Left Ventricular Diastolic Function in Sickle Cell Anaemia: Clinical and haemodynamic Correlates

Abstract

Background: Left ventricular diastolic dysfunction is an independent risk factor for mortality in sickle cell disease but the clinical and haemodynamic determinants of this complication are unknown. Aims and Objectives: This study was aimed at evaluating the clinical and haemodynamic factors associated with left ventricular diastolic dysfunction in adult Nigerian sickle cell anaemia patients. Methods: Trans-mitral Doppler echocardiography was used to assess left ventricular diastolic function in a study sample of 60 adult sickle cell anaemia patients and 60 normal age and sex matched controls. Diastolic function indices measured include: left atrial dimension, velocities of E and A waves, isovolumic relaxation time, E- wave deceleration time and pulmonary venous flow velocity curve analysis. Results: The sickle cell patients had higher trans-mitral E- wave and A- wave velocities, reduced E/A ratio, as well as prolonged deceleration time of the E- wave and isovolumic relaxation time (IVRT)which are suggestive of impaired left ventricular compliance. Left ventricular diastolic dysfunction (defined as trans-mitral E/A ratio < 1) was demonstrated in 13.3% of the patients and in none of the normal control subjects. Significant correlations were found between indices of left ventricular diastolic function and age, haematocrit,  body surface area and some blood pressure indices. Conclusion: A significant proportion of steady state adult sickle cell anaemia patients presents with impaired left ventricular diastolic function. Disease duration, body surface area, blood pressure indices and haematocrit are notable clinical correlates of left ventricular diastolic function in sickle cell anaemia.