Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-26T21:00:31.259Z Has data issue: false hasContentIssue false
  • English
  • Français

Left ventricular function by echocardiogram in children with sickle cell anaemia in Mumbai, Western India

Published online by Cambridge University Press:  18 December 2014

Abhay Tidake ,
Pranil Gangurde ,
Anup Taksande ,
Ajay Mahajan  and
Pratap Nathani
Abhay Tidake*
Affiliation:
Department of Cardiology, LTMMC and LTMGH, Sion, Mumbai, India
Pranil Gangurde
Affiliation:
Department of Cardiology, LTMMC and LTMGH, Sion, Mumbai, India
Anup Taksande
Affiliation:
Department of Cardiology, LTMMC and LTMGH, Sion, Mumbai, India
Ajay Mahajan
Affiliation:
Department of Cardiology, LTMMC and LTMGH, Sion, Mumbai, India
Pratap Nathani
Affiliation:
Department of Cardiology, LTMMC and LTMGH, Sion, Mumbai, India
*
Correspondence to: Dr A. Tidake, Department of Cardiology, LTMMC and LTMGH, Sion, Mumbai-400022, India. Tel: +91-9967885747; Fax: +91-22-24076100; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Cardiovascular events and complications are the leading cause of mortality and morbidity in patients with sickle cell disease. Cardiac abnormalities occur frequently and at an early stage in sickle cell anaemia patients, despite being more evident in adulthood. Sickle cell anaemia patients are increasingly able to reach adulthood owing to improved healthcare, and may, therefore, suffer the consequences of chronic cardiac injury. Thus, the study of cardiac abnormalities is essential in children

Objective

The aim of this study was to determine the echocardiographic changes in left ventricular function in children suffering from sickle cell disease in Mumbai, Western India.

Methods

The study comprised of 48 cases of sickle cell anaemia and 30 non-anaemic controls with normal haemoglobin and electrophoresis pattern. M-mode, two-dimensional, and Doppler echocardiographic measurements of patients and controls were performed according to the criteria of the American Echocardiography Society.

Results

On Doppler study, the A wave height was increased and the E/A ratio was decreased, whereas the deceleration and isovolumetric relaxation times were prolonged, which is typically seen in slowed or impaired myocardial relaxation (p<0.001). Although chamber dilatations were present, echocardiographic parameters showed no statistically significant correlation with severity of anaemia and age among the sickle cell patients.

Conclusions

We conclude that the increased left ventricular stiffness, compared with controls, might be due to fibrosis related to ischaemia caused by SS disease in addition to wall hypertrophy.

