Cardiovascular autonomic dysfunction in sickle cell anemia

Martins, Wolney de Andrade; Lopes, Heno Ferreira; Consolim‐Colombo, Fernanda Marciano; Gualandro, Sandra de Fátima Menosi; Arteaga-Fernández, E; Mady, Charles

doi:10.1016/j.autneu.2011.07.011

Cited by 19 publications

(21 citation statements)

References 24 publications

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“…In several cross-sectional studies, anemia has been associated with decreased VO 2peak as well as weight-adjusted 6 min walk time in children with SCA undergoing cardiopulmonary testing [5,7]. Finally, anemia has been suggested as a causative factor in exercise intolerance in adults with SCA, although it has not been fully distinguished from the contributions of cumulative myocardial dysfunction, pulmonary parenchymal disease, or pulmonary vascular disease [3,35,37,38]. In this study, Hgb concentration was lower in children with SCA than in healthy control children at all three time points, as expected, but did not change during the study period while the difference in VO 2peak between groups increased significantly.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal differences in aerobic capacity between children with sickle cell anemia and matched controls

Watson

Liem

et al. 2014

Pediatr Blood Cancer

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Background The purpose of this study was to compare longitudinal trajectories of maximal aerobic capacity in children with sickle cell anemia (SCA) and matched healthy controls, and explore whether these trajectories were associated with selected physiologic variables. Procedures Children with SCA (n=33) and healthy controls (n=30) matched at baseline for race, sex, Tanner stage, height, and weight completed three consecutive annual fitness assessments (VO2peak). Data were compared between the groups at each time point and within groups over time. Change in VO2peak between the two groups over time was assessed using a linear mixed model with age, sex, fat-free mass (FFM), Tanner stage, and hemoglobin (Hgb) concentration as covariates. Results At baseline, children with SCA had significantly lower Hgb concentration (8.9 vs. 13.7 g/dL, p<0.001) and relative VO2peak (24.2 vs. 27.9 ml/kg/min, p=0.006) than healthy controls. Over time, children with SCA had smaller increases than healthy controls in VO2peak (−0.1 and +4.9 ml/kg/min, p<0.001), Tanner stage at year 2 (15% and 66% Tanner 4, p<0.001), and FFM (+4.0 and +6.8 kg, p=0.02). Changes in Hgb concentration did not differ between groups (+0.03 and +0.09 g/dL, p=1.0). After adjusting for age, sex, Tanner stage, FFM, and Hgb concentration the differences in change in VO2peak over time remained significant (p<0.001). Conclusion Children with SCA demonstrate lower relative VO2peak compared to healthy children and the difference increases over time. The difference in VO2peak trajectories between the two groups during puberty remains significant after adjusting for age, sex, FFM, Tanner stage, and Hgb concentration.

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Section: Discussionmentioning

confidence: 99%

Longitudinal differences in aerobic capacity between children with sickle cell anemia and matched controls

Watson

Liem

et al. 2014

Pediatr Blood Cancer

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“…Third, anemia can result in a significant increase in cardiac output and an impaired cardiac reserve, which will limit cardiac compensation in certain situations such as exercise and orthostatic BP maintenance. Last, anemia might also impair the normal orthostatic BP regulation ability by exerting a negative effect on the autonomic nervous system that leads to autonomic dysfunction …”

Section: Discussionmentioning

confidence: 99%

Impaired orthostatic blood pressure stabilization and reduced hemoglobin in chronic kidney disease

Liu

Wang

Huang

et al. 2019

J of Clinical Hypertension

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Impaired orthostatic blood pressure (BP) stabilization is prevalent in patients with chronic kidney disease (CKD) and is associated with adverse outcomes. We aimed to test the hypothesis that reduced hemoglobin is an important contributor to orthostatic intolerance in CKD in the present study. This study included 262 patients with non-dialysis-dependent CKD. Seated and standing BP was measured, and orthostatic BP reduction was calculated for both systolic BP (∆ SBP) and diastolic BP (∆ DBP).The association between orthostatic BP reduction and hemoglobin was determined by multiple linear regression models. We also performed mediation analysis to test to what extent the effect of renal dysfunction on impaired orthostatic BP stabilization can be explained by reduced hemoglobin. The mean age of the patients was 57.7 (±14.5) years, and 61.5% were male. Both ∆ SBP and ∆ DBP correlated negatively with estimated glomerular filtration rate (eGFR). With adjustment for age and sex, hemoglobin level was negatively associated with ∆ SBP (β = −1.4, SE = 0.4, P < .001) and ∆ DBP (β = −0.6, SE = 0.2, P = .009). The associations remained significant with further adjustment for additional covariates. When eGFR was introduced as a covariate, it did not eliminate the significance (both P < .05). The associations remained essentially unchanged in a sensitivity analysis excluding those with concurrent erythropoietin use. Mediation analysis demonstrated that reduced hemoglobin accounted for 35.4% (P = .004) of the effect of eGFR on ∆ SBP and 47.7% (P = .032) on ∆ DBP.Our study suggests that reduced hemoglobin is a potentially important contributor to the development of orthostatic hypotension in CKD. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section at the end of the article.How to cite this article: Liu W, Wang L, Huang X, He W, Song Z, Yang J. Impaired orthostatic blood pressure stabilization and reduced hemoglobin in chronic kidney disease. J Clin Hypertens.

