1
|
Grazioli A, Rabin J, Rector RP, Wu ZJ, Burke AP, Sharifai N, Shah A, Taylor BS, Gladwin MT. Venoarterial Extracorporeal Membrane Oxygenation Therapy in Patients with Sickle Cell Disease: Case Series and Review for Intensive Care Physicians. J Intensive Care Med 2024:8850666241260605. [PMID: 39140386 DOI: 10.1177/08850666241260605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Sickle cell disease (SCD) is associated with substantial morbidity and early mortality in afflicted adults. Cardiopulmonary complications that occur at increased frequency in SCD such as pulmonary embolism, pulmonary arterial hypertension, and acute chest syndrome can acutely worsen right ventricular function and lead to cardiogenic shock. Mechanical circulatory support including venoarterial extracorporeal membrane oxygenation (VA ECMO) is being increasingly utilized to treat hemodynamic collapse in various patient populations. However, a paucity of literature exists to guide the use of mechanical circulatory support in adults with SCD where disease-related sequela and unique hematologic aspects of this disorder may complicate extracorporeal therapy and must be understood. Here, we review the literature and describe three cases of adult patients with SCD who developed cardiogenic shock from acute decompensated right heart failure and were treated clinically with VA ECMO. Using an in vitro ECMO system, we investigate a potential increased risk of systemic fat emboli in patients with SCD who may be experiencing vaso-occlusive events with bone marrow involvement given the high-volume shunting of blood from venous to arterial systems with VA ECMO. The purpose of this study is to describe available extracorporeal life support experiences, review potential complications, and discuss the special considerations needed to further our understanding of the utility of VA ECMO in those with SCD.
Collapse
Affiliation(s)
- Alison Grazioli
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph Rabin
- Department of Surgery, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Zhongjun J Wu
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Allen P Burke
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nima Sharifai
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Aakash Shah
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bradley S Taylor
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mark T Gladwin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
2
|
d'Humières T, Bouvarel A, Boyer L, Savale L, Guillet H, Alassaad L, de Luna G, Berti E, Iles S, Pham Hung d'Alexandry d'Orengiani AL, Audureau E, Troupe MJ, Schlatter RC, Lamadieu A, Galactéros F, Derumeaux G, Messonnier LA, Bartolucci P. Cardiac diastolic maladaptation is associated with the severity of exercise intolerance in sickle cell anemia patients. Sci Rep 2024; 14:11095. [PMID: 38750085 PMCID: PMC11096405 DOI: 10.1038/s41598-024-61689-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
This pilot study focusing on Sickle Cell Anemia (SCA) patients offers a comprehensive and integrative evaluation of respiratory, cardiovascular, hemodynamic, and metabolic variables during exercise. Knowing that diastolic dysfunction is frequent in this population, we hypothesize that a lack of cardiac adaptation through exercise might lead to premature increase in blood lactate concentrations in SCA patients, a potential trigger for acute disease complication. SCA patients were prospectively included in PHYSIO-EXDRE study and underwent a comprehensive stress test with a standardized incremental exercise protocol up to 4 mmol L-1 blood lactate concentration (BL4). Gas exchange, capillary lactate concentration and echocardiography were performed at baseline, during stress test (at ∼ 2 mmol L-1) and BL4. The population was divided into two groups and compared according to the median value of percentage of theoretical peak oxygen uptake (%V ˙ O 2 p e a k t h ) at BL4. Twenty-nine patients were included (42 ± 12 years old, 48% of women). Most patients reached BL4 at low-intensity exercise [median value of predicted power output (W) was 37%], which corresponds to daily life activities. The median value of %V ˙ O 2 p e a k t h at BL4 was 39%. Interestingly, diastolic maladaptation using echocardiography during stress test along with hemoglobin concentration were independently associated to early occurrence of BL4. As BL4 occurs for low-intensity exercises, SCA patients may be subject to acidosis-related complications even during their daily life activities. Beyond assessing physical capacities, our study underlines that diastolic maladaptation during exercise is associated with an early increase in blood lactate concentration.
Collapse
Affiliation(s)
- Thomas d'Humières
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France.
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
- Sickle Cell Referral Center-UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP, Créteil, France.
| | - Antoine Bouvarel
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Laurent Boyer
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Laurent Savale
- Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Henri Guillet
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC/Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Sickle Cell Referral Center-UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP, Créteil, France
| | - Lara Alassaad
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Gonzalo de Luna
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC/Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Sickle Cell Referral Center-UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP, Créteil, France
| | - Enora Berti
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Sihem Iles
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | | | - Etienne Audureau
- Biostatistics Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- CEpiA IMRB U955, FHU SENEC, Université Paris Est (UPEC), Créteil, France
| | - Marie-Joelle Troupe
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Reine-Claude Schlatter
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Anaïs Lamadieu
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Frédéric Galactéros
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC/Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Sickle Cell Referral Center-UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP, Créteil, France
| | - Geneviève Derumeaux
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
- INSERM IMRB U955, Université Paris Est (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Laurent A Messonnier
- Inter-University Laboratory of Human Movement Sciences EA 7424, Université Savoie Mont Blanc, Chambéry, France
| | - Pablo Bartolucci
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC/Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Sickle Cell Referral Center-UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP, Créteil, France
| |
Collapse
|
3
|
Pistoia L, Meloni A, Positano V, Longo F, Borsellino Z, Spasiano A, Righi R, Renne S, Izzo D, Savino K, Mavrogeni S, Quaia E, Cademartiri F, Pepe A. Multiparametric Cardiac Magnetic Resonance Assessment in Sickle Beta Thalassemia. Diagnostics (Basel) 2024; 14:691. [PMID: 38611604 PMCID: PMC11012026 DOI: 10.3390/diagnostics14070691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Cardiac involvement in sickle beta thalassemia (Sβ-thal) patients has been poorly investigated. We aimed to evaluate cardiac function and myocardial iron overload by cardiovascular magnetic resonance (CMR) in patients with Sβ-thal. One-hundred and eleven Sβ-thal patients consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network were studied and compared with 46 sickle cell anemia (SCA) patients and with 111 gender- and age- matched healthy volunteers. Cine images were acquired to quantify biventricular function. Myocardial iron overload (MIO) was assessed by the T2* technique, while macroscopic myocardial fibrosis was evaluated by the late gadolinium enhancement (LGE) technique. In Sβ-thal and SCA patients, the morphological and functional CMR parameters were not significantly different, except for the left atrial area and left ventricular (LV) stroke volume, indexed by body surface area (p = 0.023 and p = 0.048, respectively), which were significantly higher in SCA patients. No significant differences between the two groups were found in terms of myocardial iron overload and macroscopic myocardial fibrosis. When compared to healthy subjects, Sβ-thal patients showed significantly higher bi-atrial and biventricular parameters, except for LV ejection fraction, which was significantly lower. The CMR analysis confirmed that Sβ-thal and SCA patients are phenotypically similar. Since Sβ-thal patients showed markedly different morphological and functional indices from healthy subjects, it would be useful to identify Sβ-thal/SCA-specific bi-atrial and biventricular reference values.
Collapse
Affiliation(s)
- Laura Pistoia
- Unità Operativa Complessa Ricerca Clinica, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy;
- Department of Radiology, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (F.C.)
| | - Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (F.C.)
- Bioengineering Unit, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (F.C.)
- Bioengineering Unit, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy
| | - Filomena Longo
- Unità Operativa Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria “S. Anna”, 44124 Ferrara, Italy;
| | - Zelia Borsellino
- Unità Operativa Complessa Ematologia con Talassemia, ARNAS Civico “Benfratelli-Di Cristina”, 90134 Palermo, Italy;
| | - Anna Spasiano
- Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli”, 80131 Napoli, Italy;
| | - Riccardo Righi
- Diagnostica per Immagini e Radiologia Interventistica, Ospedale del Delta, 44023 Ferrara, Italy;
| | - Stefania Renne
- Struttura Complessa di Cardioradiologia-UTIC, Presidio Ospedaliero “Giovanni Paolo II”, 88046 Cosenza, Italy;
| | - Daniela Izzo
- Unità Operativa Complessa di Cardiologia-UTIC, Presidio Ospedaliero “D.ssa Anastasia Guerriero”, 81025 Caserta, Italy;
| | - Ketty Savino
- Sezione di Cardiologia e Fisiopatologia Cardiovascolare, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, 06132 Perugia, Italy;
| | | | - Emilio Quaia
- Istituto di Radiologia, Dipartimento di Medicina, Università di Padova, 35128 Padova, Italy;
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (F.C.)
| | - Alessia Pepe
- Istituto di Radiologia, Dipartimento di Medicina, Università di Padova, 35128 Padova, Italy;
| |
Collapse
|
4
|
Habibi A. Managing pregnancy in patients with sickle cell disease from a transfusion perspective. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:640-645. [PMID: 38066847 PMCID: PMC10727095 DOI: 10.1182/hematology.2023000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Advances in the management of sickle cell disease (SCD) have made it possible for most female patients (whether homozygous or compound heterozygous) to reach childbearing age and become pregnant. However, even in the less symptomatic forms of SCD a high risk of complications during pregnancy and the postpartum period can occur for both the mother (1% to 2% mortality) and the fetus. Coordinated care from the obstetrician and the sickle cell disease expert is essential, together with the active participation of the patient. Vaso-occlusive complications, such as vaso-occlusive crisis and acute chest syndrome, often increase in frequency when hydroxyurea treatment is interrupted. Obstetric complications, such as pre-eclampsia, fetal growth restriction, and preterm delivery, are more common in women with SCD. Recent meta-analysis-based studies support prophylactic transfusion. However, there have been no randomized trials assessing the benefits of prophylactic transfusion. Given the known risk of transfusion complications, including delayed hemolytic transfusion reaction and hyperhemolysis, transfusion is not systematically performed in pregnant women with SCD. We describe here a case-by-case approach to the management of pregnancy in women with SCD based on the medical and transfusion history of each patient.
Collapse
Affiliation(s)
- Anoosha Habibi
- Sickle Cell Referral Center, Unité des Maladies Génétiques du Globule Rouge, Henri Mondor University Hospital, APHP, Paris-Est Créteil University, and Institut Mondor de Recherche Biomédicale, Institut National de la Santé et de le Recherche Médicale U955, Créteil, France
| |
Collapse
|
5
|
Bartolucci P. Exploration de l’hémolyse associée à la drépanocytose et perspectives thérapeutiques spécifiques. Rev Med Interne 2023; 44:4S7-4S11. [PMID: 38049244 DOI: 10.1016/s0248-8663(23)01303-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Sickle Cell Anemia is a disease with a strong vascular tropism. Beyond anemia, the pathophysiological mechanisms responsible for hemolysis, directly affect both acute and chronic vascular damages, thus resulting in a systemic disease. Understanding the different types of hemolysis underline the need for novel specific biomarkers. Targeted therapeutic approaches for these pathophysiological pathways are necessary to improve Sickle Cell patients' prognosis. Finally, given its complexity, Sickle Cell Disease is often used as a "proof of concept" for other pathologies. It seems likely that the rapidly evolving knowledge in this field will also benefit other diseases. © 2023 Société nationale française de médecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.
