A PROSPECTIVE STUDY OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND PULMONARY HYPERTENSION IN PATIENTS OF SICKLE CELL ANAEMIA IN RIMS RAIPUR

Dr Ramgopal Ghritlahare; Dr.Brajendra Kumar; Dr.J.P.Sachdeva

Volume : VI, Issue : III, March - 2017

A PROSPECTIVE STUDY OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND PULMONARY HYPERTENSION IN PATIENTS OF SICKLE CELL ANAEMIA IN RIMS RAIPUR

Dr Ramgopal Ghritlahare, Dr. Brajendra Kumar, Dr. J. P. Sachdeva

Abstract :

Sickle cell disorder (SCD) was the first diagnosed disease that was linked to the hemoglobin protein and genetically characterized. It is an autosomal recessive disorder that occurs throughout the world. The distribution of SCD often coincides with that of falciparum malaria parasites, therefore making it common among people from sub-Saharan Africa, Mediterranean countries, Southern India and their descendants (African Americans) (Weatherall et al, 2005).The aim of our study was to assess prevalence of Pulmonary hypertension and Left ventricular diastolic dysfunction by using 2D Echocardiography in the patients of sickle cell anemia.This study was conducted in the Department of Medicine, RIMS, Raipur (C.G.) among the patients presenting in O.P.D. and admitted in medicine ward from Dec. 2014 to Sep. 2016.A total of 100 patients were taken fulfilling the inclusion criteria for the study. Detailed clinical history was recorded and allpatientsunderwent complete clinical examination.Hb electrophoresis and 2D Echocardiography of all patients were done.In our study out of 100 patients, 34 patients (34%) were male while 66 patients (66%) were female.70 subjects were having sickle cell trait out of which 18 patients were male and 52 were female, whereas 30 subjects were having sickle cell disease out of which 15 patients were male and 15 were female. Mean Hb level was 8.41 � 1.74 gm%. In our study population maximum Hb was 12 gm% whereas minimum Hb was 4 gm%.Diastolic dysfunction was present in 50% of the total cases (100) among them 45.45% were males, 52.23% were females. Diastolic dysfunction was almost equally prevalent among female compared to male (p=0.51).Mean age of women with diastolic dysfunction was 29.37 � 9.89 yrs, whereas mean age of men with diastolic dysfunction was 29.82 � 10.24 yrs. Statistically there was no association was found between age and LVDD prevalence( p=0.99).In our study we found prevalence of LVDD in studied genotypes i.e. AS and SS to be almost similar (P = 0.62, non-significant). Our study showed that diastolic dysfunction is more closely associated with moderate (Hb level 7-10 gm%) and severe anemia (Hb level 4-7gm%) than mild anemia (Hb level >10%). Statistically it was found to be significant (p=0.006).Mean Hb level of patients with diastolic dysfunction was 7.88 � 1.81 gm%, whereas mean Hb level of patients without diastolic dysfunction was 8.94 �1.49 gm% (P<0.01, significant).Pulmonary Hypertension (PH) was present in 24 cases (24%) of the study population, among them 5 were males and 19 were females. There was no significant difference of prevalence of PH between both genders. (p=0.14).Out of 100 patients 12 patients (12%) had both LVDD and PH.The findings in our study indicate that in patients of sickle cell anemia, left ventricular diastolic function is impaired much before development of systolic dysfunction. Lower Hb levels in patients of sickle cell anemia is associated with cardiopulmonary complications. No significant correlation was found in respect to prevalence of PH and LVDD with age or gender.More so presence of both PH and LVDD significantly contributes to a higher mortality in patients of sickle cell anemia. Therefore by early detection we can start early treatment and can retard the progression of these cardiopulmonary abnormalities and its future consequences. Doppler Echocardiography is a simple, non-invasive, easily available technique that identifies sickle cell subjects who have asymptomatic pulmonary hypertension and/or left ventricular diastolic dysfunction much before abnormalities detected on ECG or by clinical examination. Therefore echocardiography becomes an indispensable tool for assessment of cardiac function in SCD patients.The term sickle cell disorder (SCD) is used in a generic sense to refer to all the clinically severe sickling syndromes. The genetic abnormality involves the substitution of thymine with adenine in the sixth codon of beta gene (GTG ->GAG). So glutamic acid is replaced by valine and Hb S is produced, which upon deoxygenation undergoes polymerization leading to expression of sickling syndromes.