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“…In dogs with severe and very severe anemia, the occurrence of this rhythm was not as signifi cant, likely due to the sympathetic activity surpassing the activities of the parasympathetic nervous system. In response to hypoxemia, it was observed that patients with anemia may have generalized peripheral vasodilation leading to hypotension, and as a compensatory mechanism, the vasodilation activates the sympathetic nervous system, allowing vasoconstriction to maintain a normal blood pressure range (MARTINS et al, 2012). Apart from vasoconstriction, sympathetic activation promotes an increased heart rate and positive inotropism (HORWICH et al 2002;ANAND et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

“…Electrocardiogram characteristics compatible with atrioventricular overload are perhaps related to an increased plasma volume, high levels of myocardial wall stress and left ventricular hypertrophy that occur in response to anemia because tissue hypoxia and peripheral vasodilation related to anemia lead to a hemodynamic response, such as sympathetic activation (METIVIER et al, 2000;MARTINS et al, 2012), activation of the renin angiotensin aldosterone system and increased production of the antidiuretic hormone (HORWICH et al, 2002;ANAND et al, 2004). These mechanisms promote water retention, which, when combined with myocardial hypoxia and oxidative stress, explain why anemia may precipitate congestive heart failure, even in normal individuals (ANAND et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic evaluation and serum cardiac troponin I levels in anemic dogs with blood parasitosis

et al. 2013

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Blood parasitosis is a frequent cause of anemia and myocarditis in dogs. Because anemia can trigger hypoxia or hemodynamic disturbances and myocarditis secondary to blood parasitosis can develop arrhythmias, electrocardiogram changes and increased levels of cardiac biomarkers, such as cardiac troponin I, are expected in dogs with blood parasitosis. Thus, this study aimed to investigate the electrocardiographic characteristics and the relationship to troponin I levels in anemic dogs with blood parasitosis. Twenty-eight dogs with blood parasitosis (seropositive for Ehrlichia canis/ Babesia canis) and varying levels of anemia were evaluated. Dogs with very severe anemia (hematocrit below 13%) showed significant increases in heart rate when compared to dogs with severe, moderate or mild anemia. There was a predominance of respiratory sinus arrhythmia in dogs with mild, moderate and severe anemia and a high prevalence of sinus rhythm in dogs with very severe anemia, which showed a decrease in parasympathetic activity in this group. In all of the groups, electrocardiographic changes were detected showing compatibility with left and right atrial and left ventricular enlargement. Dogs with very severe anemia had a longer P wave duration. All groups of anemic dogs showed increased T-wave amplitude, suggestive of myocardial hypoxia. However, only the groups with moderate and severe anemia presented ST segment disturbances. Despite the lack of a correlation between the electrocardiographic changes suggestive of myocardial hypoxia and troponin I, there was a negative correlation (r = -0.95, p = 0.05) between hemoglobin levels and increased serum troponin. These data indicate that anemic dogs with blood parasitosis may have electrocardiographic changes suggestive of atrioventricular overload or hemodynamic disturbances, such as increased heart rate. Moreover, the negative correlation between hemoglobin and serum levels of troponin I may imply that dogs with severe and very severe anemia are at a higher risk for myocardial injury. Key words: Cardiac biomarker, electrocardiogram; hematocrit, myocardial hypoxia ResumoHemoparasitoses são causas frequentes de anemia e miocardite em cães. Em virtude da anemia poder provocar distúrbios hemodinâmicos relacionados à hipóxia e da miocardite secundária à hemoparasitose causar arritmias cardíacas, esperam-se alterações eletrocardiográficas e aumento dos níveis de biomarcadores cardíacos como troponina I cardíaca em cães com hemoparasitose. Por conseguinte, este estudo teve como objetivo investigar as características eletrocardiográficas de cães anêmicos por hemoparasitose e a relação da anemia com alterações eletrocardiográficas e aumento da troponina I cardíaca. Para tanto, foram avaliados vinte e oito cães com hemoparasitose, sorologicamente positivos para Ehrlichia canis/ Babesia canis, com diferentes níveis de anemia. Cães com anemia muito grave (hematócrito abaixo de 13%) apresentaram aumentos significativos da frequência cardíaca, comparados aos cães com anemia grave, mode...

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Cardiovascular autonomic dysfunction in sickle cell anemia

Cited by 19 publications

References 24 publications

Longitudinal differences in aerobic capacity between children with sickle cell anemia and matched controls

Longitudinal differences in aerobic capacity between children with sickle cell anemia and matched controls

Impaired orthostatic blood pressure stabilization and reduced hemoglobin in chronic kidney disease

Electrocardiographic evaluation and serum cardiac troponin I levels in anemic dogs with blood parasitosis

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