THE HEART IN SICKLE CELL DISEASE. ROLE OF NON INVASIVE CARDIAC IMAGING BY ADVANCED ECHOCARDIOGRAPHY AND CARDIAC MAGNETIC RESONANCE ASSESSMENT OF MYOCARDIAL FUNCTION

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Validation of the isovolumetric relaxation time for the estimation of pulmonary systolic arterial blood pressure in chronic pulmonary hypertension

Publication . Cabrita, Inês Zimbarra; Ruisanchez, C.; Grapsa, J.; Dawson, D.; North, B.; Pinto, F. J.; Gibbs, J. S. R.; Nihoyannopoulos, P.

Aims: Transthoracic echocardiography is a useful technique for non-invasive detection of pulmonary arterial systolic pressure (PASP). Isovolumic relaxation time (IVRT) measured by Doppler tissue imaging (DTI) is a sensitive measurement of changes in pulmonary vasculature. Our aim was to validate IVRT in the echocardiographic assessment of pulmonary hypertension (PH) patients. Methods and results: We studied 196 PH patients (67% women, mean age 51.8 ± 16.6 years, mean PASP: 81 ± 24 mmHg) and 37 consecutive age- and sex-matched controls (58% women, mean age 44.7 ± 16.4 years, mean PASP 27.7 ± 5.5 mmHg). The estimation of PASP was derived from tricuspid regurgitation velocity according to the Bernoulli equation. The measurement of IVRT was calculated using pulsed tissue Doppler. In the PH group and in the healthy volunteers group (P < 0.0001), the average IVRT was 113.4 ± 28.5 ms [95% confidence interval (CI): 109–117] and 41 ± 12.5 ms (95% CI: 37–45), respectively. We found a strong correlation between IVRT and systolic pulmonary pressure in the PH group (r = 0.52, P < 0.0001) and a cut-off of 75 ms showed a sensitivity and specificity of 94% and 97%, respectively, for the prediction of elevated PASP. Conclusion: The determination of IVRT by DTI is a simple and reproducible method that correlates well with PASP. It is, therefore, a parameter to consider in the echocardiographic assessment of patients with PH, and may be particularly important when the tricuspid Doppler signal is poor.

2012Artigo científico

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The association between tricuspid regurgitation velocity and 5-year survival in a North West London population of patients with sickle cell disease in the United Kingdom

Publication . Cabrita, Inês Zimbarra; Mohammed, Abubakar; Layton, Mark; Ghorashian, Sara; Gilmore, Annette; Cho, Gavin; Howard, Jo; Anie, Kofi A.; Desforges, Lynda; Bassett, Paul; Grapsa, Julia; Howard, Luke; Mahalingam, Gaia; Dawson, David; Pinto, Fausto J.; Nihoyannopoulos, Petros; Davies, Sally C.; Gibbs, J. Simon R.

Raised tricuspid regurgitant velocity (TRV) occurs in approximately 30% of adults with sickle cell disease (SCD), and has been shown to be an independent risk factor for death. TRV was assessed in 164 SCD patients who were subsequently followed up for survival. Raised pulmonary pressures were defined as a TRV jet ≥2.5 m/s on echocardiography. Elevated TRV was present in 29.1% of patients and it was associated with increased age and left atrial diameter. There were 15 deaths (9.1%) over a median of 68.1 months follow up; seven patients had increased TRV, and eight patients had a TRV<2.5 m/s. Higher TRV values were associated with a greater than 4-fold increased risk of death (Hazard Ratio: 4.48, 99% confidence interval 1.01-19.8), although we found a lower overall mortality rate than has been reported in previous studies. TRV was not an independent risk factor for death. We have confirmed the association between raised TRV and mortality in a UK SCD population whose disease severity appears to be less than that reported in previous studies. Further prospective studies are needed to more clearly characterize which patient factors modify survival in SCD patients with raised TRV.

2013Artigo científico

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Fundação para a Ciência e a Tecnologia

Número da atribuição

SFRH/BD/47751/2008