Collapse
Affiliation(s)
- P Bartolucci
- Recherche IH, EFS Créteil-Mondor, Créteil, France; IMRB Inserm 955, équipe Pirenne, Créteil, France; Centre de références des syndromes drépanocytaires majeures, hôpital Henri-Mondor, Créteil, France; Université Paris-Est Créteil, Créteil, France.
| |
Collapse
|
6
|
Kirkham JK, Estepp JH, Weiss MJ, Rashkin SR. Genetic Variation and Sickle Cell Disease Severity: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2337484. [PMID: 37851445 PMCID: PMC10585422 DOI: 10.1001/jamanetworkopen.2023.37484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/30/2023] [Indexed: 10/19/2023] Open
Abstract
Importance Sickle cell disease (SCD) is a monogenic disorder, yet clinical outcomes are influenced by additional genetic factors. Despite decades of research, the genetics of SCD remain poorly understood. Objective To assess all reported genetic modifiers of SCD, evaluate the design of associated studies, and provide guidelines for future analyses according to modern genetic study recommendations. Data Sources PubMed, Web of Science, and Scopus were searched through May 16, 2023, identifying 5290 publications. Study Selection At least 2 reviewers identified 571 original, peer-reviewed English-language publications reporting genetic modifiers of human SCD phenotypes, wherein the outcome was not treatment response, and the comparison was not between SCD subtypes or including healthy controls. Data Extraction and Synthesis Data relevant to all genetic modifiers of SCD were extracted, evaluated, and presented following STREGA and PRISMA guidelines. Weighted z score meta-analyses and pathway analyses were conducted. Main Outcomes and Measures Outcomes were aggregated into 25 categories, grouped as acute complications, chronic conditions, hematologic parameters or biomarkers, and general or mixed measures of SCD severity. Results The 571 included studies reported on 29 670 unique individuals (50% ≤ 18 years of age) from 43 countries. Of the 17 757 extracted results (4890 significant) in 1552 genes, 3675 results met the study criteria for meta-analysis: reported phenotype and genotype, association size and direction, variability measure, sample size, and statistical test. Only 173 results for 62 associations could be cross-study combined. The remaining associations could not be aggregated because they were only reported once or methods (eg, study design, reporting practice) and genotype or phenotype definitions were insufficiently harmonized. Gene variants regulating fetal hemoglobin and α-thalassemia (important markers for SCD severity) were frequently identified: 19 single-nucleotide variants in BCL11A, HBS1L-MYB, and HBG2 were significantly associated with fetal hemoglobin (absolute value of Z = 4.00 to 20.66; P = 8.63 × 10-95 to 6.19 × 10-5), and α-thalassemia deletions were significantly associated with increased hemoglobin level and reduced risk of albuminuria, abnormal transcranial Doppler velocity, and stroke (absolute value of Z = 3.43 to 5.16; P = 2.42 × 10-7 to 6.00 × 10-4). However, other associations remain unconfirmed. Pathway analyses of significant genes highlighted the importance of cellular adhesion, inflammation, oxidative and toxic stress, and blood vessel regulation in SCD (23 of the top 25 Gene Ontology pathways involve these processes) and suggested future research areas. Conclusions and Relevance The findings of this comprehensive systematic review and meta-analysis of all published genetic modifiers of SCD indicated that implementation of standardized phenotypes, statistical methods, and reporting practices should accelerate discovery and validation of genetic modifiers and development of clinically actionable genetic profiles.
Collapse
Affiliation(s)
- Justin K. Kirkham
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jeremie H. Estepp
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
- Now with Agios Pharmaceuticals, Cambridge, Massachusetts
| | - Mitch J. Weiss
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sara R. Rashkin
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
| |
Collapse
|
7
|
d'Humières T, Saba J, Savale L, Dupuy M, Boyer L, Guillet H, Alassaad L, de Luna G, Iles S, Pham Hung d'Alexandry d'Orengiani AL, Zaouali Y, Boukour N, Pelinski Y, Messonnier L, Audureau E, Derbel H, Habibi A, Lellouche N, Derumeaux G, Bartolucci P. Determinants of ventricular arrhythmias in sickle cell anemia: toward better prevention of sudden cardiac death. Blood 2023; 142:409-420. [PMID: 37216685 DOI: 10.1182/blood.2022019571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
Sudden death is 1 of the leading causes of death in adults with sickle cell anemia (SCA) but its etiology remains mostly unknown. Ventricular arrhythmia (VA) carries an increased risk of sudden death; however, its prevalence and determinants in SCA are poorly studied. This study aimed to identify the prevalence and predictors of VA in patients with SCA. From 2019 to 2022, 100 patients with SCA were referred to the physiology department to specifically analyze cardiac function and prospectively included in the DREPACOEUR registry. They underwent a 24-hour electrocardiogram monitoring (24h-Holter), transthoracic echocardiography, and laboratory tests on the same day. The primary end point was the occurrence of VA, defined as sustained or nonsustained ventricular tachycardia (VT), >500 premature ventricular contractions (PVCs) on 24h-Holter, or a recent history of VT ablation. The mean patient age was 46 ± 13 years, and 48% of the patients were male. Overall, VA was observed in 22 (22%) patients. Male sex (81% vs 34%; P = .02), impaired global longitudinal strain (GLS): -16% ± 1.9% vs -18.3% ± 2.7%; P = .02), and decreased platelet count (226 ± 96 giga per liter [G/L] vs 316 ± 130 G/L) were independently associated with VA. GLS correlated with PVC load every 24 hours (r = 0.39; P < .001) and a cutoff of -17.5% could predict VA with a sensitivity of 82% and a specificity of 63%. VAs are common in patients with SCA, especially in men. This pilot study uncovered GLS as a valuable parameter for improving rhythmic risk stratification.
Collapse
MESH Headings
- Adult
- Humans
- Male
- Middle Aged
- Female
- Pilot Projects
- Arrhythmias, Cardiac/etiology
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Anemia, Sickle Cell/complications
Collapse
Affiliation(s)
- Thomas d'Humières
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Joseph Saba
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Laurent Savale
- Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension, Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Marie Dupuy
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Laurent Boyer
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Henri Guillet
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Lara Alassaad
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Gonzalo de Luna
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Sihem Iles
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Anne L Pham Hung d'Alexandry d'Orengiani
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Yosr Zaouali
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Nouhaila Boukour
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Yanis Pelinski
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Laurent Messonnier
- Inter-university Laboratory of Human Movement Sciences EA 7424, Université Savoie Mont Blanc, Chambéry, France
| | - Etienne Audureau
- Department of Biostatistics, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, CEpiA IMRB U955, FHU SENEC, Université Paris Est, Créteil, France
| | - Haytham Derbel
- Department of Radiology, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Est, Créteil, France
| | - Anoosha Habibi
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Est, Créteil, France
| | - Geneviève Derumeaux
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Pablo Bartolucci
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| |
Collapse
|
8
|
Cheminet G, Brunetti A, Khimoud D, Ranque B, Michon A, Flamarion E, Pouchot J, Jannot AS, Arlet JB. Acute chest syndrome in adult patients with sickle cell disease: The relationship with the time to onset after hospital admission. Br J Haematol 2023. [PMID: 36965115 DOI: 10.1111/bjh.18777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 03/27/2023]
Abstract
Data on acute chest syndrome (ACS) in adult sickle cell disease patients are scarce. In this study, we describe 105 consecutive ACS episodes in 81 adult patients during a 32-month period and compare the characteristics as a function of the time to onset after hospital admission for a vaso-occlusive crisis (VOC), that is early-onset episodes (time to onset ≤24 h, 42%) versus secondary episodes (>24 h, 58%; median [interquartile range] time to onset: 2 [2-3] days). The median age was 27 [22-34] years, 89% of the patients had an S/S or S/β0 -thalassaemia genotype; 81% of the patients had a history of ACS (median: 3 [2-5] per patient), only 61% were taking a disease-modifying treatment at the time of the ACS. Fever and chest pain were noted in respectively 54% and 73% of the episodes. Crackles (64%) and bronchial breathing (32%) were the main abnormal auscultatory findings. A positive microbiological test was found for 20% of episodes. Fifty percent of the episodes required a blood transfusion; ICU transfer and mortality rates were respectively 29% and 1%. Secondary and early-onset forms of ACS did not differ significantly. Disease-modifying treatments should be revaluated after each ACS episode because the recurrence rate is high.
Collapse
Affiliation(s)
- Geoffrey Cheminet
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Antoine Brunetti
- Service d'Informatique, de biostatistique et santé publique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Djamal Khimoud
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Brigitte Ranque
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
- Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, INSERM U970 Equipe 4 "Epidémiologie cardiovasculaire et mort subite", Paris Centre de Recherche Cardiovasculaire, Paris, France
| | - Adrien Michon
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Edouard Flamarion
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Jacques Pouchot
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Anne-Sophie Jannot
- Université Paris Cité, Paris, France
- Service d'Informatique, de biostatistique et santé publique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- HEKA, Centre de Recherche des Cordeliers, INSERM, INRIA, Paris, France
| | - Jean-Benoît Arlet
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
- Laboratoire d'excellence GR-Ex, Hôpital Necker, AP-HP, Université Paris Cité, INSERM U1163, CNRS 8254, institut IMAGINE, Paris, France
| |
Collapse
|
9
|
Lopes A, Dantas MT, Ladeia AMT. Prevalence of Cardiovascular Complications in Individuals with Sickle Cell Anemia and Other Hemoglobinopathies: A Systematic Review. Arq Bras Cardiol 2022; 119:893-899. [PMID: 36417618 DOI: 10.36660/abc.20220207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sickle cell anemia (SCA) is a hereditary disease whose cardiovascular complications are the main cause of death, the same being observed in other hemoglobinopathies. Early identification of these changes can favorably modify the course of the disease. OBJECTIVE To compare the prevalence of cardiovascular complications between individuals with SCA and individuals with other hemoglobinopathies. METHOD Following the recommendations of the PRISMA protocol, a systematic literature review was carried out with searches in PubMed/Medline databases, associated with a manual search. Studies that analyzed the prevalence of cardiovascular alterations in hemoglobinopathies (SCA, sickle cell trait, SC hemoglobinopathy, alpha-thalassemia and beta-thalassemia) were included. The methodological quality of the articles was assessed using the Newcastle-Ottawa scale. RESULTS Four studies were selected for analysis, resulting in a sample size of 582 participants: 289 with SCA, 133 with SC hemoglobinopathy, 40 with beta-thalassemia, 100 healthy individuals and none with alpha-thalassemia or sickle cell trait. Dilatation of the cardiac chambers, left and right ventricular hypertrophy, pulmonary hypertension, diastolic dysfunction, mitral regurgitation and tricuspid regurgitation are more prevalent in SCA than in the other hemoglobinopathies considered. Myocardial iron overload is more frequent in thalassemia major than in sickle cell anemia. Systolic function is similar between different hemoglobinopathies. CONCLUSION There is greater cardiovascular impairment in individuals with SCA than in those with other hemoglobinopathies, reinforcing the necessity for regular cardiovascular follow-up in sickle cell patients.
