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Left ventricular rotational mechanics in Tanzanian children with sickle cell disease

Left ventricular rotational mechanics in Tanzanian children with sickle cell disease
Left ventricular rotational mechanics in Tanzanian children with sickle cell disease

BACKGROUND: Sickle cell disease (SCD) is a common inherited hemoglobinopathy. Adults with SCD manifest both systolic and diastolic cardiac dysfunction, though the age of onset of dysfunction has not been defined. Left ventricular (LV) rotational mechanics have not been studied in children with SCD. The aim of this study was to investigate whether cardiac rotational mechanics differed between children with SCD and age-matched controls.

METHODS: Basal and apical LV short-axis images were acquired prospectively in 213 patients with SCD (mean age, 14.1 ± 2.6 years) and 49 controls (mean age, 13.3 ± 2.8 years) from the Muhimbili Sickle Cohort in Dar es Salaam, Tanzania. The magnitude of basal and apical rotation, net twist angle, torsion, and untwist rate were obtained by two-dimensional speckle-tracking. The timing of events was normalized to aortic valve closure.

RESULTS: Mean basal rotation was significantly lower in patients with SCD compared with controls (P = .012), although no difference was observed in apical rotation (P = .37). No statistically significant differences in torsion or net twist angle were detected. Rotation rate at the apex (P = .001) and base (P = .0004) were significantly slower in subjects with SCD compared with controls. Mean peak untwisting rate was also significantly slower in patients with SCD (P = .006). No associations were found between hemoglobin concentration and apical rotation, basal rotation, net twist, and torsion.

CONCLUSION: This study demonstrates alterations in LV rotational mechanics in children with SCD, including lower basal rotation, peak differential twist, and untwist rate. These abnormalities denote subclinical changes in LV systolic and diastolic performance in children with SCD. Future work may reveal an association between rotational metrics and long-term patient outcomes.

Adolescent, Anemia, Sickle Cell, Causality, Child, Comorbidity, Echocardiography, Female, Humans, Incidence, Male, Reproducibility of Results, Risk Assessment, Sensitivity and Specificity, Tanzania, Torsion Abnormality, Ventricular Dysfunction, Left, Young Adult, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't
0894-7317
340-346
Di Maria, Michael V.
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Hsu, Hao H.
87a84e60-e820-49e2-937a-c86e2009061b
Al-Naami, Ghassan
8b965925-4b7c-42ee-83dc-0150fe0254fb
Gruenwald, Jeanine
feef3cbb-93db-4033-a187-20c75393103f
Kirby, K. Scott
ec12be8f-c603-448b-878f-8f0028e95f1e
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Cox, Sharon E.
d4b5dbba-941f-4f2a-9c31-72b747684c7f
Younoszai, Adel K.
b64e2ff6-a646-4e2a-bfda-602ee7eed860
Di Maria, Michael V.
5fc5339b-9fc0-4aec-b101-e4168b40b8b7
Hsu, Hao H.
87a84e60-e820-49e2-937a-c86e2009061b
Al-Naami, Ghassan
8b965925-4b7c-42ee-83dc-0150fe0254fb
Gruenwald, Jeanine
feef3cbb-93db-4033-a187-20c75393103f
Kirby, K. Scott
ec12be8f-c603-448b-878f-8f0028e95f1e
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Cox, Sharon E.
d4b5dbba-941f-4f2a-9c31-72b747684c7f
Younoszai, Adel K.
b64e2ff6-a646-4e2a-bfda-602ee7eed860

Di Maria, Michael V., Hsu, Hao H., Al-Naami, Ghassan, Gruenwald, Jeanine, Kirby, K. Scott, Kirkham, Fenella J., Cox, Sharon E. and Younoszai, Adel K. (2015) Left ventricular rotational mechanics in Tanzanian children with sickle cell disease. Journal of the American Society of Echocardiography, 28 (3), 340-346. (doi:10.1016/j.echo.2014.11.014).

Record type: Article

Abstract

BACKGROUND: Sickle cell disease (SCD) is a common inherited hemoglobinopathy. Adults with SCD manifest both systolic and diastolic cardiac dysfunction, though the age of onset of dysfunction has not been defined. Left ventricular (LV) rotational mechanics have not been studied in children with SCD. The aim of this study was to investigate whether cardiac rotational mechanics differed between children with SCD and age-matched controls.

METHODS: Basal and apical LV short-axis images were acquired prospectively in 213 patients with SCD (mean age, 14.1 ± 2.6 years) and 49 controls (mean age, 13.3 ± 2.8 years) from the Muhimbili Sickle Cohort in Dar es Salaam, Tanzania. The magnitude of basal and apical rotation, net twist angle, torsion, and untwist rate were obtained by two-dimensional speckle-tracking. The timing of events was normalized to aortic valve closure.

RESULTS: Mean basal rotation was significantly lower in patients with SCD compared with controls (P = .012), although no difference was observed in apical rotation (P = .37). No statistically significant differences in torsion or net twist angle were detected. Rotation rate at the apex (P = .001) and base (P = .0004) were significantly slower in subjects with SCD compared with controls. Mean peak untwisting rate was also significantly slower in patients with SCD (P = .006). No associations were found between hemoglobin concentration and apical rotation, basal rotation, net twist, and torsion.

CONCLUSION: This study demonstrates alterations in LV rotational mechanics in children with SCD, including lower basal rotation, peak differential twist, and untwist rate. These abnormalities denote subclinical changes in LV systolic and diastolic performance in children with SCD. Future work may reveal an association between rotational metrics and long-term patient outcomes.

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e-pub ahead of print date: 30 December 2014
Published date: March 2015
Additional Information: Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
Keywords: Adolescent, Anemia, Sickle Cell, Causality, Child, Comorbidity, Echocardiography, Female, Humans, Incidence, Male, Reproducibility of Results, Risk Assessment, Sensitivity and Specificity, Tanzania, Torsion Abnormality, Ventricular Dysfunction, Left, Young Adult, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't

Identifiers

Local EPrints ID: 420600
URI: https://eprints.soton.ac.uk/id/eprint/420600
ISSN: 0894-7317
PURE UUID: eaf09af3-dbeb-47e1-bc82-19921e2c62ae
ORCID for Fenella J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 10 May 2018 16:31
Last modified: 20 Jul 2019 01:05

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Contributors

Author: Michael V. Di Maria
Author: Hao H. Hsu
Author: Ghassan Al-Naami
Author: Jeanine Gruenwald
Author: K. Scott Kirby
Author: Fenella J. Kirkham ORCID iD
Author: Sharon E. Cox
Author: Adel K. Younoszai

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