Prognostic value of left ventricular longitudinal strain by speckle-tracking echocardiography in patients with sickle ce
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ORIGINAL PAPER
Prognostic value of left ventricular longitudinal strain by speckle‑tracking echocardiography in patients with sickle cell disease Maria Betânia Solis Resende1 · Teresa Cristina A. Ferrari1 · Christiano Gonçalves Araujo1 · Maria Carmen Melo Vasconcelos2 · Julia Teixeira Tupinambás2 · Rebeca Coeli Teodoro Maciel Dias1 · Flávio Coelho Barros1 · José Nélio Januário3 · Marcia Melo Barbosa4 · Maria Carmo Pereira Nunes1,5 Received: 18 April 2020 / Accepted: 22 June 2020 © Springer Nature B.V. 2020
Abstract 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. Keywords Sickle cell disease · Speckle-tracking echocardiography · Left ventricular longitudinal strain · Clinical outcome
Introduction * Maria Carmo Pereira Nunes [email protected] 1
School of Medicine, Hospital das Clinicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
2
Fundação Centro de Hematologia E Hemoterapia de Minas Gerais (HEMOMINAS Foundation), Belo Horizonte, Brazil
3
School of Medicine, Núcleo de Ações E Pesquisa Em Apoio Diagnóstico (Nupad), Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
4
Ecocenter, Socor Hospital, Belo Horizonte, Brazil
5
Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais. Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG 30130 100, Brazil
Sickle cell disease (SCD) is a multisystem disorder caused by a mutat
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