Exercise-induced Pulmonary Hypertension in Patients With Sickle-cell Anemia
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Purpose
Pulmonary hypertension (PH) at rest is a risk factor for death in patients with sickle-cell anemia (SCA). Exercise echocardiography (EE) can detect latent PH. We sought to investigate the occurrence of exercise-induced PH in patients with SCA and normal pulmonary pressure (PP) at rest, and its relationship with clinical and echocardiographic variables.Forty-four patients with SCA and normal PP at rest were studied and divided into two groups: exhibiting normal PP after treadmill EE (TRV≤2.7m/s) (G1), and exhibiting exercise-induced PH (TRV>2.7m/s) (G2). TRV cutoff points at rest and during exercise were based on data from healthy control subjects, matched for age, sex, and body surface area. Data obtained from EE were correlated with clinical, echocardiographic and ergometric variables.Exercise-induced PH occurred in 57% of the sample (G2), significantly higher than those of G1. Exercise-induced PH was related to higher levels of creatinine (p<0.05), increased left atrial volume (p<0.05) and right ventricular diastolic area (p<0.05), larger E/Em waves ratio derived from spectral and tissue Doppler (p<0.05), and higher TRV at rest (p<0.005).We concluded that patients with SCA and normal PP at rest may exhibit exercise-induced PH, which was related to renal function, increased cardiac chambers, abnormal indices of diastolic function and baseline TRV levels.
| Condition |
|---|
|
Sickle Cell Anemia Pulmonary Hypertension |
| Study Type: | Observational |
| Study Design: | Observational Model: Cohort Time Perspective: Cross-Sectional |
| Official Title: | Exercise-induced Pulmonary Hypertension in Patients With Sickle-cell Anemia: an Echocardiographic Study. |
- Exercise-induced pulmonary hypertension [ Time Frame: until one minute after exercise ] [ Designated as safety issue: Yes ]
| Enrollment: | 44 |
| Study Start Date: | June 2006 |
| Study Completion Date: | November 2007 |
| Primary Completion Date: | December 2006 (Final data collection date for primary outcome measure) |
| Groups/Cohorts |
|---|
|
Patients without pulmonary hypertension
Patients with sickle cell with normal response of pulmonary artery pressure to exercise
|
|
Exercise-induced pulmonary hypertension
Patients with sickle-cell anemia with exercise-induced pulmonary hypertension.
|
Detailed Description:
Pulmonary hypertension (PH) at rest is a risk factor for death in patients with sickle-cell anemia (SCA). Exercise echocardiography (EE) can detect latent PH. We sought to investigate the occurrence of exercise-induced PH in patients with SCA and normal pulmonary pressure (PP) at rest, and its relationship with clinical and echocardiographic variables.Forty-four patients (22 men, mean age 25 y.o.) with SCA and normal PP at rest (tricuspid regurgitant jet flow velocity [TRV] <2.5 m/s) were studied and divided into two groups: exhibiting normal PP after treadmill EE (TRV≤2.7m/s) (G1), and exhibiting exercise-induced PH (TRV>2.7m/s) (G2). TRV cutoff points at rest and during exercise were based on data from healthy control subjects, matched for age, sex, and body surface area. Data obtained from EE were correlated with clinical, echocardiographic and ergometric variables.Exercise-induced PH occurred in 57% of the sample (G2), with mean TRV level of 3.4±0.4 m/s (range 2.8 - 4.5m/s), significantly higher than those of G1 (2.5±0.3 m/s, p<0.001). Exercise-induced PH was related to higher levels of creatinine (p<0.05), increased left atrial volume (p<0.05) and right ventricular diastolic area (p<0.05), larger E/Em waves ratio derived from spectral and tissue Doppler (p<0.05), and higher TRV at rest (p<0.005).We concluded that patients with SCA and normal PP at rest may exhibit exercise-induced PH, which was related to renal function, increased cardiac chambers, abnormal indices of diastolic function and baseline TRV levels. The clinical meaning of these findings requires clarification in future studies.
Eligibility| Ages Eligible for Study: | 17 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | Yes |
| Sampling Method: | Probability Sample |
patients with SCA, homozygous to hemoglobin S with preserved physical capacity, followed at the Hematology and Blood Transfusion Division of the Federal University of Sao Paulo (UNIFESP) or at the Hematology and Oncology Division of Santa Casa de Misericordia de Sao Paulo Medical School.
Inclusion Criteria:
- patients with Sickle Cell Anemia homozygous to hemoglobin S
- preserved physical capacity
- steady state of the disease
Exclusion Criteria:
- Pulmonary Hypertension at rest
- Recent sickling crisis(<2 months)
- High Blood Pressure
- Atrial fibrillation
- Chronic obstructive pulmonary disease
- Last blood transfusion > 3 months before
- Signs of congestive heart failure or significant valve disease
- Normal global and regional systolic function on echocardiography
Contacts and Locations More Information
No publications provided
| Responsible Party: | Newton Nunes de Lima Filho, Federal University of São Paulo |
| ClinicalTrials.gov Identifier: | NCT00948012 History of Changes |
| Other Study ID Numbers: | HPSC01 |
| Study First Received: | July 28, 2009 |
| Last Updated: | July 28, 2009 |
| Health Authority: | Brazil: Ethics Committee |
Keywords provided by Federal University of São Paulo:
|
Sickle Cell Anemia Pulmonary Hypertension Exercise echocardiography Echocardiography |
Additional relevant MeSH terms:
|
Anemia Anemia, Sickle Cell Hypertension Hypertension, Pulmonary Hematologic Diseases Anemia, Hemolytic, Congenital Anemia, Hemolytic |
Hemoglobinopathies Genetic Diseases, Inborn Vascular Diseases Cardiovascular Diseases Lung Diseases Respiratory Tract Diseases |
ClinicalTrials.gov processed this record on May 16, 2013