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Left ventricular remodeling in patients with sickle cell disease: determinants factors and impact on outcome

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Abstract

Cardiovascular complications have been increasingly detected as a result of prolonged longevity of patients with sickle cell disease (SCD). Previous studies have focused especially on pulmonary hypertension and its consequences on the right-side heart chambers, whereas factors associated with morphological changes in left ventricle (LV) remain poorly understood. This study was designed to identify clinical, laboratorial, and echocardiographic parameters associated with LV remodeling and its impact on outcome in SCD. Ninety patients aged 28 ± 7 years and 20 age- and gender-balanced healthy subjects were enrolled. Laboratory tests, electrocardiogram, and an echocardiogram with tissue Doppler imaging were performed in all patients. Patients with SCD had larger left and right heart chambers dimensions, LV mass, and tricuspid regurgitation (TR) velocity compared to health controls with similar demographic features. Despite chambers enlargement, systolic function of both ventricles was preserved. The mitral inflow velocities were higher in the patients than in controls, whereas septal and lateral annular motion velocities were normal, suggesting normal ventricular relaxation. SCD patients who were on hydroxyurea therapy and/or hypertransfusion had higher hemoglobin concentrations, but similar echocardiographic findings in comparison to those without treatment. Systolic blood pressure, ferritin concentration, TR velocity, and parameters of diastolic function were independently associated with increased LV mass. In addition, the predictors of adverse events were ferritin concentration, lactate dehydrogenase levels, and TR velocity. LV remodeling in SCD patients seems to be influenced by a combination of factors including blood pressure, ferritin concentration, TR velocity, and parameters of LV diastolic function, and was not associated with adverse outcomes.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

    Maria Carmen M. Vasconcelos, Maria Carmo P. Nunes, Bárbara Martins Fernandes, Luiz Guilherme Passaglia & Teresa Cristina A. Ferrari

  2. Fundação Centro de Hematologia e Hemoterapia de Minas Gerais (HEMOMINAS Foundation), Belo Horizonte, Brazil

    Maria Carmen M. Vasconcelos & Célia Maria Silva

  3. Ecocenter, Socor Hospital, Belo Horizonte, Brazil

    Marcia M. Barbosa

  4. Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130 100, Belo Horizonte, MG, Brazil

    Maria Carmo P. Nunes

Authors
  1. Maria Carmen M. Vasconcelos
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  2. Maria Carmo P. Nunes
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  3. Marcia M. Barbosa
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  4. Bárbara Martins Fernandes
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  5. Luiz Guilherme Passaglia
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  6. Célia Maria Silva
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  7. Teresa Cristina A. Ferrari
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Correspondence to Maria Carmo P. Nunes.

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Vasconcelos, M.C.M., Nunes, M.C.P., Barbosa, M.M. et al. Left ventricular remodeling in patients with sickle cell disease: determinants factors and impact on outcome. Ann Hematol 94, 1621–1629 (2015). https://doi.org/10.1007/s00277-015-2430-z

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  • DOI: https://doi.org/10.1007/s00277-015-2430-z

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