Pro brain natriuretic peptide (BNP) hormone and tissue Doppler abnormalities in patients with homozygous sickle cell disease in Bahrain: echocardiographic study

  • Authors

    • Taysir Garadah Arabian gulf university
    • Adla B Hassan
    • Ahmed A Jaradat
    • Reginald P Sequeira
    • Abdulla Alajmi
    2014-04-19
    https://doi.org/10.14419/ijm.v2i1.2257

  • Abstract

    Background: Pulse Doppler echocardiography has a diagnostic value in right and left ventricular function in patients with homozygous sickle cell disease (SCD), however the role of the tissue Doppler is unclear.

    Aim: To evaluate the diagnostic role of tissue Doppler in the assessment of right ventricle (RV) and left ventricular function in adult patients with SCD. And to study the prevalence of pulmonary hypertension (PAH) in patients with SCD using the tricuspid valve velocity on echocardiogram.

    Method: Seventy patients with homozygous SSD were compared with healthy control. Every patient had clinical assessment, had pulsed and tissue Doppler evaluation, in addition to assessing serum level of hemoglobin, ferritin and pro Brain Natriuretic Peptide (BNP). The mean difference between the two groups for tissue Doppler and biometric variables was assessed.

    Results: Seventy patients had SCD (mean age 28 years, 14-40) and 54 (77%) were males.  The age and gender proportions were similar in both groups. Patients with SCD compared with the control had significantly low diastolic pressure, lower hemoglobin level, but high serum ferritin and pro BNP hormone. Furthermore, there was a significant increase in the diameter of left atrium, higher left ventricle mass index, and higher right ventricle diameter and wall thickness.

    The left ventricle ejection fraction percentage was similar between both groups, but SCD had significantly higher right ventricle tricuspid annular plane systolic excursion (TAPSE) of 1.42±0.21 vs. 1.11±0.23 cm (P= 0.02). The RV pulsed Doppler data showed restrictive filling pattern with significantly higher E wave, high E/A  ratio and short Deceleration time ; likewise, the upper pulmonary vein systolic/diastolic velocity was significantly lower 1.5 ±0.12 vs. 2.4±0.11cm (p=0.002).

    The tissue Doppler of lateral annulus of tricuspid valve and the septum mitral annulus in SCD patients showed a significant lower S wave, higher E/E- ratio and lower A wave.

    The incidence of pulmonary hypertension in SCD patients via tricuspid valve regurgitation (TVR) velocity of >2.6 m/s was 22 %. There was a positive correlation between serum level of ferritin, pro BNP and tricuspid valve regurgitation velocity (r=0.35) and (r=0.43) respectively.

    Conclusion: Adult patients with SCD have included right ventricular diameter and increased RV wall thickness. The LV systolic function is normal but with RV systolic and diastolic dysfunction that was suggestive of restrictive pattern.

    The incidence of pulmonary hypertension in SCD was 22% with positive correlation between serum level of ferritin, pro BNP and the development of pulmonary hypertension.

     

    Keywords: Sickle Cell Anemia, Tissue Doppler, Bahrain.

