Exercise Testing In Patients with Sickle Cell Disease: Safety, Feasibility and Potential Prognostic Implication

Area of Science:

• Cardiology
• Hematology
• Exercise Physiology

Background:

• Sickle cell disease (SCD) patients face elevated cardiovascular complication risks.
• Exercise testing is a known prognostic marker in cardiovascular diseases, but its role in SCD is understudied.
• Evidence regarding the safety, feasibility, and prognostic value of exercise testing in SCD is limited.

Purpose of the Study:

• To assess the safety and feasibility of maximal treadmill testing in SCD patients.
• To identify factors associated with exercise duration in SCD.
• To evaluate the impact of exercise-induced changes on clinical outcomes in SCD.

Main Methods:

• 113 clinically stable SCD patients underwent maximal treadmill testing and comprehensive cardiovascular evaluation (echocardiography, BNP levels).
• Long-term outcomes were a composite of death, severe painful episodes, acute chest syndrome, or SCD-related hospitalizations.
• Cox regression analysis identified predictors of adverse events, with p<0.05 considered significant.

Main Results:

• Exercise testing was feasible, with 17% showing ischemic ECG changes and 9% abnormal blood pressure (BP) response.
• Exercise duration correlated with age, sex, tricuspid regurgitation velocity, and E/e' ratio.
• Adverse events occurred in 23% of patients during a mean 10.1-month follow-up. Predictors included hemoglobin, A wave velocity, and BP response.

Conclusions:

• Maximal treadmill testing is feasible and safe for clinically stable SCD patients.
• Exercise duration is linked to diastolic function and pulmonary artery pressure.
• Abnormal BP response to exercise independently predicts adverse events in SCD, suggesting prognostic utility.