source: American Journal of Hematology

year: 2020

authors: Payal Shah, Silvie Suriany, Roberta Kato, Adam Michael Bush, Patjanaporn Chalacheva, Saranya Veluswamy, Christopher Clement Denton, Kelly Russell, Maha Khaleel, Henry Jay Forman, Michael C. K. Khoo, Richard Sposto, Thomas D. Coates, John C. Wood, Jon Detterich

Sickle cell disease (SCD) is a monogenic hemoglobinopathy associated with significant morbidity and mortality. Cardiopulmonary, vascular and sudden death underlies the majority of young adult mortality in SCD. To better understand the clinical importance of multi‐level vascular dysfunction, in 2009 we assessed cardiac function including tricuspid regurgitant jet velocity (TRV), tissue velocity in systole(S’) and diastole (E’), inflammatory, rheologic and hemolytic biomarkers as predictors of mortality in patients with SCD. With up to 9 years of follow up, we determined survival in 95 children, adolescents and adults with SCD. Thirty‐eight patients (40%) were less than 21 years old at initial evaluation. Survival and Cox proportional‐hazards analysis were performed. There was 19% mortality in our cohort, with median age at death of 35 years. In the pediatric subset, there was 11% mortality during the follow up period.

The causes of death included cardiovascular and pulmonary complications in addition to other end‐organ failure. On Cox proportional‐hazards analysis, our model predicts that a 0.1 m/s increase in TRV increases risk of mortality 3%, 1 cm/s increase in S’ results in a 91% increase and 1 cm/s decrease in E’ results in a 43% increase in mortality. In conclusion, Elevated TRV and altered markers of cardiac systolic and diastolic function predict mortality in a cohort of adolescents and young adult patients with SCD. These predictors should be considered when counseling cardiovascular risk and therapeutic optimization at transition to adult providers.

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