function, might be a useful tool in SCD. It has been applied in many fields to detect early cardiac function deterioration, and it is less load dependent compared with other function parameters. Studies in patients with SCD are rare, and the results are conflicting. The present study aimed to determine whether left ventricular global longitudinal strain (LV-GLS) was abnormal in a population of adults with SCD and whether it was correlated with clinical or biological parameters.

Methods

We prospectively enrolled 37 patients and 34 age- and sex-matched healthy controls. Echocardiography was performed in patients and controls.

Results

We found that the left ventricular diameter and mass were higher and the ejection fraction and longitudinal strain were lower in patients compared with controls. Diastolic dysfunction was uncommon. LV-GLS was abnormal in 21% of the patients. No correlation was observed between strain and clinical or biological parameters.

Conclusions

We concluded that LV-GLS could be a useful tool for evaluating these patients. However, the clinical impact of reduced LV-GLS remains to be determined.