Collapse
Affiliation(s)
- Andressa Lopes
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
| | | | | |
Collapse
|
10
|
Silva Lopes J, Garcia Viana Í, Cordeiro Santos ML, Freire de Melo F, Oliveira MV, Souza CL. Cardiopulmonary changes in patients with sickle cell anemia: A systematic review. World J Hematol 2022; 9:20-29. [DOI: 10.5315/wjh.v9.i3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 06/23/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Given the high prevalence of cardiovascular and pulmonary abnormalities associated with sickle cell anemia (SCA), the clinical impact caused in addition to compromising the quality of life of patients and the overcharge that it represents to the public health system, this study systematized and evaluated scientific publications on pulmonary complications and cardiovascular diseases in sickle cell patients from 1920 to 2020. This compilation aims to provide knowledge for health professionals and managers in order to draw attention to the importance of chronic diseases in SCA patients and in addition to providing elements that provide improvements in management of useful resources that contribute to improve the quality and increase the life expectancy of these patients.
AIM To systematically compile information about cardiopulmonary changes in patients with SCA.
METHODS A systematic literature review was performed based on the PRISMA recom-mendation including scientific articles indexed in the Scientific Electronic Library Online databases of the United States National Library of Medicine and Biblioteca Virtual de Saúde. The search period was delimited between 1990 and 2020 and selected in Portuguese, English and Spanish. Three sets of descriptors were used for each database including research carried out with human beings. After reading the articles, those useful for this review were extracted using a collection instrument designed for this purpose.
RESULTS The final selection included 27 studies. The year with the highest number of publications was 2016 with 5 studies (18.51%), followed by 2017 with 4 (14.81%). The type of study most carried out in the period was cohort 10 (37.03%) followed by cross-sectional and case-control with 8 studies in each (29.62%). Regarding the language of publication, the distribution was as follows: 25 (92.59%) in English, 1 (3.70%) in Spanish and 1 (3.70%) in Portuguese.
CONCLUSION The findings of the present study suggest that cardiopulmonary alterations represent a serious clinical repercussion of SCA. Of the analyzed studies, the high occurrence of pulmonary hypertension, ventricular hypertrophy and diastolic dysfunction stands out as the main cardiopulmonary complications. In view of the increased survival in SCA, there is a need for surveillance and the development of strategies aimed at preserving the cardiopulmonary function and consequently improving the quality of life of these patients.
Collapse
Affiliation(s)
- Jamile Silva Lopes
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Ícaro Garcia Viana
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Maria Luísa Cordeiro Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Cláudio Lima Souza
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| |
Collapse
|
11
|
d'Humières T, Savale L, Inamo J, Deux J, Deswarte S, Lionnet F, Loko G, Chantalat C, Damy T, Guillet H, Pham Hung d'Alexandry d'Orengiani AL, Galactéros F, Audureau E, Maitre B, Humbert M, Derumeaux G, Bartolucci P. Cardiovascular phenotypes predict clinical outcomes in sickle cell disease: An echocardiography-based cluster analysis. Am J Hematol 2021; 96:1166-1175. [PMID: 34143511 DOI: 10.1002/ajh.26271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 12/30/2022]
Abstract
This study sought to link cardiac phenotypes in homozygous Sickle Cell Disease (SCD) patients with clinical profiles and outcomes using cluster analysis. We analyzed data of 379 patients included in the French Etendard Cohort. A cluster analyses was performed based on echocardiographic variables, and the association between clusters, clinical profiles and outcomes was assessed. Three clusters were identified. Cluster 1 (n = 123) patients had the lowest cardiac output, mild left cardiac cavities remodeling, mild diastolic dysfunction, and higher tricuspid regurgitation velocity (TRV). They were predominantly female and displayed the most altered functional limitation. Cluster 2 (n = 102) patients had the highest cardiac output and the most remodeled cardiac cavities. Diastolic function and TRV were similar to cluster 1. These patients had a higher blood pressure and a severe hemolytic anemia. Cluster 3 (n = 154) patients had mild left cardiac cavities remodeling, normal diastolic function and lowest TRV values. They were younger with the highest hemoglobin value. Right heart catheterization was performed in 94 patients. Cluster 1 (n = 33) included the majority of pre-capillary PH whilst cluster 2 (n = 34) included post-capillary PH. No PH was found in cluster 3 (n = 27). After a follow-up of 11.4 ± 2 years, death occurred in 41 patients (11%). Cluster 2 patients had the worst prognosis with a 19% mortality rate versus 12% in cluster 1 and 5% in cluster 3 (p log-rank = 0.003). Cluster analysis of echocardiography variables identified three hemodynamic and clinical phenotypes among SCD patients, each predicting a different prognosis.
Collapse
Affiliation(s)
- Thomas d'Humières
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- INSERM IMRB U955, Team 8, Université Paris Est (UPEC) Créteil France
- Sickle Cell Referral Center – UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP Créteil France
| | - Laurent Savale
- Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris Le Kremlin‐Bicêtre France
- Université Paris‐Saclay, School of Medicine Le Kremlin‐Bicêtre France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies Hôpital Marie Lannelongue Le Plessis‐Robinson France
| | - Jocelyn Inamo
- Department of Cardiology University of the French West Indies and Guiana Fort‐de‐France Martinique France
| | - Jean‐François Deux
- INSERM IMRB U955, Team 8, Université Paris Est (UPEC) Créteil France
- Department of Radiology FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
| | - Simon Deswarte
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- INSERM IMRB U955, Team 8, Université Paris Est (UPEC) Créteil France
| | - Francois Lionnet
- Department of Internal Medicine Tenon Hospital, Assistance Publique Hôpitaux de Paris Paris France
| | - Gylna Loko
- Sickle Cell Center University of the French West Indies and Guiana Martinique France
| | - Christelle Chantalat
- Department of Hematology Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris Kremlin‐Bicêtre France
| | - Thibaud Damy
- Department of Cardiovascular Medicine FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- INSERM IMRB U955, Team 8, Université Paris Est Créteil Créteil France
| | - Henri Guillet
- Sickle Cell Referral Center – UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP Créteil France
- Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC/Assistance Publique‐Hôpitaux de Paris Créteil France
| | | | - Frédéric Galactéros
- Sickle Cell Referral Center – UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP Créteil France
- Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC/Assistance Publique‐Hôpitaux de Paris Créteil France
| | - Etienne Audureau
- Biostatistics Department Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- CEpiA IMRB U955, FHU SENEC, Université Paris Est (UPEC) Créteil France
| | - Bernard Maitre
- Pulmonary Unit FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- INSERM IMRB U955, Université Paris Est (UPEC) Créteil France
| | - Marc Humbert
- Sickle Cell Referral Center – UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP Créteil France
- Pulmonary Unit FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- INSERM IMRB U955, Université Paris Est (UPEC) Créteil France
| | - Geneviève Derumeaux
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- INSERM IMRB U955, Team 8, Université Paris Est (UPEC) Créteil France
| | - Pablo Bartolucci
- Sickle Cell Referral Center – UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP Créteil France
- Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC/Assistance Publique‐Hôpitaux de Paris Créteil France
| |
Collapse
|
12
|
Koyuncu MB, Tombak A, Orscelik O, Koseci T, Turker A, Basir H, Akdeniz A, Tiftik EN. Cardiac Chamber Quantification by Echocardiography in Adults With Sickle Cell Disease: Need Attention to Eccentric Hypertrophy. Cureus 2021; 13:e15592. [PMID: 34277213 PMCID: PMC8270058 DOI: 10.7759/cureus.15592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and aim Sickle cell anemia (SCA) is the most common hemoglobinopathy worldwide, and cardiovascular diseases are the most common causes of death. In these patients, cardiac remodeling begins from childhood and leads to sickle cell cardiomyopathy in the following years. Concentric hypertrophy and eccentric hypertrophy are known to predict early cardiac events. This study aims to reveal the relationship between cardiac remodeling types and survival in patients with SCA and investigate the factors that may affect left ventricular mass. Materials and methods A total of 146 patients with SCA were included in the study, and the left ventricular mass index (LVMI) and relative wall thickness (RWT) of the patients were calculated according to echocardiographic measurements, and the patients were categorized into normal, concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH) groups. Results The median age of the patients is 32 (18-72). In logistic regression analysis, hemoglobin S (HbS) and ferritin levels were independent predictors for LVMI (p = 0.01 and p < 0.001, respectively). It was observed that 56 (38.4%) of the patients had normal left ventricles, 24 (16.4%) had CR, 21 (14.4%) had CH, and 45 (30.8%) had EH. 31 (21.2%) of the patients died. When we look at the survival curves, there was a statistically significant difference between the four groups (log-rank p < 0.001). It was observed that patients with EH were the group with the lowest probability of survival. Conclusion Cardiac death is one of the most common causes of death in patients with SCA. Early detection of cardiac disorders and starting treatment may be important in reducing mortality in these patients.
Collapse
Affiliation(s)
- Mahmut B Koyuncu
- Hematology, Adana City Research and Training Hospital, Adana, TUR
| | - Anil Tombak
- Hematology, Mersin University, Faculty of Medicine, Mersin, TUR
| | - Ozcan Orscelik
- Cardiology, Mersin University, Faculty of Medicine, Mersin, TUR
| | - Tolga Koseci
- Medical Oncology, Adana City Research and Training Hospital, Adana, TUR
| | - Ali Turker
- Internal Medicine, Mersin University, Faculty of Medicine, Mersin, TUR
| | - Hakan Basir
- Internal Medicine, Mersin University, Faculty of Medicine, Mersin, TUR
| | - Aydan Akdeniz
- Hematology, Mersin University, Faculty of Medicine, Mersin, TUR
| | - Eyup N Tiftik
- Hematology, Mersin University, Faculty of Medicine, Mersin, TUR
| |
Collapse
|
13
|
Sachdev V, Tian X, Gu Y, Nichols J, Sidenko S, Li W, Beri A, Layne WA, Allen D, Wu CO, Thein SL. A phenotypic risk score for predicting mortality in sickle cell disease. Br J Haematol 2021; 192:932-941. [PMID: 33506990 PMCID: PMC9123430 DOI: 10.1111/bjh.17342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/30/2020] [Indexed: 02/02/2023]
Abstract
Risk assessment for patients with sickle cell disease (SCD) remains challenging as it depends on an individual physician's experience and ability to integrate a variety of test results. We aimed to provide a new risk score that combines clinical, laboratory, and imaging data. In a prospective cohort of 600 adult patients with SCD, we assessed the relationship of 70 baseline covariates to all-cause mortality. Random survival forest and regularised Cox regression machine learning (ML) methods were used to select top predictors. Multivariable models and a risk score were developed and internally validated. Over a median follow-up of 4·3 years, 131 deaths were recorded. Multivariable models were developed using nine independent predictors of mortality: tricuspid regurgitant velocity, estimated right atrial pressure, mitral E velocity, left ventricular septal thickness, body mass index, blood urea nitrogen, alkaline phosphatase, heart rate and age. Our prognostic risk score had superior performance with a bias-corrected C-statistic of 0·763. Our model stratified patients into four groups with significantly different 4-year mortality rates (3%, 11%, 35% and 75% respectively). Using readily available variables from patients with SCD, we applied ML techniques to develop and validate a mortality risk scoring method that reflects the summation of cardiopulmonary, renal and liver end-organ damage. Trial Registration: ClinicalTrials.gov Identifier: NCT#00011648.