  • References

    1. Bunn HF (1997) Pathogenesis and treatment of sickle cell disease. (1997) The New England Journal of medicine 337,762-9. doi:10.1056/NEJM199709113371107.
    2. Platt OS, Brambilla DJ, Rosse WF, Milner PF, Castro O, Steinberg MH, et al (1994) Mortality in sickle cell disease. Life expectancy and risk factors for early death. The New England Journal of medicine 330, 1639-44. doi:10.1056/NEJM199406093302303.
    3. Alhamdan NA, Almazrou YY, Alswaidi FM, Choudhry AJ (2007) Premarital screening for thalassemia and sickle cell disease in Saudi Arabia. Genetics in medicine: Official Journal of the American College of Medical Genetics 9, 372-7. doi:10.1097GIM.0b013e318065a9e8.
    4. Nasserullah Z, Alshammari A, Abbas MA, Abu-Khamseen Y, Qadri M, Jafer SA, et al. (2003) Regional experience with newborn screening for sickle cell disease, other hemoglobinopathies and G6PD deficiency. Annals of Saudi medicine 23,354-7.
    5. el-Hazmi MA, Warsy AS, al-Swailem AR, al-Swailem AM (1996) Bahakim HM. Sickle cell gene in the population of Saudi Arabia. Hemoglobin 20, 187-98.
    6. Pearson HA (1999) Reply: Sickle cell disease in the Kingdom of Saudi Arabia: East and West. Annals of Saudi medicine 19, 281-2.
    7. Batra AS, Acherman RJ, Wong WY, Wood JC, Chan LS, Ramicone E, et al. (2002) Cardiac abnormalities in children with sickle cell anemia. American Journal of Hematology 70, 306-12. doi:10.1002/ajh.10154.
    8. Zilberman MV, Du W, Das S, Sarnaik SA (2007) Evaluation of left ventricular diastolic function in pediatric sickle cell disease patients. American Journal of hematology 82, 433-8. doi:10.1002/ajh.20866.
    9. Bahl VK, Malhotra OP, Kumar D, Agarwal R, Goswami KC, Bajaj R, et al (1992) Noninvasive assessment of systolic and diastolic left ventricular function in patients with chronic severe anemia: a combined M-mode, two-dimensional, and Doppler echocardiographic study. American Heart Journal 124, 1516-23.
    10. Lindqvist P, Henein MY, Wikstrom G (2009) Right ventricular myocardial velocities and timing estimate pulmonary artery systolic pressure. International Journal of Cardiology137,130-6. doi:10.1016/j.ijcard.2008.06.043.
    11. Choong CY, Herrmann HC, Weyman AE, Fifer MA(1987) Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans. Journal of the American College of Cardiology 10, 800-8.
    12. Moyssakis I, Tzanetea R, Tsaftaridis P, Rombos I, Papadopoulos DP, Kalotychou V, et al (2005) Systolic and diastolic function in middle aged patients with sickle beta thalassaemia. An echocardiographic study. Postgraduate Medical Journal 81, 711-4. doi:10.1136/pgmj.2004.031096.
    13. Nishimura RA, Schwartz RS, Tajik AJ, Holmes DR, Jr (1993) Noninvasive measurement of rate of left ventricular relaxation by Doppler echocardiography. Validation with simultaneous cardiac catheterization. Circulation 88, 146-55.
    14. Ghaderian M, Keikhaei B, Heidari M, Salehi Z, Azizi Malamiri R (2012). Tissue Doppler echocardiographic findings of left ventricle in children with sickle-cell anemia. The Journal of Tehran Heart Center 7, 106-10.
    15. Naqvi TZ, Neyman G, Broyde A, Mustafa J, Siegel RJ (2001) Comparison of myocardial tissue Doppler with transmitral flow Doppler in left ventricular hypertrophy. Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography14, 1153-60.
    16. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation 102, 1788-94.
    17. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 18, 1440-63. doi:10.1016/j.echo.2005.10.005.
    18. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et a (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. The American Journal of Cardiology 57, 450-8.
    19. Gladwin MT, Sachdev V, Jison ML, Shizukuda Y, Plehn JF, Minter K, et al (2004) Pulmonary hypertension as a risk factor for death in patients with sickle cell disease. The New England Journal of Medicine 350, 886-95. doi:10.1056/NEJMoa035477.
    20. Metivier F, Marchais SJ, Guerin AP, Pannier B, London GM (2000) Pathophysiology of anaemia: focus on the heart and blood vessels. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 15 Suppl 3, 14-8.
    21. Aessopos A, Deftereos S, Farmakis D, Corovesis C, Tassiopoulos S, Tsironi M, et al. (2004) Cardiovascular adaptation to chronic anemia in the elderly: an echocardiographic study. Clinical and investigative medicine Medecine clinique et experimentale 27, 265-73.
    22. Mandinov L, Kaufmann P, Brunner F, Hess OM (1997) [Anemia and heart function]. Praxis 86, 1687-92.
    23. Appleton CP, Hatle LK, Popp RL (1987) Superior vena cava and hepatic vein Doppler echocardiography in healthy adults. Journal of the American College of Cardiology 10: 1032-9.
    24. Braden DS, Covitz W, Milner PF (1996) Cardiovascular function during rest and exercise in patients with sickle-cell anemia and coexisting alpha thalassemia-2. American Journal of hematology52,96-102. doi:10.1002/(SICI)1096-8652(199606)52:2<96:AID-AJH5>3.0.CO;2-0.
    25. Akgul F, Yalcin F, Babayigit C, Seyfeli E, Seydaliyeva T, Gali E (2006) Right ventricular and pulmonary function in sickle cell disease patients with pulmonary hypertension. Pediatric cardiology 27,440-6. doi:10.1007/s00246-006-1257-8.
    26. Abdul-Mohsen MF (2012) Echocardiographic evaluation of left ventricular diastolic and systolic function in Saudi patients with sickle cell disease. Journal of the Saudi Heart Association24,217-24. doi:10.1016/j.jsha.2012.05.001.
    27. Howard LS, Grapsa J, Dawson D, Bellamy M, Chambers JB, Masani ND, et al (2012) Echocardiographic assessment of pulmonary hypertension: standard operating procedure. European respiratory review : Official Journal of the European Respiratory Society21,239-48. doi:10.1183/09059180.00003912.
    28. Sachdev V, Machado RF, Shizukuda Y, Rao YN, Sidenko S, Ernst I, et al (2007) Diastolic dysfunction is an independent risk factor for death in patients with sickle cell disease. Journal of the American College of Cardiology 49, 472-9. doi:10.1016/j.jacc.2006.09.038.
    29. Gladwin MT, Schechter AN, Ognibene FP, Coles WA, Reiter CD, Schenke WH, et al (2003) Divergent nitric oxide bioavailability in men and women with sickle cell disease. Circulation 107, 271-8.
    30. Lin G, Macdonald RL, Marton LS, Kowalczuk A, Solenski NJ, Weir BK (2001) Hemoglobin increases endothelin-1 in endothelial cells by decreasing nitric oxide. Biochemical and biophysical research communications 280, 824-30. doi:10.1006/bbrc.2000.4167.
    31. Aessopos A, Farmakis D (2005) Pulmonary hypertension in beta-thalassemia. Annals of the New York Academy of Sciences 1054, 342-9. doi:10.1196/annals.1345.041.

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  • How to Cite

    Garadah, T., Hassan, A. B., Jaradat, A. A., Sequeira, R. P., & Alajmi, A. (2014). Pro brain natriuretic peptide (BNP) hormone and tissue Doppler abnormalities in patients with homozygous sickle cell disease in Bahrain: echocardiographic study. International Journal of Medicine, 2(1), 32-35. https://doi.org/10.14419/ijm.v2i1.2257

    Received date: 2014-03-19

    Accepted date: 2014-04-12

    Published date: 2014-04-19