Resende Maria Betânia Solis, Ferrari Teresa Cristina A, Araujo Christiano Gonçalves, Vasconcelos Maria Carmen Melo, Tupinambás Julia Teixeira, Dias Rebeca Coeli Teodoro Maciel, Barros Flávio Coelho, Januário José Nélio, Barbosa Marcia Melo, Nunes Maria Carmo Pereira
School of Medicine, Hospital das Clinicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Fundação Centro de Hematologia E Hemoterapia de Minas Gerais (HEMOMINAS Foundation), Belo Horizonte, Brazil.
Int J Cardiovasc Imaging. 2020 Nov;36(11):2145-2153. doi: 10.1007/s10554-020-01924-3. Epub 2020 Jul 3.
Cardiovascular complications have been increasingly detected in patients with sickle cell disease (SCD). Two-dimensional speckle-tracking echocardiography (STE) detects early myocardial changes in a number of pathophysiological processes, which may be useful in SCD. This study was designed to examine the value of STE in predicting clinical outcome in adult patients with SCD. A total of 219 patients, mean age 33 ± 12 years were prospectively enrolled. Several clinical, laboratory and echocardiographic variables including left ventricular global longitudinal strain (LVGLS) by STE were assessed. The endpoint was a composite of the following events: (1) all-cause mortality, (2) three or more acute painful episodes that require hospitalization in one year, (3) acute chest syndrome and (4) hospitalization due to disease complication. The majority of the patients had enlargement of LV and left atrial (LA) with preserved ejection fraction. During the mean follow-up of 30 months, 69 patients (32%) had reached the endpoint, including eight deaths (3.7%). No difference was observed in the parameters of diastolic function comparing the patients with and without events. LVGLS ranged from - 12.25 to - 25.44 (mean - 20.26 ± 2.5), with higher values in the patients who had events compared with those who did not. In the multivariable analysis, higher LVGLS values were associated with adverse events (adjusted OR 1.25; 95% CI 1.04-1.51; p = 0.021), independently of the TR maximal velocity and LV ejection fraction. In patients with SCD, higher LV global longitudinal strain was a predictor of adverse outcome, independently of age, TR velocity and LV function.
心血管并发症在镰状细胞病（SCD）患者中越来越多地被检测到。二维斑点追踪超声心动图（STE）可检测多种病理生理过程中的早期心肌变化，这在SCD中可能有用。本研究旨在探讨STE在预测成年SCD患者临床结局中的价值。前瞻性纳入了总共219例患者，平均年龄33±12岁。评估了包括STE测量的左心室整体纵向应变（LVGLS）在内的多个临床、实验室和超声心动图变量。终点是以下事件的复合：（1）全因死亡率，（2）一年内需要住院治疗的三次或更多次急性疼痛发作，（3）急性胸综合征，以及（4）因疾病并发症住院。大多数患者左心室（LV）和左心房（LA）增大，射血分数保留。在平均30个月的随访期间，69例患者（32%）达到终点，包括8例死亡（3.7%）。比较有事件和无事件的患者，舒张功能参数未观察到差异。LVGLS范围为-12.25至-25.44（平均-20.26±2.5），有事件的患者的值高于无事件的患者。在多变量分析中，较高的LVGLS值与不良事件相关（调整后的OR为1.25；95%CI为1.04-1.51；p=0.021），独立于三尖瓣反流（TR）最大速度和左心室射血分数。在SCD患者中，较高的左心室整体纵向应变是不良结局的预测指标，独立于年龄、TR速度和左心室功能。