Collapse
Affiliation(s)
- Vandana Sachdev
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Xin Tian
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Yuan Gu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - James Nichols
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Stanislav Sidenko
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Wen Li
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Andrea Beri
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - W. Austin Layne
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Darlene Allen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Colin O. Wu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Swee Lay Thein
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| |
Collapse
|
14
|
End points for sickle cell disease clinical trials: renal and cardiopulmonary, cure, and low-resource settings. Blood Adv 2020; 3:4002-4020. [PMID: 31809537 DOI: 10.1182/bloodadvances.2019000883] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/07/2019] [Indexed: 01/19/2023] Open
Abstract
To address the global burden of sickle cell disease and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to patient-reported outcome, pain (non-patient-reported outcomes), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the end-organ considerations, measurement of cure, and low-resource settings panels as well as relevant findings and recommendations from the biomarkers panel.
Collapse
|
15
|
Nouraie M, Darbari DS, Rana S, Minniti CP, Castro OL, Luchtman‐Jones L, Sable C, Dham N, Kato GJ, Gladwin MT, Ensing G, Arteta M, Campbell A, Taylor JG, Nekhai S, Gordeuk VR. Tricuspid regurgitation velocity and other biomarkers of mortality in children, adolescents and young adults with sickle cell disease in the United States: The PUSH study. Am J Hematol 2020; 95:766-774. [PMID: 32243618 DOI: 10.1002/ajh.25799] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/25/2020] [Indexed: 01/03/2023]
Abstract
In the US, mortality in sickle cell disease (SCD) increases after age 18-20 years. Biomarkers of mortality risk can identify patients who need intensive follow-up and early or novel interventions. We prospectively enrolled 510 SCD patients aged 3-20 years into an observational study in 2006-2010 and followed 497 patients for a median of 88 months (range 1-105). We hypothesized that elevated pulmonary artery systolic pressure as reflected in tricuspid regurgitation velocity (TRV) would be associated with mortality. Estimated survival to 18 years was 99% and to 25 years, 94%. Causes of death were known in seven of 10 patients: stroke in four (hemorrhagic two, infarctive one, unspecified one), multiorgan failure one, parvovirus B19 infection one, sudden death one. Baseline TRV ≥2.7 m/second (>2 SD above the mean in age-matched and gender-matched non-SCD controls) was observed in 20.0% of patients who died vs 4.6% of those who survived (P = .012 by the log rank test for equality of survival). The baseline variable most strongly associated with an elevated TRV was a high hemolytic rate. Additional biomarkers associated with mortality were ferritin ≥2000 μg/L (observed in 60% of patients who died vs 7.8% of survivors, P < .001), forced expiratory volume in 1 minute to forced vital capacity ratio (FEV1/FVC) <0.80 (71.4% of patients who died vs 18.8% of survivors, P < .001), and neutrophil count ≥10x109 /L (30.0% of patients who died vs 7.9% of survivors, P = .018). In SCD children, adolescents and young adults, steady-state elevations of TRV, ferritin and neutrophils and a low FEV1/FVC ratio may be biomarkers associated with increased risk of death.
Collapse
Affiliation(s)
- Mehdi Nouraie
- University of Pittsburgh Pittsburgh Pennsylvania USA
| | | | - Sohail Rana
- Center for Sickle Cell DiseaseHoward University Washington District of Columbia USA
| | - Caterina P. Minniti
- Montfiore Medical Center, Einstein College of Medicine New York New York USA
| | - Oswaldo L. Castro
- Center for Sickle Cell DiseaseHoward University Washington District of Columbia USA
| | - Lori Luchtman‐Jones
- Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Craig Sable
- Children's National Medical Center Washington District of Columbia USA
| | - Niti Dham
- Children's National Medical Center Washington District of Columbia USA
| | | | | | | | | | - Andrew Campbell
- Children's National Medical Center Washington District of Columbia USA
| | - James G. Taylor
- Center for Sickle Cell DiseaseHoward University Washington District of Columbia USA
| | - Sergei Nekhai
- Center for Sickle Cell DiseaseHoward University Washington District of Columbia USA
| | | |
Collapse
|
16
|
Lüscher TF. Sex and gender and cardiovascular medicine: impact in diabetes, acute coronary syndromes, and heart failure. Eur Heart J 2020; 41:1311-1314. [DOI: 10.1093/eurheartj/ehaa217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK
- Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland
- Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
| |
Collapse
|
17
|
Sachdev V, Rosing DR, Thein SL. Cardiovascular complications of sickle cell disease. Trends Cardiovasc Med 2020; 31:187-193. [PMID: 32139143 DOI: 10.1016/j.tcm.2020.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/26/2020] [Accepted: 02/07/2020] [Indexed: 12/12/2022]
Abstract
Sickle cell disease (SCD) is the most common inherited blood disorder in the United States, and a global health problem. Pathological features of the abnormal hemoglobin (HbS) result in 2 hallmarks of the disease - recurrent episodes of acute microvascular occlusion and chronic hemolytic anemia - that inflict continuous and insidious damage to multiple organs. With improved childhood survival, SCD in adults has evolved into a chronic degenerative disease with underlying damage to multiple organs including the heart and lungs. Cardiopulmonary complications, including cardiomyopathy, diastolic dysfunction, pulmonary hypertension (PH), and sudden cardiac death are the most common causes of morbidity and mortality. Awareness of the sickle-related cardiovascular phenotypes is important for screening, early diagnosis, and intervention of cardiac complications in this disorder.
Collapse
Affiliation(s)
- Vandana Sachdev
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Douglas R Rosing
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Swee Lay Thein
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
18
|
Wood KC, Gladwin MT, Straub AC. Sickle cell disease: at the crossroads of pulmonary hypertension and diastolic heart failure. Heart 2019; 106:562-568. [DOI: 10.1136/heartjnl-2019-314810] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 12/31/2022] Open
Abstract
Sickle cell disease (SCD) is caused by a single point mutation in the gene that codes for beta globin synthesis, causing haemoglobin polymerisation, red blood cell stiffening and haemolysis under low oxygen and pH conditions. Downstream effects include widespread vasculopathy due to recurring vaso-occlusive events and haemolytic anaemia, affecting all organ systems. Cardiopulmonary complications are the leading cause of death in patients with SCD, primarily resulting from diastolic heart failure (HF) and/or pulmonary hypertension (PH). HF in SCD often features biventricular cardiac hypertrophy and left ventricular (LV) diastolic dysfunction. Among HF cases in the general population, approximately half occur with preserved ejection fraction (HFpEF). The insidious evolution of HFpEF differs from the relatively acute evolution of HF with reduced ejection fraction. The PH of SCD has diverse origins, which can be pulmonary arterial (precapillary), pulmonary venous (postcapillary) or pulmonary thromboembolic. It is also appreciated that patients with SCD can develop both precapillary and postcapillary PH, with elevations in LV diastolic pressures, as well as elevations in transpulmonary pressure gradient and pulmonary vascular resistance. Regardless of the cause of PH in SCD, its presence significantly reduces functional capacity and increases mortality. PH that occurs in the presence of HFpEF is usually of postcapillary origin. This review aims to assemble what has been learnt from clinical and animal studies about the manifestation of PH-HFpEF in SCD, specifically the contributions of LV diastolic dysfunction and myocardial fibrosis, in an attempt to gain an understanding of its evolution.
Collapse
|
19
|
Liem RI, Lanzkron S, D Coates T, DeCastro L, Desai AA, Ataga KI, Cohen RT, Haynes J, Osunkwo I, Lebensburger JD, Lash JP, Wun T, Verhovsek M, Ontala E, Blaylark R, Alahdab F, Katabi A, Mustafa RA. American Society of Hematology 2019 guidelines for sickle cell disease: cardiopulmonary and kidney disease. Blood Adv 2019; 3:3867-3897. [PMID: 31794601 PMCID: PMC6963257 DOI: 10.1182/bloodadvances.2019000916] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prevention and management of end-organ disease represent major challenges facing providers of children and adults with sickle cell disease (SCD). Uncertainty and variability in the screening, diagnosis, and management of cardiopulmonary and renal complications in SCD lead to varying outcomes for affected individuals. OBJECTIVE These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about screening, diagnosis, and management of cardiopulmonary and renal complications of SCD. METHODS ASH formed a multidisciplinary guideline panel that included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The Mayo Evidence-Based Practice Research Program supported the guideline development process, including performing systematic evidence reviews up to September 2017. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS The panel agreed on 10 recommendations for screening, diagnosis, and management of cardiopulmonary and renal complications of SCD. Recommendations related to anticoagulation duration for adults with SCD and venous thromboembolism were also developed. CONCLUSIONS Most recommendations were conditional due to a paucity of direct, high-quality evidence for outcomes of interest. Future research was identified, including the need for prospective studies to better understand the natural history of cardiopulmonary and renal disease, their relationship to patient-important outcomes, and optimal management.
