Sickle cell anaemia (SCA) is associated with macrovascular complications at relatively normal blood pressures. This has led to the development of the term ‘relative systemic hypertension’ (RSH). The electrocardiography (ECG) and echocardiography (ECHO) findings in these people has not been well highlighted. Patients with SCA in steady state were consecutively recruited. History, physical examination, ECG and ECHO information were obtained from all participants after informed consent was obtained. Eighty-three people were recruited in all- 15 of which had RSH, giving a prevalence of 18.1%. Those with RSH had higher packed cell volumes (PCV), smaller right atria area, lower tricuspid regurgitant velocities, lower incidence of early satiety, longer QTc and higher frequency of a history of vaso-occlusive crises. The indices of right and left ventricular function were normal in both groups. Right atrial area was the only significant determinant of RSH in this study. RSH is associated with higher PCV, longer QTc and smaller right atrial area in SCA patients. More studies to evaluate sympathetic output in SCA with RSH is required.
Cardiovascular diseases are the major cause of death worldwide. Since its discovery in the 20th century, Echocardiography (ECHO) has become one of the pivotal tools in assessing cardiac structure and function. With the increase in requests for ECHO, there has risen an unwanted problem - inappropriate requests for ECHO. There has therefore arisen the need to audit ECHO labs for the appropriateness of ECHO requests. The patients referred from the outpatient clinics and in-patient wards for ECHO from June 1st, 2015 till September 30th, 2016 were recruited. Their request form data, clinical information, and ECHO results were analyzed as appropriate. The 2011 appropriate use criteria for Transthoracic ECHO was utilized. The most common indication out of the 2174 ECHOs reviewed was hypertension (16%), closely followed by hypertensive heart disease (12.4%). The percentage of appropriate, inappropriate, and uncertain indications according to the 2011 appropriate use criteria (AUC) for transthoracic echocardiography were 41.4%, 31.1%, and 0.1% respectively. Less than ten percent (9.3%) of the indications could not be classified by the 2011 AUC while 18.1% of the ECHOs had no indication. When indications of Hypertension, Hypertensive Heart Disease (HHD) and heart failure were compared, heart failure was significantly associated with eccentric Left Ventricular Hypertrophy (LVH), larger LV mass, lower BMI, larger cardiac dimensions, reduced ejection fraction, lower trans mitral A velocities than the other two indications. Concentric LVH was showed a trend towards being most in those with HHD (p= 0.072). The percentage of appropriate indications was low in this study as compared to others, largely because of large inappropriate indications. There is a need to ensure appropriate indications are filled for ECHO request forms. The 2011 AUC may need to be reviewed to expand the appropriate group of indications.
Sickle cell anaemia(SCA) is a recognized cause of heart failure and pulmonary hypertension(PHT). However, the impact of PHT of right ventricular(RV) function has not been well elucidated. Objective To determine the impact of PHT on right ventricular function in patients with SCA. Methods Cases were adults with SCA with PHT. Controls were SCA patients without pulmonary hypertension. All patients were recruited in steady-state. Echocardiography was done for cases and controls. Measures of RV function used were RV fractional area change (RV FAC), peak tricuspid annular systolic velocity (S') and Tricuspid annular plane systolic excursion (TAPSE). Pulmonary hypertension was estimated from Tricuspid regurgitation jet velocities. Right atrial pressure was estimated using the ratio of the Trans tricuspid early diastolic velocity to the early tissue doppler diastolic velocity of the tricuspid annulus. Values >35mmHg were said to have PHT. Results Out of 86 patients, there were 36 people with SCA that had tricuspid regurgitation-11 with PHT, 25 without PHT. The mean values of RV systolic function-RV FAC (0.41SD0.1 vs 0.41SD0.1; p= 0.999), S' (16.5SD5.1 vs 15.9SD4.3; p= 0.116) and TAPSE (30.7SD5 vs 29.7SD4.3; p=0.389) were not significantly different between cases and controls respectively. Trans tricuspid E/A ratio (1.49SD0.4 vs 1.61SD0.4; p=0.381) was essentially the same between both groups while the early trans tricuspid deceleration time showed a trend towards being shorter in those with PHT (194.1SD35.1vs 223.3SD53.6; p=0.084). Conclusion: The prevalence of PHT was 12.8% in SCA patients. There is no significant impact of PHT on RV function in SCA.
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