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Altered ventricular longitudinal strain in children with sickle cell disease: Role of TGF-β and IL-18
Reham Wagdy1, Hala Assem1, Ali M Abd-Elmohsen1
1Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Insights
Transforming growth factor beta (TGF-β) and interleukin-18 (IL-18) show promise as biomarkers for sickle cell cardiomyopathy in children. Elevated levels correlate with altered cardiac strain, indicating potential subclinical heart damage.
Area of Science:
- Cardiology
- Pediatrics
- Hematology
Background:
- Cardiovascular complications significantly impact morbidity and mortality in sickle cell disease (SCD).
- Interleukin-18 (IL-18) and transforming growth factor beta (TGF-β) are emerging as potential biomarkers for sickle cell cardiomyopathy.
- Global longitudinal strain (GLS) is a key indicator of myocardial deformation.
Purpose of the Study:
- To investigate the role of TGF-β and IL-18 as risk indicators for altered cardiac strain in children with SCD.
- To assess the correlation between these biomarkers and echocardiographic parameters of cardiac function.
Main Methods:
- A study involving 40 children with SCD and 40 age- and sex-matched healthy controls.
- Assessment included clinical examination, complete blood count, serum ferritin, TGF-β, IL-18 levels, and echocardiography for cardiac function.
Main Results:
- TGF-β, IL-18, and LDH levels were significantly elevated in children with SCD compared to controls.
- Right ventricular free wall longitudinal strain (FWLS-RV) was significantly reduced in SCD patients.
- FWLS-RV correlated with IL-18 and LDH, while GLS-RV correlated with TGF-β. GLS-LV correlated with vaso-occlusive crises (VOCs).
Conclusions:
- TGF-β, IL-18, and LDH, along with frequent VOCs, are associated with altered longitudinal strain, particularly in the right ventricle.
- These markers may serve as indicators for subclinical cardiomyopathy in pediatric SCD patients.
Background:
Cardiovascular involvement in sickle cell disease (SCD) has a great impact on patients' morbidity and mortality. Recently, interleukin-18 (IL-18) and transforming growth factor beta (TGF-β) were suggested as potential biomarkers for sickle cell cardiomyopathy. Global longitudinal strain (GLS) is a reliable early parameter for estimation of deformed myocardium. This study evaluated the role of TGF-β and IL-18 as risk indicators of altered strain in patients with SCD.
Methods:
Forty children with SCD (age >5 years) and 40 healthy children as controls, matched in age and sex, were enrolled in the study. All participants were subjected to clinical examination, complete blood count, serum ferritin, TGF-β, IL-18, and assessment of cardiac function by echocardiography.
Results:
TGF-β, IL-18, and lactic acid dehydrogenase (LDH) were significantly higher among cases (mean age: 10.6 ± 3.5 years) when compared to controls (p < .001), at cutoff values 41.7 ng/mL, 128.9 pg/mL, and 340 unit, respectively. The LS of free wall of RV (FW-RV) was significantly lower among cases when compared to controls (-23.55% ± 5.55% vs. -28.73% ± 2.43%, p < .001). Free wall longitudinal strain of the right ventricle (FWLS-RV) was significantly correlated to IL-18 and LDH (p < .001), while GLS-RV was significantly correlated to TGF-β. The GLS-LV was correlated to frequency of vaso-occlusive crises (VOCs) per year (p < .001). Diastolic function, E/A of LV, and RV were negatively correlated to the hemoglobin and serum ferritin levels.
Conclusions:
The TGF-β, IL-18, and LDH along with frequent VOCs are correlated to altered LS, especially the right ventricle, and could serve as risk indicators for subclinical cardiomyopathy in children with SCD.
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