Collapse
Affiliation(s)
- Robert I Liem
- Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sophie Lanzkron
- Division of Adult Hematology, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Thomas D Coates
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Laura DeCastro
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ankit A Desai
- Krannert Institute of Cardiology, School of Medicine, Indiana University, Indianapolis, IN
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
| | - Robyn T Cohen
- Division of Pediatric Pulmonary and Allergy, Boston Medical Center, School of Medicine, Boston University, Boston, MA
| | - Johnson Haynes
- Division of Pulmonary Disease, College of Medicine, University of South Alabama, Mobile, AL
| | - Ifeyinwa Osunkwo
- Division of Hematology, The Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Jeffrey D Lebensburger
- Division of Pediatric Hematology/Oncology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - James P Lash
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Theodore Wun
- Division of Hematology and Oncology, School of Medicine, University of California Davis, Sacramento, CA
| | - Madeleine Verhovsek
- Division of Hematology and Thromboembolism, McMaster University, Hamilton, ON, Canada
| | | | | | - Fares Alahdab
- Division of General Internal Medicine, Mayo Medical School, Rochester, MN; and
| | - Abdulrahman Katabi
- Division of General Internal Medicine, Mayo Medical School, Rochester, MN; and
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, School of Medicine, University of Kansas, Kansas City, KS
| |
Collapse
|
20
|
Comparison between Adult Patients with Sickle Cell Disease of Sub-Saharan African Origin Born in Metropolitan France and in Sub-Saharan Africa. J Clin Med 2019; 8:jcm8122173. [PMID: 31835320 PMCID: PMC6947353 DOI: 10.3390/jcm8122173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023] Open
Abstract
Sickle cell disease (SCD) prevalence has increased rapidly in Europe as a result of an increase in the life expectancy of these patients and the arrival of SCD migrants from Africa. The aim of our study was to compare the phenotypes of adult patients born in Sub-Saharan Africa (SSA) who migrated to France with those of patients with the same origin who were born in France. This single-center observational study compared the demographic, clinical and biological characteristics of SCD adult patients of SSA origin who were born in France or SSA. Data were collected from computerized medical charts. Groups were compared using multivariate logistic regression with adjustment for age, gender and type of SCD. Of the 323 SCD patients followed in our center, 235 were enrolled, including 111 patients born in France and 124 patients born in SSA. SCD genotypes were balanced between groups. Patients born in Africa were older (median age 32.1 (24.4-39) vs. 25.6 (22.1-30.5) years, p < 0.001) and more often women (n = 75 (60.5%) vs. 48 (43.2%), p = 0.008). The median age at arrival in France was 18 years (13-23). The median height was lower among patients born in SSA (169 (163-175) vs. 174.5 cm (168-179), p < 0.001). Over their lifetimes, patients born in France had more acute chest syndromes (median number 2 (1-4) vs. 1 (0-3), p = 0.002), with the first episode occurring earlier (19 (11.6-22.3) vs. 24 (18.4-29.5) years, p < 0.007), and were admitted to intensive care units more often (53.3% vs. 34.9%, p = 0.006). This difference was more pronounced in the SS/Sβ0 population. Conversely, patients born in SSA had more skin ulcers (19.4% vs. 6.3%, p = 0.03). No significant differences were found in social and occupational insertion or other complications between the two groups. Patients born in SSA had a less severe disease phenotype regardless of their age than those born in France. This difference could be related to a survival bias occurring in Africa during childhood and migration to Europe that selected the least severe phenotypes.
Collapse
|
21
|
Allogeneic Hematopoietic Stem Cell Transplantation for Adults with Sickle Cell Disease. J Clin Med 2019; 8:jcm8101565. [PMID: 31581479 PMCID: PMC6832368 DOI: 10.3390/jcm8101565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 12/30/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited red blood cell disorder that leads to substantial morbidity and early mortality. Acute and chronic SCD-related complications increase with older age, and therapies are urgently needed to treat adults. Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative therapy, but has been used less frequently in adults compared to children. This is, in part, due to (1) greater chronic organ damage, limiting tolerability to myeloablative conditioning regimens, (2) a higher rate of HSCT-related complications in adults versus children with SCD, and (3) limited coverage by public and private health insurance. Newer approaches using nonmyeloablative and reduced-intensity conditioning HSCT regimens have demonstrated better safety and tolerability, with high rates of stable engraftment in SCD adults. This review will focus on the impacts of HSCT, using more contemporary approaches to SCD-related complications in adults.
Collapse
|
22
|
Agarwal MA, Shah M, Patel B, Nolan VG, Reed GL, Oudiz RJ, Choudhary G, Maron BA. Association between Pulmonary Hypertension and Clinical Outcomes in Hospitalized Patients with Sickle Cell Disease. Am J Respir Crit Care Med 2019; 198:534-537. [PMID: 29648884 DOI: 10.1164/rccm.201802-0261le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Manyoo A Agarwal
- 1 University of Tennessee Health Science Center Memphis, Tennessee
| | - Mahek Shah
- 2 Lehigh Valley Healthcare Network Allentown, Pennsylvania
| | - Brijesh Patel
- 2 Lehigh Valley Healthcare Network Allentown, Pennsylvania
| | | | - Guy L Reed
- 4 University of Arizona College of Medicine Phoenix, Arizona
| | - Ronald J Oudiz
- 5 LA Biomedical Research Institute at Harbor-UCLA Medical Center Torrance, California
| | - Gaurav Choudhary
- 6 Brown University Providence, Rhode Island.,7 Providence VA Medical Center Providence, Rhode Island
| | - Bradley A Maron
- 8 Brigham and Women's Hospital Boston, Massachusetts and.,9 Boston VA Medical Center Boston, Massachusetts
| |
Collapse
|
23
|
de Roux Q, Maghrebi S, Fiore A, Arminot-Fremaux M, Dessalle T, Lim P, Folliguet T, Bartolucci P, Langeron O, Mongardon N. Venoarterial Extracorporeal Membrane Oxygenation in Sickle Cell Disease for Urgent Cardiac Surgery. Ann Thorac Surg 2019; 109:e161-e162. [PMID: 31362014 DOI: 10.1016/j.athoracsur.2019.05.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
Sickle cell disease (SCD) is among the most common genetic diseases, with a recent increase in life expectancy. Patients may therefore need similar surgical procedures as does the general population, including cardiac surgery. Cardiopulmonary bypass is a homeostasis challenge for SCD patients, with high risk of vasoocclusive crisis. In the most severe cases of cardiogenic shock, venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be required, with prolonged exposure to extreme nonphysiological conditions. We report a case of postcardiotomy shock in an SCD patient successfully managed with VA-ECMO. This highlights that SCD should not be a counterindication to VA-ECMO, pending multidisciplinary management.
Collapse
Affiliation(s)
- Quentin de Roux
- Service d'Anesthésie-Réanimation Chirurgicale, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France; U955-IMRB, Equipe 03 "Stratégies pharmacologiques et thérapeutiques expérimentales des insuffisances cardiaques et coronaires," Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Sami Maghrebi
- Service d'Anesthésie-Réanimation Chirurgicale, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Antonio Fiore
- Service de Chirurgie Cardiaque, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Margot Arminot-Fremaux
- Service d'Anesthésie-Réanimation Chirurgicale, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Thomas Dessalle
- Service d'Anesthésie-Réanimation Chirurgicale, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Pascal Lim
- Service de Cardiologie, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Thierry Folliguet
- Service de Chirurgie Cardiaque, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France; Faculté de Médecine, Université Paris-Est Créteil, Créteil, France
| | - Pablo Bartolucci
- Faculté de Médecine, Université Paris-Est Créteil, Créteil, France; Unité des Maladies Génétiques du Globule Rouge, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Olivier Langeron
- Service d'Anesthésie-Réanimation Chirurgicale, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France; Faculté de Médecine, Université Paris-Est Créteil, Créteil, France
| | - Nicolas Mongardon
- Service d'Anesthésie-Réanimation Chirurgicale, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France; Faculté de Médecine, Université Paris-Est Créteil, Créteil, France; U955-IMRB, Equipe 03 "Stratégies pharmacologiques et thérapeutiques expérimentales des insuffisances cardiaques et coronaires," Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.
| |
Collapse
|
24
|
Pulmonary Hypertension in Children with Sickle Cell Disease: a Review of the Current Literature. CURRENT PEDIATRICS REPORTS 2019. [DOI: 10.1007/s40124-019-00188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Reduced peripheral blood superoxide dismutase 2 expression in sickle cell disease. Ann Hematol 2019; 98:1561-1572. [DOI: 10.1007/s00277-019-03709-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/05/2019] [Indexed: 01/06/2023]
|
26
|
Hammoudi N, Lionnet F, Redheuil A, Montalescot G. Cardiovascular manifestations of sickle cell disease. Eur Heart J 2019; 41:1365-1373. [DOI: 10.1093/eurheartj/ehz217] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Sickle cell disease (SCD) is the most frequent genetic haemoglobinopathy worldwide. Early childhood mortality has dramatically decreased in high-income countries, and most patients now survive beyond the 5th decade. However, in the aging SCD population, the morbidity related to chronic organ damage, especially kidney and heart, has become a major concern. While pulmonary hypertension has attracted most attention, it appears that this condition is frequently linked to left heart failure (HF). Accordingly, SCD-associated cardiomyopathy is emerging as a major cause of reduced quality of life and early mortality in these patients. The diagnosis of this particular phenotype of high-output HF is challenging. Exercise intolerance and dyspnoea in SCD patients are linked to multiple causes including chronic anaemia. Moreover, echocardiographic features are unusual and can be misinterpreted. The classical diagnosis algorithm for HF is generally not suitable in SCD patients, and HF is poorly recognized and mostly diagnosed at a late congestive stage in routine practice. Such patients need to be identified at an earlier stage of myocardial dysfunction via improved phenotyping. This constitutes the first step towards further investigations in SCD needed to improve the prognosis and the quality of life. This article provides an updated review of the recent advances in the pathophysiology and diagnosis, and in addition, perspectives of new therapeutic approaches in SCD-related cardiac manifestations.
Collapse
Affiliation(s)
- Nadjib Hammoudi
- Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group and Department of Cardiology, Institute of Cardiology (AP-HP), Hôpital Pitié- Salpêtrière, Boulevard de l'hôpital, Paris F-75013, France
| | - François Lionnet
- Sorbonne Université, Department of Internal Medicine, centre de référence de la drépanocytose (AP-HP), Centre Hospitalier Universitaire Tenon, rue de la Chine, 75020 Paris, France
| | - Alban Redheuil
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology (DICVRIT), Hôpital Pitié- Salpêtrière, Boulevard de l'hôpital, Sorbonne Université, Inserm, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Institute of Cardiometabolism and Nutrition (ICAN), Institute of Cardiology (AP-HP), Paris F-75013, France
| | - Gilles Montalescot
- Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group and Department of Cardiology, Institute of Cardiology (AP-HP), Hôpital Pitié- Salpêtrière, Boulevard de l'hôpital, Paris F-75013, France
| |
Collapse
|
27
|
Benites BD, Cisneiros IS, Bastos SO, Lino APBL, Costa FF, Gilli SCO, Saad STO. Echocardiografic abnormalities in patients with sickle cell/β-thalassemia do not depend on the β-thalassemia phenotype. Hematol Transfus Cell Ther 2019; 41:158-163. [PMID: 31084765 PMCID: PMC6517685 DOI: 10.1016/j.htct.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/26/2018] [Accepted: 09/11/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES AND METHODS We evaluated possible relationships between echocardiographic findings and clinical and laboratory parameters, in a cohort of Brazilian patients diagnosed with sickle cell/β-thalassemia, to better understand the cardiac involvement in this disease. RESULTS Left atrial (LA) and left ventricular (LV) dilation were found in 19.5 and 11% of patients, respectively; systolic left ventricular dysfunction was present in a single patient. There were no differences in masses and volumes of cardiac chambers comparing Sβ0 with Sβ+ patients, and no relationship between these parameters and specific complications of the disease. However, parameters of altered ventricular geometry were significantly correlated with serum creatinine, hepatic transaminases and bilirubin levels. Moreover, 3 patients presented stroke; they were significantly older [53 (41-56)×37.5 (18-70), p=0.048], had higher values of LV posterior wall diastolic thickness [10 (10-11)×8 (6-14), p=0.03], LV mass [226 (194-260)×147 (69-537), p=0.039] and LA/aortic ratio [1.545 (1.48-1.61)×1.26 (0.9-1.48), p=0.032]. CONCLUSIONS Cardiac involvement in this disease does not appear to depend on the thalassemia phenotype. The presence of signs of myocardial remodeling in this group of patients was related to multi-organ impairment and rendered a higher propensity for stroke in older patients, suggesting the need for greater vigilance and control of associated factors.
