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Left ventricular diastolic filling abnormalities identified by Doppler echocardiography in asymptomatic patients with
J F Lewis1, B J Maron, O Castro
1Department of Medicine, Howard University College of Medicine, Washington, D.C.
Insights
Left ventricular diastolic abnormalities are common in sickle cell anemia patients, even without heart failure symptoms. These findings suggest early cardiac disease markers in sickle cell anemia.
Area of Science:
- Cardiology
- Hematology
- Echocardiography
Background:
- Sickle cell anemia is a genetic blood disorder.
- Cardiac complications are known in sickle cell anemia.
- Early detection of cardiac involvement is crucial.
Purpose of the Study:
- To investigate left ventricular diastolic function in sickle cell anemia patients.
- To identify early signs of cardiac disease in sickle cell anemia.
- To assess diastolic filling patterns using Doppler echocardiography.
Main Methods:
- Pulsed Doppler echocardiography was used to assess diastolic filling in 30 sickle cell anemia patients.
- Patients had normal left ventricular systolic function and no heart failure symptoms.
- Data were compared to 30 age-matched healthy controls.
Main Results:
- 57% of sickle cell anemia patients showed abnormal left ventricular diastolic filling.
- Abnormalities included restrictive filling (6 patients) and impaired relaxation (11 patients).
- Diastolic dysfunction was present despite normal systolic function and absence of symptoms.
Conclusions:
- Left ventricular diastolic abnormalities are an early feature of sickle cell anemia.
- Doppler echocardiography can detect these diastolic abnormalities.
- These findings may serve as early markers for cardiac disease in sickle cell anemia.
Abstract:
To determine whether left ventricular diastolic abnormalities are an early feature of sickle cell anemia, indexes of diastolic filling were obtained with pulsed Doppler echocardiography in 30 consecutive patients with this disease (mean age 29 years; range 19 to 39) who had not experienced symptoms of heart failure and had normal left ventricular systolic function. Data were compared with those in 30 normal control subjects of similar ages. Seventeen (57%) of the 30 patients with sickle cell anemia had evidence of abnormal left ventricular diastolic filling. Six of these 17 patients had a Doppler pattern consistent with "restrictive" filling, characterized by reduced early diastolic deceleration time (less than 110 ms) or an increased rate of decline of early flow velocity (EF slope greater than 7.4 m/s2), or both, as well as decreased late diastolic velocity-time integral (2.6 +/- 0.7 vs. 3.4 +/- 0.8 cm in normal subjects; p less than 0.05). Another 11 patients showed a Doppler waveform consistent with impaired relaxation, characterized by prolonged deceleration time (greater than 166 ms) or reduced EF slope (less than 3.8 m/s2), as well as increased late diastolic velocity-time integral (4.0 +/- 0.5 vs. 3.4 +/- 0.8 cm in normal subjects; p = 0.03). This Doppler echocardiographic analysis demonstrates that left ventricular diastolic filling patterns are altered in patients with sickle cell anemia and that these diastolic abnormalities may be present in the absence of symptoms of heart failure. These abnormal patterns suggest an intrinsic myocardial abnormality in patients with sickle anemia and may prove to be early markers of cardiac disease.