Keywords

Sickle cell anaemiadeceleration timeisovolumetric relaxation time
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 7 , October 2015 , pp. 1319 - 1325
Check for updates
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. De Baun, MR, Vichinsky, E. Haemoglobinopathies. In: Bherman RE, Kliegman RM, Jenson HB (eds). Nelson Textbook of Paediatrics, 18th edn. Judith Fletcher, New York, 2008: 2025–2038.Google Scholar
2. Herrick, JB. Peculiar elongated and sickle-shaped red blood corpuscles in a case of severe anaemia. Arch Intern Med 1910; 6: 517–521.Google Scholar
3. Shukla, RM, Solanki, BR. Sickle cell trait in central India. Lancet 1985; 1: 297–298.Google Scholar
4. Lester, LA, Sodt, PC, Hutcheon, N, Arcilla, RA. Cardiac abnormalities in children with sickle cell anemia. Chest 1990; 11: 1169–1174.Google Scholar
5. Grossman, W, Jones, D, McLaurin, LP. Wall stress and patterns of hypertrophy in the human left ventricle. J Clin Invest 1975; 56: 56–64.Google Scholar
6. Gerry, JL, Baird, MG, Nicholas, JF. Evaluation of left ventricular function in patients with sickle cell anaemia. Am J Med 1976; 60: 968–972.Google Scholar
7. Hassell, KL. Population estimates of sickle cell disease in the US. Am J Prev Med 2010; 38: S512–S521.CrossRefGoogle Scholar
8. Devereux, RB, Alonso, DR, Lutas, EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458.Google Scholar
9. Tei, C, Ling, LH, Hodge, DJ, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function – a study in normals and dilated cardiomyopathy. J Cardiol 1995; 26: 327–366.Google Scholar
10. Gladwin, MT, Sachdev, V, Jison, ML, et al. Pulmonary hypertension as a risk factor for death in patients with sickle cell disease. N Engl J Med 2004; 350: 886–895.Google Scholar
11. Ataga, KI, Sood, N, De Gent, G, et al. Pulmonary hypertension in sickle cell disease. Am J Med 2004; 117: 665–669.Google Scholar
12. Gerry, GL, Bulkley, BH, Hutchins, GM. Clinicopathological analysis of cadiac dysfunction in 52 patients with sickle cell anaemia. Am J Cardiol 1978; 42: 211–216.Google Scholar
13. Sachdev, V, Machado, RF, Shizukuda, Y, et al. Diastolic dysfunction is an independent risk factor for death in patients with sickle cell disease. J Am Coll Cardiol 2007; 49: 472–479.CrossRefGoogle ScholarPubMed
14. Covitz, W, Espeland, M, Gallagher, D, Hellenbrand, W, Leff, S, Talner, N. The heart in sickle cell anaemia. The cooperative study of sickle cell disease (CSSCD). Chest 1995; 108: 1214–1219.CrossRefGoogle ScholarPubMed
15. Martins, W, Mesquita, ET, Cunha, DM, Pinheiro, LA, Romeo Filho, LJ. Pareto Junior RC. Doppler echocardiographic study in adolescents and young adults with sickle cell anemia [in Portuguese]. Arq Bras Cardiol 1999; 73: 463–474.Google Scholar
16. Willens, HJ, Lawrence, C, Frishman, WH, Strom, JA. A noninvasive comparison of left ventricular performance in sickle cell anaemia and chronic aortic regurgitation. Clin Cardiol 1983; 6: 542–548.Google Scholar
17. Seliem, MA, Al-Saad, HI, Bou-Holaigah, IH, Khan, MN, Palileo, MR. Left ventricular diastolic dysfunction in congenital chronic anaemias during childhood as determined by comprehensive echocardiographic imaging including acoustic quantification. Eur J Echocardiogr 2002; 3: 103–110.Google Scholar
18. Ribera, MC, Ribera, RB, Koifman, RJ, Koifman, S. Echocardiography in sickle cell anaemia patients under 20 years of age: a descriptive study in the Brazilian Western Amazon. Cardiol Young 2013, 24: 1–8; [Epub ahead of print].Google Scholar
19. Kilinc, Y, Acarturk, E, Kumi, M. Echocardiographic findings in mild and severe forms of sickle cell anaemia. Acta Paediatr Jpn 1993; 35: 243–246.CrossRefGoogle Scholar
20. Wali, YA, Venugopalan, P, Rivera, E, al-Lamki, Z. Cardiovascular function in Omani children with sickle cell anaemia. Ann Trop Paediatr 2000; 20: 243–246.Google Scholar
21. Ghaderian, M, Keikhaei, B, Heidari, M, Salehi, Z, Azizi Malamiri, R. Tissue doppler echocardiographic findings of left ventricle in children with sickle-cell anemia. The Journal of Tehran University Heart Center 2012; 7: 106–110.Google Scholar
22. Kato, GJ, Onyekwere, OC, Gladwin, MT. Pulmonary hypertension in sickle cell disease: relevance to children. Pediatr Hematol Oncol 2007; 24: 159–170.Google Scholar
23. Minniti, CP, Sable, C, Campbell, A, et al. Elevated tricuspid regurgitant jet velocity in children and adolescents with sickle cell disease: association with hemolysis and hemoglobin oxygen desaturation. Haematologica 2009; 94: 340–347.Google Scholar
24. Zilberman, MV, Du, W, Das, S, Sarnaik, SA. Evaluation of left ventricular diastolic function in paediatric sickle- cell disease patients. Am J Hematol 2007; 82: 433–438.Google Scholar
25. Cox, SE, Soka, D, Kirkham, FJ, et al. Tricuspid regurgitant jet velocity and hospitalization in Tanzanian children with sickle cell anemia. Haematologica 2014; 99: e1–e4; doi:10.3324/haematol.2013.089235.Google Scholar