Collapse
|
28
|
Fort R. Recommendations for the use of red blood cell exchange in sickle cell disease. Transfus Apher Sci 2019; 58:128-131. [PMID: 30879904 DOI: 10.1016/j.transci.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Sickle cell disease (SCD) is a genetic disorder characterised by a single mutation of the beta globin gene, causing the production of an abnormal haemoglobin called sickle haemoglobin (HbS). In its deoxygenated form, HbS polymerises, causing major rheological disorders, which presents clinically as periodic vaso-occlusive crises, chronic haemolysis and chronic vascular dysfunction. Patients often resort to a background treatment, and transfusion remains the cornerstone in the management of the disease, significantly reducing morbidity and mortality. The aim of red blood cell exchange (RBCX) is to improve tissue oxygenation by increasing haemoglobin levels while lowering HbS levels. RBCX can be performed by manual or automated exchange, and each technique has its own set of advantages and disadvantages. This article will outline the transfusion indications for the main complications of SCD, as well as the most appropriate strategy to use.
Collapse
Affiliation(s)
- Romain Fort
- Department of Internal Medicine, CHU Edouard Herriot, Lyon, France; Laboratoire LIBM EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard, Lyon, France; Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France.
| |
Collapse
|
29
|
Gellen B, Messonnier LA, Galactéros F, Audureau E, Merlet AN, Rupp T, Peyrot S, Martin C, Féasson L, Bartolucci P, Habibi A, Guillet E, Gellen-Dautremer J, Ribeil JA, Arlet JB, Mattioni S, Berkenou J, Delrieux N, Lionnet F, Grenot JF, Mira J, Peyrard A, Lacroix R, Garcin A, Di Liberto G, Hourdé C. Moderate-intensity endurance-exercise training in patients with sickle-cell disease without severe chronic complications (EXDRE): an open-label randomised controlled trial. LANCET HAEMATOLOGY 2018; 5:e554-e562. [PMID: 30389037 DOI: 10.1016/s2352-3026(18)30163-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 01/17/2023]
|
30
|
Sundd P, Gladwin MT, Novelli EM. Pathophysiology of Sickle Cell Disease. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2018; 14:263-292. [PMID: 30332562 DOI: 10.1146/annurev-pathmechdis-012418-012838] [Citation(s) in RCA: 330] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since the discovery of sickle cell disease (SCD) in 1910, enormous strides have been made in the elucidation of the pathogenesis of its protean complications, which has inspired recent advances in targeted molecular therapies. In SCD, a single amino acid substitution in the β-globin chain leads to polymerization of mutant hemoglobin S, impairing erythrocyte rheology and survival. Clinically, erythrocyte abnormalities in SCD manifest in hemolytic anemia and cycles of microvascular vaso-occlusion leading to end-organ ischemia-reperfusion injury and infarction. Vaso-occlusive events and intravascular hemolysis promote inflammation and redox instability that lead to progressive small- and large-vessel vasculopathy. Based on current evidence, the pathobiology of SCD is considered to be a vicious cycle of four major processes, all the subject of active study and novel therapeutic targeting: ( a) hemoglobin S polymerization, ( b) impaired biorheology and increased adhesion-mediated vaso-occlusion, ( c) hemolysis-mediated endothelial dysfunction, and ( d) concerted activation of sterile inflammation (Toll-like receptor 4- and inflammasome-dependent innate immune pathways). These molecular, cellular, and biophysical processes synergize to promote acute and chronic pain and end-organ injury and failure in SCD. This review provides an exhaustive overview of the current understanding of the molecular pathophysiology of SCD, how this pathophysiology contributes to complications of the central nervous and cardiopulmonary systems, and how this knowledge is being harnessed to develop current and potential therapies.
Collapse
Affiliation(s)
- Prithu Sundd
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA; .,Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA.,Sickle Cell Center of Excellence, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA
| | - Mark T Gladwin
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA; .,Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA.,Sickle Cell Center of Excellence, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA
| | - Enrico M Novelli
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA.,Sickle Cell Center of Excellence, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA.,Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA
| |
Collapse
|
31
|
|
32
|
Abstract
PURPOSE OF REVIEW Iron overload cardiomyopathy (IOC) is an important predictor of prognosis in a significant number of patients with hereditary hemochromatosis and hematologic diseases. Its prevalence is increasing because of improved treatment strategies, which significantly improve life expectancy. We will review diagnosis, treatment, and recent findings in the field. RECENT FINDINGS The development of preclinical translational disease models during the last years have helped our understanding of specific disease pathophysiological pathways that might eventually change the outcomes of these patients. SUMMARY IOC is an overlooked disease because of the progressive silent disease pattern and the lack of physicians' expertise. It mainly affects patients with hemochromatosis and hematologic diseases and its prevalence is expected to increase with the improvement in life expectancy of hematologic disorders. Early diagnosis of IOC in patients at risk by means of biochemical parameters and cardiac imaging can lead to early treatment and improved prognosis. The mainstay of treatment of IOC is conventional heart failure treatment, combined with phlebotomies or iron chelation in the context of anemia. The development of preclinical models has provided a comprehensive look into specific pathophysiological pathways with potential treatment strategies that must be sustained by future randomized trials.
Collapse
Affiliation(s)
| | - Josep Comín-Colet
- Community Heart Failure Unit, IDIBELL, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | |
Collapse
|
33
|
Guedeney P, Lionnet F, Ceccaldi A, Stankovic Stojanovic K, Cohen A, Mattioni S, Montalescot G, Bachmeyer C, Isnard R, Haymann JP, Hammoudi N. Cardiac manifestations in sickle cell disease varies with patient genotype. Br J Haematol 2018; 181:664-671. [DOI: 10.1111/bjh.15238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/25/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Paul Guedeney
- Sorbonne Universités, UPMC Univ Paris 06; Institut de Cardiologie (AP-HP); Centre Hospitalier Universitaire Pitié-Salpêtrière; Institute of Cardiometabolism and Nutrition (ICAN); INSERM UMRS 1166; ACTION Study Group; Paris France
| | - François Lionnet
- Sorbonne Universités, UPMC Univ Paris 06; Service de médecine interne, centre de référence de la drépanocytose (AP-HP); Centre Hospitalier Universitaire Tenon; Paris France
| | - Alexandre Ceccaldi
- Sorbonne Universités, UPMC Univ Paris 06; Institut de Cardiologie (AP-HP); Centre Hospitalier Universitaire Pitié-Salpêtrière; Institute of Cardiometabolism and Nutrition (ICAN); INSERM UMRS 1166; ACTION Study Group; Paris France
| | - Katia Stankovic Stojanovic
- Sorbonne Universités, UPMC Univ Paris 06; Service de médecine interne, centre de référence de la drépanocytose (AP-HP); Centre Hospitalier Universitaire Tenon; Paris France
| | - Ariel Cohen
- Sorbonne Universités; UPMC Univ Paris 06; Service de Cardiologie (AP-HP), Centre Hospitalier Universitaire Saint-Antoine; Paris France
| | - Sarah Mattioni
- Sorbonne Universités, UPMC Univ Paris 06; Service de médecine interne, centre de référence de la drépanocytose (AP-HP); Centre Hospitalier Universitaire Tenon; Paris France
| | - Gilles Montalescot
- Sorbonne Universités, UPMC Univ Paris 06; Institut de Cardiologie (AP-HP); Centre Hospitalier Universitaire Pitié-Salpêtrière; Institute of Cardiometabolism and Nutrition (ICAN); INSERM UMRS 1166; ACTION Study Group; Paris France
| | - Claude Bachmeyer
- Sorbonne Universités, UPMC Univ Paris 06; Service de médecine interne, centre de référence de la drépanocytose (AP-HP); Centre Hospitalier Universitaire Tenon; Paris France
| | - Richard Isnard
- Sorbonne Universités, UPMC Univ Paris 06; Institut de Cardiologie (AP-HP); Centre Hospitalier Universitaire Pitié-Salpêtrière; Institute of Cardiometabolism and Nutrition (ICAN); INSERM UMRS 1166; ACTION Study Group; Paris France
| | - Jean-Philippe Haymann
- Sorbonne Universités; UPMC Univ Paris 06; Département de physiologie et de néphrologie (AP-HP); Centre Hospitalier Universitaire Tenon; INSERM UPMC 1155; Paris France
| | - Nadjib Hammoudi
- Sorbonne Universités, UPMC Univ Paris 06; Institut de Cardiologie (AP-HP); Centre Hospitalier Universitaire Pitié-Salpêtrière; Institute of Cardiometabolism and Nutrition (ICAN); INSERM UMRS 1166; ACTION Study Group; Paris France
| |
Collapse
|
34
|
Maron BA, Wertheim BM, Gladwin MT. Under Pressure to Clarify Pulmonary Hypertension Clinical Risk. Am J Respir Crit Care Med 2018; 197:423-426. [PMID: 29216444 PMCID: PMC5821912 DOI: 10.1164/rccm.201711-2306ed] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Bradley A Maron
- 1 Division of Cardiovascular Medicine Brigham and Women's Hospital and Harvard Medical School Boston, Massachusetts
- 2 Department of Cardiology Boston VA Healthcare System Boston, Massachusetts
| | - Bradley M Wertheim
- 3 Division of Pulmonary and Critical Care Medicine Brigham and Women's Hospital and Harvard Medical School Boston, Massachusetts
| | - Mark T Gladwin
- 4 University of Pittsburgh Medical Center and
- 5 Pittsburgh Heart, Lung, Blood, and Vascular Medical Institute University of Pittsburgh Pittsburgh, Pennsylvania
| |
Collapse
|
35
|
Kuck JL, Bastarache JA, Shaver CM, Fessel JP, Dikalov SI, May JM, Ware LB. Ascorbic acid attenuates endothelial permeability triggered by cell-free hemoglobin. Biochem Biophys Res Commun 2018; 495:433-437. [PMID: 29129689 PMCID: PMC5736437 DOI: 10.1016/j.bbrc.2017.11.058] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/08/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increased endothelial permeability is central to shock and organ dysfunction in sepsis but therapeutics targeted to known mediators of increased endothelial permeability have been unsuccessful in patient studies. We previously reported that cell-free hemoglobin (CFH) is elevated in the majority of patients with sepsis and is associated with organ dysfunction, poor clinical outcomes and elevated markers of oxidant injury. Others have shown that Vitamin C (ascorbate) may have endothelial protective effects in sepsis. In this study, we tested the hypothesis that high levels of CFH, as seen in the circulation of patients with sepsis, disrupt endothelial barrier integrity. METHODS Human umbilical vein endothelial cells (HUVEC) were grown to confluence and treated with CFH with or without ascorbate. Monolayer permeability was measured by Electric Cell-substrate Impedance Sensing (ECIS) or transfer of 14C-inulin. Viability was measured by trypan blue exclusion. Intracellular ascorbate was measured by HPLC. RESULTS CFH increased permeability in a dose- and time-dependent manner with 1 mg/ml of CFH increasing inulin transfer by 50% without affecting cell viability. CFH (1 mg/ml) also caused a dramatic reduction in intracellular ascorbate in the same time frame (1.4 mM without CFH, 0.23 mM 18 h after 1 mg/ml CFH, p < 0.05). Pre-treatment of HUVECs with ascorbate attenuated CFH induced permeability. CONCLUSIONS CFH increases endothelial permeability in part through depletion of intracellular ascorbate. Supplementation of ascorbate can attenuate increases in permeability mediated by CFH suggesting a possible therapeutic approach in sepsis.
