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Reduced cardiac reserve contributes to exercise tolerance in adult patients with sickle cell anemia

Session Poster session 3

Speaker Alexandre Ceccaldi

Event : Heart Failure 2017

  • Topic : preventive cardiology
  • Sub-topic : Exercise Testing
  • Session type : Poster Session

Authors : A Ceccaldi (Paris,FR), S Hatem (Paris,FR), K Stankovic-Stojanovic (Paris,FR), P Guedeney (Paris,FR), F Nicolas-Jilwan (Paris,FR), JP Haymann (Paris,FR), G Montalescot (Paris,FR), F Lionnet (Paris,FR), R Isnard (Paris,FR), N Hammoudi (Paris,FR)

Authors:
A Ceccaldi1 , S Hatem1 , K Stankovic-Stojanovic2 , P Guedeney1 , F Nicolas-Jilwan2 , JP Haymann2 , G Montalescot1 , F Lionnet2 , R Isnard1 , N Hammoudi1 , 1Hospital Pitie-Salpetriere, Cardiology - Paris - France , 2Hospital Tenon - Paris - France ,

Citation:
European Journal of Heart Failure ( 2017 ) 19 ( Suppl. S1 ), 489

Background: Sickle cell anemia (SCA) is associated with marked exercise intolerance. However, mechanisms underlying this functional limitation remain incompletely characterized. We hypothesized that abnormal cardiovascular reserve is an important determinant of SCA exercise capacity.
Objectives: To investigate the cardiac response to exercise in a contemporary adult SCA population.
Methods: We compared 60 SCA patients (median age, 31 years, 60% women) to 20 controls matched for age and gender. All subjects prospectively underwent a symptom-limited cardiopulmonary exercise testing with combined echocardiography. The oxygen uptake (VO2) and cardiac index (Ci) were simultaneously measured.  The difference between arterial and venous oxygen content (C(a-v)O2) was calculated using Fick principle. The left ventricular (LV) function was comprehensively studied at rest and during exercise.
Results: Compared to controls, the SCA patients had severe exercise intolerance (median peak VO2, 19.7 versus 34.3 ml/min/kg, p<0.0001). In SCA population the increase in Ci from rest to peak exercise was widely scattered and correlated closely with peak VO2 (r = 0.71, p <0.0001); in contrast, the C(a-v)O2 reserve was homogenously reduced and did not correlate with exercise capacity (r=0.18, p=0.16). Compared to controls, SCA patients had chronotropic incompetence, blunted LV preload reserve and higher LV filling pressures.
The SCA patients were classified in tertiles according to peak VO2. While hemoglobin level and C(a-v)O2 were similar, SCA patients in the lower VO2 tertile were characterized by an alteration of cardiovascular reserve related to ageing and to left atrial function deterioration (table).
Conclusion: The ability of cardiovascular system to increase Ci is an important determinant of SCA exercise capacity.

Lower VO2 tertile (n=20)

Other VO2 tertiles (n=40)

p

Age(years)

40 [34-48]

27 [22-34]

0.0002

Hemoglobin(g/dl)

8.1 [7.5-9.5]

8.5 [8.1-9.7]

0.09

Peak VO2(ml/min/kg)

15.1 [14.4-16.8]

21.8 [19.7-23.4]

<0.0001

Rest Cardiac index(l/min/m²)

4.2 [3.5-5.1]

3.9 [3.4-4.6]

0.33

Peak Cardiac index(l/min/m²)

9.0 [8.5-9.5]

10.5 [9.2-12.1]

0.0004

Peak Ca-vO2(ml/dl)

6.6 [6.0 - 7.3]

7.3 [6.2-8.0]

0.11

LV ejection fraction at peak(%)

70 [68-74]

71 [67-74]

0.88

Left atrial volume index at rest(ml/m²)

57 [40-68]

45 [37-52]

0.02

Left atrial longitudinal strain at rest(%)

31 [28-32]

40 [34-43]

<0.0001

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