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Coronary flow reserve in sickle cell anemia
José Leão de Souza1, Ana Clara Tude Rodrigues, Paula Cássia Buck
1Instituto do Coração, Hospital das Clínicas, FM, USP, São Paulo, SP, Brazil. jleaojunior@cardiol.br
Insights
Patients with sickle cell anemia (SCA) experience elevated coronary flow velocities, but their coronary microcirculation remains preserved. Recurrent vaso-occlusion episodes do not cause these cardiac findings in SCA patients.
Area of Science:
- Cardiology
- Hematology
- Vascular Biology
Background:
- Sickle cell anemia (SCA) is associated with cardiac abnormalities, including chest pain and ECG changes.
- Patients with SCA often exhibit structural and functional cardiac alterations.
Purpose of the Study:
- To investigate the impact of recurrent vaso-occlusion episodes on coronary microcirculation in SCA patients.
- To assess coronary flow velocity and coronary flow reserve (CFR) in SCA.
Main Methods:
- Transesophageal echocardiography measured coronary flow velocity and CFR in SCA patients (n=10) at baseline and during hyperemia.
- Comparison groups included sickle cell trait (TRA, n=10), iron deficiency anemia (IRO, n=8), and healthy controls (NOR, n=10).
Main Results:
- SCA patients showed significantly higher diastolic coronary flow velocities at baseline and hyperemia compared to TRA, IRO, and NOR groups.
- Coronary flow reserve (CFR) was normal in SCA patients and comparable across all groups.
Conclusions:
- Despite elevated coronary flow velocities, SCA patients maintain normal CFR, indicating preserved coronary microcirculation.
- Vaso-occlusion episodes are unlikely to be the primary cause of cardiac findings in SCA.
Background:
Patients with sickle cell anemia (SCA) frequently present with episodes of chest pain, alterations in the resting electrocardiogram, and changes in cardiac structure and functions.
Objective:
To evaluate the effect of recurrent episodes of vaso-occlusion on the coronary microcirculation.
Methods:
Coronary flow velocity and coronary flow reserve (CFR) of stable patients with SCA (n=10, 5 females, 24.4+/-5.4 years) were measured in the anterior descending coronary artery with transesophageal echocardiogram at baseline and after intravenous adenosine-induced maximum hyperemia, and compared to those of patients with sickle cell trait (TRA, n=10, 5 females, 27.7+/-3.2 years), iron deficiency anemia (IRO, n=8, 8 females, 26.6+/-5.2 years) and control group (NOR, n=10, 5 females, 26.3+/-6.3 years).
Results:
The SCA group presented increased diastolic coronary flow velocities (p<0.01) at baseline and during maximum hyperemia (67.3+/-14.0 and 198.2+/-37.9 cm/s, respectively) when compared with the other three groups - TRA (34.4+/-11.9 and 114.7+/-36.4 cm/s), IRO (42.4+/-10.4 and 141.0+/-18.7 cm/s) and NOR (38.1+/-10.0 and 126.8+/-24.6 cm/s). However, CFR was normal in the SCA group (3.0+/-0.7) and comparable (p=0.70) to the other groups - TRA (3.4+/-0.8), IRO (3.5+/-1.2), and NOR (3.4+/-0.8).
Conclusion:
Despite the higher coronary flow velocities already observed at baseline and also during maximum hyperemia, CFR is normal in SCA, which suggests preserved coronary microcirculation. The episodes of vaso-occlusion are not responsible for the cardiologic findings in this disease.
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