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Altered cardiac reserve is a determinant of exercise intolerance in sickle cell anaemia patients.

Authors
  • Hammoudi, Nadjib1
  • Ceccaldi, Alexandre1
  • Haymann, Jean-Philippe2
  • Guedeney, Paul1
  • Nicolas-Jilwan, Fadila2
  • Zeitouni, Michel1
  • Montalescot, Gilles1
  • Lionnet, François3
  • Isnard, Richard1
  • Hatem, Stéphane N1
  • 1 Sorbonne Université, ACTION Study Group, INSERM, UMR_S 1166, Institute of Cardiometabolism And Nutrition (ICAN), and Hôpital Pitié-Salpêtrière (AP-HP), Paris, France. , (France)
  • 2 Département de physiologie et de néphrologie (AP-HP), Centre Hospitalier Universitaire Tenon, Sorbonne Université, INSERM UPMC 1155, Paris, France. , (France)
  • 3 Service de médecine interne, Centre de référence de la drépanocytose (AP-HP), Centre Hospitalier Universitaire Tenon, Sorbonne Université, Paris, France. , (France)
Type
Published Article
Journal
European Journal of Clinical Investigation
Publisher
Wiley (Blackwell Publishing)
Publication Date
Jan 01, 2022
Volume
52
Issue
1
Identifiers
DOI: 10.1111/eci.13664
PMID: 34390499
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The underlying mechanisms of exercise intolerance in sickle cell anaemia (SCA) patients are complex and not yet completely understood. While latent heart failure at rest could be unmasked upon exercise, most previous studies assessed cardiac function at rest. We aimed to investigate exercise cardiovascular reserve as a potential contributor to exercise intolerance in adult SCA patients. In this observational prospective study, we compared prospectively 60 SCA patients (median age 31 years, 60% women) to 20 matched controls. All subjects underwent symptom-limited combined exercise echocardiography and oxygen uptake (VO2 ) measurements. Differences between arterial and venous oxygen content (C(a-v)O2 ) were calculated. Cardiac reserve was defined as the absolute change in cardiac index (Ci) from baseline to peak exercise. Compared to controls, SCA patients demonstrated severe exercise intolerance (median peakVO2 , 34.3 vs. 19.7 ml/min/kg, respectively, p < .0001). SCA patients displayed heterogeneously increased Ci from rest to peak exercise (median +5.8, range 2.6 to 10.6 L/min/m²) which correlated with peakVO2 (r = 0.71, p < .0001). In contrast, the C(a-v)O2 exercise reserve was homogenously reduced and did not correlate with peakVO2 (r = 0.18, p = .16). While haemoglobin level and C(a-v)O2 were similar in SCA subgroups, SCA patients in the lower VO2 tertile had chronotropic incompetence and left ventricular diastolic dysfunction (left atrial peak longitudinal strain was reduced, and both E/e' ratio and left atrial volume index were increased) and were characterized by a reduced cardiac reserve, +5.0[4.2-5.5] compared to +6.7[5.5-7.8] L/min/m² for the rest of the patient cohort, p < .0001. Altered cardiac reserve due to chronotropic incompetence and left ventricular diastolic dysfunction seems to be an important determinant of exercise intolerance in adult SCA patients. © 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

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