Collapse
Affiliation(s)
- Jamie L. Kuck
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Julie A. Bastarache
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Ciara M. Shaver
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Joshua P. Fessel
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN,Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN
| | - Sergey I. Dikalov
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN
| | - James M. May
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Lorraine B. Ware
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN,Corresponding author: Lorraine B. Ware, MD, Professor of Medicine and Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, T1218 MCN, Nashville, TN 37232,
| |
Collapse
|
36
|
Maron BA, Brittain EL, Choudhary G, Gladwin MT. Redefining pulmonary hypertension. THE LANCET RESPIRATORY MEDICINE 2017; 6:168-170. [PMID: 29269004 DOI: 10.1016/s2213-2600(17)30498-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Bradley A Maron
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Cardiology, Boston Veterans Affairs Healthcare System, Boston, MA 02115, USA.
| | - Evan L Brittain
- Division of Cardiovascular Medicine and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gaurav Choudhary
- Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI, USA
| | - Mark T Gladwin
- Department of Medicine, University of Pittsburgh Medical Center and Pittsburgh Heart, Lung, Blood, and Vascular Medical Institute, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
37
|
Longitudinal Analysis of Echocardiographic Abnormalities in Children With Sickle Cell Disease. J Pediatr Hematol Oncol 2017; 39:500-505. [PMID: 28859033 DOI: 10.1097/mph.0000000000000930] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cardiac abnormalities have been described in echocardiograms of children with sickle cell disease (SCD). However, longitudinal studies investigating progression of echocardiographic abnormalities across the pediatric age spectrum in SCD are lacking. METHODS A retrospective longitudinal analysis of 829 echocardiograms from pediatric patients with SCD at steady-state was performed. Left heart parameters included left ventricular end-systolic, end-diastolic diameters, fractional shortening, and mass. Right ventricular pressure was estimated by tricuspid regurgitation gradient. Tricuspid regurgitation gradient ≥25 mm Hg, a z-score ≥2 for LV parameters and ≤-2 for left ventricular fractional shortening were considered abnormal. RESULTS Kaplan-Meier analysis revealed that echocardiographic abnormalities were detected by 5 years of age, and the cumulative incidence progressively increased throughout childhood. Age, male gender, HbSS and Sβ thalassemia genotype, white blood cell count, platelet count, total bilirubin, admissions for pain crises and acute chest syndrome were positively, whereas hemoglobin was negatively associated with cardiac abnormalities. CONCLUSION Cardiac abnormalities began early in childhood and progressively increased with age. Our study highlights the high cumulative incidence of cardiac abnormalities in children with SCD, which could represent a marker of disease severity.
Collapse
|
38
|
Shilo NR, Morris CR. Pathways to pulmonary hypertension in sickle cell disease: the search for prevention and early intervention. Expert Rev Hematol 2017; 10:875-890. [PMID: 28817980 DOI: 10.1080/17474086.2017.1364989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Pulmonary hypertension (PH) develops in a significant number of patients with sickle cell disease (SCD), resulting in increased morbidity and mortality. This review focuses on PH pathophysiology, risk stratification, and new recommendations for screening and treatment for patients with SCD. Areas covered: An extensive PubMed literature search was performed. While the pathophysiology of PH in SCD is yet to be fully deciphered, it is known that the etiology is multifactorial; hemolysis, hypercoagulability, hypoxemia, ischemic-reperfusion injury, oxidative stress, and genetic susceptibility all contribute in varying degrees to endothelial dysfunction. Hemolysis, in particular, seems to play a key role by inciting an imbalance in the regulatory axis of nitric oxide and arginine metabolism. Systematic risk stratification starting in childhood based on clinical features and biomarkers that enable early detection is necessary. Multi-faceted, targeted interventions, before irreversible vasculopathy develops, will allow for improved patient outcomes and life expectancy. Expert commentary: Despite progress in our understanding of PH in SCD, clinically proven therapies remain elusive and additional controlled clinical trials are needed. Prevention of disease starts in childhood, a critical window for intervention. Given the complex and multifactorial nature of SCD, patients will ultimately benefit from combination therapies that simultaneously targets multiple mechanisms.
Collapse
Affiliation(s)
- Natalie R Shilo
- a Department of Pediatrics, Division of Pulmonary Medicine , University of Connecticut Heath Center , Farmington , CT , USA
| | - Claudia R Morris
- b Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory-Children's Center for Cystic Fibrosis and Airways Disease Research , Emory University School of Medicine , Atlanta , GA , USA
| |
Collapse
|
39
|
Kormann R, Jannot AS, Narjoz C, Ribeil JA, Manceau S, Delville M, Joste V, Prié D, Pouchot J, Thervet E, Courbebaisse M, Arlet JB. Roles of APOL1 G1 and G2 variants in sickle cell disease patients: kidney is the main target. Br J Haematol 2017; 179:323-335. [PMID: 28699644 DOI: 10.1111/bjh.14842] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/28/2017] [Indexed: 12/29/2022]
Abstract
In African-American patients with sickle cell disease (SCD), APOL1 G1 and G2 variants are associated with increased risk of sickle cell nephropathy (SCN). To determine the role of APOL1 variants in SCD patients living in Europe, we genotyped 152 SCD patients [aged 30·4 (24·3-36·4) years], mainly of Sub-Saharan African ancestry, for APOL1 G1 and G2 and for variants of four genes with kidney tropism (GSTM1, GSTT1, GSTP1, and HMOX1). Homozygous or double-heterozygous APOL G1 and G2 genotypes were strongly associated with end stage renal disease (P = 0·003) and worse Kidney Disease: Improving Global Outcomes stages (P = 0·001). Further, these genotypes were associated in an age-dependent manner with lower estimated glomerular filtration rate (eGFR, P = 0·008), proteinuria (P = 0·009) and albuminuria (P < 0·001) but not with other SCD complications. Compared to APOL1 G1/wild type (WT), the APOL1 G2/WT genotype was associated with a lower eGFR (P = 0·04) in an age-dependent manner, suggesting that the G2/WT patients are likely to have worse kidney prognosis. Other genes variants analysed were not associated with SCN or other SCD complications. Our data indicate that APOL1 screening should be considered for the management of SCD patients, including those of non-African-American origin, as those with homozygous or double heterozygous variants are clearly at higher risk of SCN.
Collapse
Affiliation(s)
- Raphaël Kormann
- Physiology Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes Faculty of Medicine, Paris, France
| | - Anne-Sophie Jannot
- Paris Descartes Faculty of Medicine, Paris, France.,INSERM UMR 1138-E22: Information Sciences & Personalized Medicine, Paris, France.,Medical Informatics, Biostatistics and Public Health Department, Georges Pompidou University Hospital, Paris, France
| | - Céline Narjoz
- Paris Descartes Faculty of Medicine, Paris, France.,Biochemistry Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Institut National pour la Santé et la Recherche Médicale (INSERM) UMR-S 1147, Paris, France
| | - Jean-Antoine Ribeil
- Paris Descartes Faculty of Medicine, Paris, France.,Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Biotherapy Clinical Investigation Centre, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM, Paris, France.,Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades University Hospital, APHP, Université Paris 5, Paris, France
| | - Sandra Manceau
- Paris Descartes Faculty of Medicine, Paris, France.,Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marianne Delville
- Paris Descartes Faculty of Medicine, Paris, France.,Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades University Hospital, APHP, Université Paris 5, Paris, France
| | - Valentin Joste
- Paris Descartes Faculty of Medicine, Paris, France.,Biochemistry Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dominique Prié
- Paris Descartes Faculty of Medicine, Paris, France.,INSERM U1151-CNRS UMR8253, Paris, France.,AP-HP, Necker Children's Hospital, Physiology Department, Paris Descartes University, Paris, France
| | - Jacques Pouchot
- Paris Descartes Faculty of Medicine, Paris, France.,Internal Medicine Department, Sickle Cell Referral Centre, Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité et Assistance Publique-Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| | - Eric Thervet
- Paris Descartes Faculty of Medicine, Paris, France.,Institut National pour la Santé et la Recherche Médicale (INSERM) UMR-S 1147, Paris, France.,Department of Nephrology, Georges Pompidou University Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Marie Courbebaisse
- Physiology Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes Faculty of Medicine, Paris, France.,INSERM U1151-CNRS UMR8253, Paris, France
| | - Jean-Benoît Arlet
- Paris Descartes Faculty of Medicine, Paris, France.,Internal Medicine Department, Sickle Cell Referral Centre, Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité et Assistance Publique-Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| |
Collapse
|
40
|
Ilboudo Y, Bartolucci P, Rivera A, Sedzro JC, Beaudoin M, Trudel M, Alper SL, Brugnara C, Galactéros F, Lettre G. Genome-wide association study of erythrocyte density in sickle cell disease patients. Blood Cells Mol Dis 2017; 65:60-65. [PMID: 28552477 DOI: 10.1016/j.bcmd.2017.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 05/10/2017] [Accepted: 05/10/2017] [Indexed: 12/14/2022]
Abstract
Deoxy-hemoglobin S polymerization into rigid fibers is the direct cause of the clinical sequelae observed in sickle cell disease (SCD). The rate of polymerization of sickle hemoglobin is determined primarily by intracellular hemoglobin concentration, itself dependent on the amount of sickle hemoglobin and on red blood cell (RBC) volume. Dense, dehydrated RBC (DRBC) are observed in SCD patients, and their number correlates with hemolytic parameters and complications such as renal dysfunction, leg ulcers and priapism. To identify new genes involved in RBC hydration in SCD, we performed the first genome-wide association study for DRBC in 374 sickle cell anemia (HbSS) patients. We did not find genome-wide significant results, indicating that variants that modulate DRBC have modest-to-weak effects. A secondary analysis demonstrated a nominal association (P=0.003) between DRBC in SCD patients and a variant associated with mean corpuscular hemoglobin concentration (MCHC) in non-anemic individuals. This intronic variant controls the expression of ATP2B4, the main calcium pump in erythrocytes. Our study highlights ATP2B4 as a promising target for modulation of RBC hydration in SCD patients.
