Surrogates of Poor Prognostic Sign in Adult Patients with Homozygous Sickle Cell Disease: An Echocardiographic Study.
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Date
2014-09-11
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Abstract
Background: Pulmonary Arterial hypertension (PAH) is a late complication in adult
patients with homozygous sickle cell Anaemia (SCA). The early identification of PAH
may be of paramount importance.
Aim: This study is aimed at evaluating the usefulness of NT pro BNP in the assessment
of diastolic function of RV in adult patients with sickle cell disease. It is also aimed at the
assessment of the predictive risk of serum level of NT pro BNP hormone and ferritin with
other pulsed and tissue Doppler indices for the development of pulmonary hypertension
in patients with SCA. In addition, we measured the usefulness of tissue Doppler velocity
of lateral annulus of tricuspid valve in the assessment of diastolic function of RV in adult
patients with SCD.
Method: In this cross sectional prospective study, 103 patients with homozygous SCD
were studied and compared with age and gender matched healthy control. Every patient
had a clinical assessment, pulsed and tissue Doppler evaluation. Blood samples were
withdrawn for the level of haemoglobin, ferritin and NT pro BNP hormone. The mean
Original Research Article
British Journal of Medicine & Medical Research, 4(26): 4431-4443, 2014
4432
difference between the two groups for echo Doppler and biometric variables were
assessed. Multiple regression analysis applied for measuring the odds ratio of different
biometric and Doppler variables for risk of PAH in SCD.
Results: The study group consist of 103 patients with SCA, mean age of 28.52±14.11
year, (range 14-42), with 68 male (66.0%) Patients with SCA compared with control had
a significantly low diastolic pressure, lower haemoglobin level but high serum level
ferritin and pro BNP hormone. Further, there was a significant increment in the left atrium
area (LA), higher right ventricle (RV) wall thickness and diameter. The RV tricuspid
annular systolic excursion (TAPSE) was high of 1.42±0.21 vs. 1.11±0.23, P<0.05. RV
Pulsed Doppler data showed restrictive filling pattern with significant higher E wave
velocity, higher early diastolic filling wave (E)/ atria wave velocity (A) ratio and short
Deceleration Time (DT). Further, the ratio of upper pulmonary vein for systolic/diastolic
Doppler velocity was significantly lower 1.5±0.12 vs.2.4±0.11, p<0.05. The tissue
Doppler of lateral annulus of tricuspid valve in SCA patients showed a significantly lower
S wave of 6.7±1.7 vs 11.3±1.9, p<0.01, higher pulsed early velocity( E)/ early Tissue
velocity (E-) ratio and lower atria wave velocity (A). The incidence of pulmonary
hypertension in SCD patients via tricuspid valve velocity defined as ≥2.5 m/s was 28%.
There were positive correlation between the serum level of ferritin, NT pro BNP hormone
and tricuspid valve velocity of (r= 0.38) and (r=0.43) respectively. The odds ratio for
development of PAH was 3.1 for E/E- ratio ≥13, 2.5 for DT of <160msec, 2.2 for Left
ventricle mass Index (LVMI)>121 gm/M2, 1.9 for ferritin ≥600g/l, 1.6cm for left atrial
area ≥20cm, 1.3 for pro- BNP ≥150Pmol/L.
Conclusion: Adult patients with SCA have normal Systolic function but increase of LV
mass and restrictive diastolic dysfunction. RV has increase wall thickness, systolic and
diastolic dysfunction of restrictive pattern. The prevalence of pulmonary hypertension in
SCA is 28% with positive correlation between ferritin, pro BNP level and tricuspid valve
velocity on echo. The risk of PAH in SCA patients is higher if the patient had on echo DT
<160msec, LVMI >121gm/M2, cm, E/E- ratio ≥13 or RV wall thickness >3mm.
Description
Keywords
Adult sickle anaemia, tissue doppler echocardiogram, pro-BNP, Bahrain
Citation
Garadah Taysir, Hassan Adla B, Alawi Mohamed Al, Jaradat Ahmed, Sequeira Reginald , Qureshi Fathia.Surrogates of Poor Prognostic Sign in Adult Patients with Homozygous Sickle Cell Disease: An Echocardiographic Study. British Journal of Medicine and Medical Research. 2014 Sept; 4(26): 4431-4443.