Chiadika Simbo, Lim-Fung Mary, Llanos-Chea Fiorella, Serauto Canache Astrid, Yang Wei, Paruthi Christina, Zhang Xu, McPherson David D, Idowu Modupe
Division of Cardiology, Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA.
Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA.
Echocardiography. 2018 Sep;35(9):1271-1276. doi: 10.1111/echo.14028. Epub 2018 May 14.
Sickle cell disease (SCD) affects millions of people and causes chronic hemolytic anemia leading to vasculopathies such as pulmonary hypertension and abnormalities in cardiac function that increase complications and mortality. It is therefore crucial to identify cardiac abnormalities in SCD. We aimed to assess the prevalence of echocardiographic parameters in SCD to help identify cardiopulmonary risk.
Ninety-one patients (53% male), median age of 30, body surface area (BSA) of 1.79 m , hemoglobin of 8.8 g/dL, and creatinine of 0.7 mg/dL identified. We retrospectively measured laboratory and echocardiographic parameters in patients with SCD : left ventricular (LV) dimensions, LV ejection fraction (LVEF), LV Myocardial Performance Index (MPI), LV Mass Index (MI), Left Atrial Volume Index (LAVI), Tricuspid Regurgitation Velocity (TRV), tricuspid annular plane systolic excursion (TAPSE), right heart dimensions.
Prevalence of left heart abnormalities was 32%: increased LV end-diastolic diameter (EDD), 78%: LV MPI, 21%: diastolic dysfunction, 38%: decreased LVEF, 24%: increased LVMI, and 47%: increased LAVI. Right heart abnormalities were 39%: TAPSE, 38%: increased TRV, and 59%: increased pulmonary systolic pressure (PASP). Multivariate logistic regression analysis was significant for increased LVMI and LAVI in those with hemoglobin ≤8 g/dL (odds ratio (OR) 7.4, 95% confidence interval (CI) 2.23-24.6, P = .001) and (OR 3.32, 95% CI 1.18-9.33, P = .023).
We confirmed increased prevalence of abnormal LVEDD, LVMI, diastolic function, LAVI, and PASP in SCD. In addition, we identified abnormal LV MPI (78%), TAPSE (29%). These parameters may be useful and readily accessible echocardiographic prognostic tools in this population.
镰状细胞病（SCD）影响着数百万人，导致慢性溶血性贫血，进而引发诸如肺动脉高压等血管病变以及心脏功能异常，增加了并发症和死亡率。因此，识别SCD患者的心脏异常至关重要。我们旨在评估SCD患者超声心动图参数的患病率，以帮助识别心肺风险。
纳入91例患者（53%为男性），中位年龄30岁，体表面积（BSA）为1.79 m²，血红蛋白为8.8 g/dL，肌酐为0.7 mg/dL。我们回顾性测量了SCD患者的实验室和超声心动图参数：左心室（LV）尺寸、左心室射血分数（LVEF）、左心室心肌性能指数（MPI）、左心室质量指数（MI）、左心房容积指数（LAVI）、三尖瓣反流速度（TRV）、三尖瓣环平面收缩期位移（TAPSE）、右心尺寸。
左心异常的患病率为32%：左心室舒张末期内径（EDD）增加、78%：左心室MPI升高、21%：舒张功能障碍、38%：LVEF降低、24%：左心室质量指数（LVMI）增加、47%：LAVI增加。右心异常为39%：TAPSE、38%：TRV升高、59%：肺动脉收缩压（PASP）升高。多因素逻辑回归分析显示，血红蛋白≤8 g/dL的患者中，LVMI和LAVI升高具有显著性（比值比（OR）7.4，95%置信区间（CI）2.23 - 24.6，P = 0.001）以及（OR 3.32，95% CI 1.18 - 9.33，P = 0.023）。
我们证实了SCD患者中异常LVEDD、LVMI、舒张功能、LAVI和PASP的患病率增加。此外，我们还发现了异常的左心室MPI（78%）、TAPSE（29%）。这些参数可能是该人群中有用且易于获取的超声心动图预后工具。