Collapse
Affiliation(s)
- Yann Ilboudo
- Faculty of Medicine, Program in Bioinformatics, Université de Montréal, Montreal, Quebec, Canada; Montreal Heart Institute, Montreal, Quebec, Canada
| | - Pablo Bartolucci
- Red Cell Genetic Disease Unit, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Est, IMRB - U955 - Equipe no 2, Créteil, France
| | - Alicia Rivera
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, USA; Department of Medicine, Harvard Medical School, Boston, USA
| | | | | | - Marie Trudel
- Faculty of Medicine, Department of Medicine and Department of Biochemistry, Université de Montréal, Montreal, Quebec, Canada; Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, USA; Department of Medicine, Harvard Medical School, Boston, USA
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Frédéric Galactéros
- Red Cell Genetic Disease Unit, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Est, IMRB - U955 - Equipe no 2, Créteil, France
| | - Guillaume Lettre
- Faculty of Medicine, Program in Bioinformatics, Université de Montréal, Montreal, Quebec, Canada; Montreal Heart Institute, Montreal, Quebec, Canada.
| |
Collapse
|
41
|
Kato GJ, Steinberg MH, Gladwin MT. Intravascular hemolysis and the pathophysiology of sickle cell disease. J Clin Invest 2017; 127:750-760. [PMID: 28248201 DOI: 10.1172/jci89741] [Citation(s) in RCA: 410] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Hemolysis is a fundamental feature of sickle cell anemia that contributes to its pathophysiology and phenotypic variability. Decompartmentalized hemoglobin, arginase 1, asymmetric dimethylarginine, and adenine nucleotides are all products of hemolysis that promote vasomotor dysfunction, proliferative vasculopathy, and a multitude of clinical complications of pulmonary and systemic vasculopathy, including pulmonary hypertension, leg ulcers, priapism, chronic kidney disease, and large-artery ischemic stroke. Nitric oxide (NO) is inactivated by cell-free hemoglobin in a dioxygenation reaction that also oxidizes hemoglobin to methemoglobin, a non-oxygen-binding form of hemoglobin that readily loses heme. Circulating hemoglobin and heme represent erythrocytic danger-associated molecular pattern (eDAMP) molecules, which activate the innate immune system and endothelium to an inflammatory, proadhesive state that promotes sickle vaso-occlusion and acute lung injury in murine models of sickle cell disease. Intravascular hemolysis can impair NO bioavailability and cause oxidative stress, altering redox balance and amplifying physiological processes that govern blood flow, hemostasis, inflammation, and angiogenesis. These pathological responses promote regional vasoconstriction and subsequent blood vessel remodeling. Thus, intravascular hemolysis represents an intrinsic mechanism for human vascular disease that manifests clinical complications in sickle cell disease and other chronic hereditary or acquired hemolytic anemias.
Collapse
|
42
|
Delville M, Manceau S, Ait Abdallah N, Stolba J, Awad S, Damy T, Gellen B, Sabbah L, Debbache K, Audard V, Beaumont JL, Arnaud C, Chantalat-Auger C, Driss F, Lefrère F, Cavazzana M, Franco G, Galacteros F, Ribeil JA, Gellen-Dautremer J. Arterio-venous fistula for automated red blood cells exchange in patients with sickle cell disease: Complications and outcomes. Am J Hematol 2017; 92:136-140. [PMID: 27813144 DOI: 10.1002/ajh.24600] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
Erythrocytapheresis (ER) can improve outcome in patients with sickle cell disease (SCD). A good vascular access is required but frequently it can be difficult to obtain for sickle cell patients. Arterio-venous fistulas (AVFs) have been suggested for ER in SCD supported by limited evidence. We report the largest cohort of ER performed with AVFs from three French SCD reference centers. Data of SCD patients undergoing ER with AVFs in the French SCD reference center were retrospectively collected. The inclusion criteria were: SS or Sβ-Thalassemia and AVF surgery for ER. SCD-related complications, transfusion history, details about AVF surgical procedure, echocardiographic data before and after AVF, AVF-related surgical and hemodynamical complications were collected. Twenty-six patients (mean age 20.5 years, mean follow-up 68 months [11-279]) were included. Twenty-three patients (88.5%) required central vascular access before AVF. Fifteen AVFs (58%) were created on the forearm and 11 (42%) on the arm. Nineteen patients (73%) had stenotic, thrombotic or infectious AVF complications. A total of 0.36 stenosis per 1,000 AVF days, 0.37 thrombosis per 1,000 AVF days and 0.078 infections per 1.000 AVF days were observed. The mean AVF lifespan was 51 months [13-218]. One patient with severe pulmonary hypertension worsened after AVF creation and died. We report the first series of SCD patients with AVF for ER, demonstrating that AVFs could be considered as a potential vascular access for ER. Patients with increased risk for hemodynamic intolerance of AVFs must be carefully identified, so that alternative vascular accesses can be considered. Am. J. Hematol. 92:136-140, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Marianne Delville
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | - Sandra Manceau
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | - Nassim Ait Abdallah
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Jan Stolba
- Vascular surgery department; La Roseraie Clinic; Aubervilliers France
| | - Sameh Awad
- Interventional Radiology Clinique Labrouste; Paris France
| | - Thibaud Damy
- Cardiology Department; Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Barnabas Gellen
- Cardiology Department; Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
- ELSAN, Polyclinique de Poitiers; France
| | - Laurent Sabbah
- Cardiology department; Necker Enfants malades university Hospital, APHP, Université Paris 5; France
| | - Karima Debbache
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Vincent Audard
- Nephrology and Renal Transplantation Department Henri Mondor University Hospital; APHP, Université Paris-Est Créteil; France
| | - Jean-Louis Beaumont
- Etablissement français du sang, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Cécile Arnaud
- Pediatrics Department; Centre hospitalier intercommunal de Créteil; Créteil France
| | - Christelle Chantalat-Auger
- Department of Internal medicine; Bicetre University Hospital; Université Paris 11, le Kremlin-Bicêtre France
| | - Françoise Driss
- Department of Internal medicine; Bicetre University Hospital; Université Paris 11, le Kremlin-Bicêtre France
| | - François Lefrère
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | - Marina Cavazzana
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | | | - Frederic Galacteros
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Jean-Antoine Ribeil
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | - Justine Gellen-Dautremer
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
- Internal Medicine Department; Poitiers University Hospital; Poitiers France
| |
Collapse
|
43
|
Maitra P, Caughey M, Robinson L, Desai PC, Jones S, Nouraie M, Gladwin MT, Hinderliter A, Cai J, Ataga KI. Risk factors for mortality in adult patients with sickle cell disease: a meta-analysis of studies in North America and Europe. Haematologica 2017; 102:626-636. [PMID: 28104703 PMCID: PMC5395103 DOI: 10.3324/haematol.2016.153791] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/12/2017] [Indexed: 02/02/2023] Open
Abstract
Although recent studies show an improved survival of children with sickle cell disease in the US and Europe, for adult patients mortality remains high. This study was conducted to evaluate the factors associated with mortality in adult patients following the approval of hydroxyurea. We first evaluated the association between selected variables and mortality at an academic center (University of North Carolina). Data sources were then searched for publications from 1998 to June 2016, with meta-analysis of eligible studies conducted in North America and Europe to evaluate the associations of selected variables with mortality in adult patients. Nine studies, combined with the UNC cohort (total n=3257 patients) met the eligibility criteria. Mortality was significantly associated with age (per 10-year increase in age) [7 studies, 2306 participants; hazard ratio (HR): 1.28; 95% confidence interval (CI): 1.10-1.50], tricuspid regurgitant jet velocity 2.5 m/s or more (5 studies, 1577 participants; HR: 3.03; 95%CI: 2.0-4.60), reticulocyte count (3 studies, 1050 participants; HR: 1.05; 95%CI: 1.01-1.10), log(N-terminal-pro-brain natriuretic peptide) (3 studies, 800 participants; HR: 1.68; 95%CI: 1.48-1.90), and fetal hemoglobin (7 studies, 2477 participants; HR: 0.97; 95%CI: 0.94-1.0). This study identifies variables associated with mortality in adult patients with sickle cell disease in the hydroxyurea era.
Collapse
Affiliation(s)
- Poulami Maitra
- Department of Biostatistics, University of North Carolina, Chapel Hill
| | - Melissa Caughey
- Division of Cardiology, University of North Carolina, Chapel Hill
| | | | - Payal C Desai
- Division of Hematology, The Ohio State University, Columbus
| | - Susan Jones
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill
| | - Mehdi Nouraie
- Department of Medicine, Howard University, Washington, DC, USA
| | - Mark T Gladwin
- Department of Medicine, University of Pittsburgh, PA, USA
| | | | - Jianwen Cai
- Department of Biostatistics, University of North Carolina, Chapel Hill
| | - Kenneth I Ataga
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill
| |
Collapse
|
44
|
Farmakis D, Triposkiadis F, Lekakis J, Parissis J. Heart failure in haemoglobinopathies: pathophysiology, clinical phenotypes, and management. Eur J Heart Fail 2016; 19:479-489. [PMID: 28000341 DOI: 10.1002/ejhf.708] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/18/2016] [Accepted: 11/07/2016] [Indexed: 12/28/2022] Open
Abstract
Hereditary haemoglobinopathies, mainly beta-thalassemia and sickle cell disease, constitute the most common monogenic disorders in humans, and although once geographically confined, they are currently globally distributed. They are demanding clinical entities that require multidisciplinary medical management. Despite their genotypic and phenotypic heterogeneity, the haemoglobinopathies share several similarities in pathophysiology, clinical manifestations, therapeutic requirements, and complications, among which heart failure (HF) represents a leading cause of mortality and morbidity. However, haemoglobinopathies have generally been addressed in a rather fragmentary manner. A unifying approach focusing on the underlying similarities of HF attributes in the two main entities might contribute to their better understanding, characterization, and management. In the present review, we attempt such an approach to the pathophysiology, clinical phenotypes, and management of HF in haemoglobinopathies.
Collapse
Affiliation(s)
- Dimitrios Farmakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - John Lekakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Parissis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
45
|
Ségot A, Deux JF, Thuillier T, Maitre B, Galactéros F, Bartolucci P. Pulmonary and cerebral microvasculopathy in a patient with sickle cell disease: A role for dense red blood cells? Am J Hematol 2016; 91:963-4. [PMID: 27152657 DOI: 10.1002/ajh.24413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/23/2016] [Accepted: 05/03/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Amandine Ségot
- Sickle Cell Referral Center, Internal Medicine, CHU Henri Mondor, APHP, UPEC; Créteil France
| | | | | | - Bernard Maitre
- APHP, Pneumology, CHU Henri Mondor, UPEC; Créteil France
| | - Frédéric Galactéros
- Sickle Cell Referral Center, Internal Medicine, CHU Henri Mondor, APHP, UPEC; Créteil France
- IMRB, Team 2. Laboratory of Excellence GRex
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Internal Medicine, CHU Henri Mondor, APHP, UPEC; Créteil France
- IMRB, Team 2. Laboratory of Excellence GRex
| |
Collapse
|
46
|
Affiliation(s)
- Thomas F Lüscher
- Editor-in-Chief, Zurich Heart House, Careum Campus, Moussonstrasse 4, 8091 Zurich, Switzerland
| |
Collapse
|