Myocardial infarction in sickle cell disease: use of translational imaging to diagnose an under-recognized problem

Area of Science:

• Cardiology
• Hematology
• Medical Imaging

Background:

• Sickle cell disease (SCD) is an inherited blood disorder causing microvascular occlusion and multi-organ complications.
• Myocardial ischemia and infarction (MI) are potential complications of SCD, but their incidence and cause are not well understood.
• Atherosclerotic lesions are typically absent in SCD patients experiencing MI, suggesting a microvascular etiology.

Purpose of the Study:

• To investigate the utility of Cardiac Magnetic Resonance (CMR) in diagnosing microvascular disease in symptomatic SCD patients.
• To highlight the role of CMR in identifying cardiac microvascular obstruction in SCD.
• To underscore the under-recognized nature of myocardial injury in SCD.

Main Methods:

• Case demonstrations illustrating the application of CMR in SCD patients presenting with chest pain.
• Qualitative assessment of CMR's ability to depict cardiac microvascular obstruction.

Main Results:

• CMR successfully visualized cardiac microvascular obstruction in SCD patients with chest pain.
• The study demonstrated instances where CMR identified myocardial injury that might otherwise be overlooked.
• The findings emphasize CMR's unique capability in this patient population.

Conclusions:

• Cardiac MRI is a valuable tool for assessing myocardial injury in sickle cell disease patients with chest pain.
• Further research is needed to establish prevalence, detection, and management strategies for ischemic heart disease in SCD.
• Developing risk assessment tools and management algorithms may help reduce sudden cardiac death in SCD.