Altered ventricular longitudinal strain in children with sickle cell disease: Role of TGF‐β and IL‐18

Abstract

BackgroundCardiovascular involvement in sickle cell disease (SCD) has a great impact on patients’ morbidity and mortality. Recently, interleukin‐18 (IL‐18) and transforming growth factor beta (TGF‐β) were suggested as potential biomarkers for sickle cell cardiomyopathy. Global longitudinal strain (GLS) is a reliable early parameter for estimation of deformed myocardium. This study evaluated the role of TGF‐β and IL‐18 as risk indicators of altered strain in patients with SCD.MethodsForty children with SCD (age >5 years) and 40 healthy children as controls, matched in age and sex, were enrolled in the study. All participants were subjected to clinical examination, complete blood count, serum ferritin, TGF‐β, IL‐18, and assessment of cardiac function by echocardiography.ResultsTGF‐β, IL‐18, and lactic acid dehydrogenase (LDH) were significantly higher among cases (mean age: 10.6 ± 3.5 years) when compared to controls (p < .001), at cutoff values 41.7 ng/mL, 128.9 pg/mL, and 340 unit, respectively. The LS of free wall of RV (FW‐RV) was significantly lower among cases when compared to controls (−23.55% ± 5.55% vs. −28.73% ± 2.43%, p < .001). Free wall longitudinal strain of the right ventricle (FWLS‐RV) was significantly correlated to IL‐18 and LDH (p < .001), while GLS‐RV was significantly correlated to TGF‐β. The GLS‐LV was correlated to frequency of vaso‐occlusive crises (VOCs) per year (p < .001). Diastolic function, E/A of LV, and RV were negatively correlated to the hemoglobin and serum ferritin levels.ConclusionsThe TGF‐β, IL‐18, and LDH along with frequent VOCs are correlated to altered LS, especially the right ventricle, and could serve as risk indicators for subclinical cardiomyopathy in children with SCD.