Left ventricular systolic function in sickle cell anaemia: an echocardiographic  evaluation in adult Nigerian patients.

Emmanuel Ejim, Nelson Oguanobi
University of Nigeria Teaching Hospital, Enugu, Medicine

Abstract:
Background: Reliable diagnostic measures for the evaluation of left ventricular systolic performance in the setting of altered  myocardial loading characteristics in sickle cell anaemia remains unresolved.

Objective: The study was designed to assess left ventricular systolic function in adult sickle cell patients using non-invasive endsystolic stress – end-systolic volume index ratio.

Methods: A descriptive cross sectional comparative study was done using 52 patients recruited at the adult sickle cell anaemia  clinic of the University of Nigeria Teaching Hospital Enugu. An equal number of age and sex-matched healthy volunteers  served as controls. All the participants had haematocrit estimation, haemoglobin electrophoresis, as well as echocardiographic  evaluation.

Result:The mean age of the patients and controls were 23.93 ± 5.28 (range 18-42) and 24.17 ± 4.39 (range 19 -42) years respectively, (t = 0.262; p= .794). No significant difference was seen in estimate of fractional shortening, and ejection fraction. The  cardiac out-put, cardiac index and velocity of circumferential shortening were all significantly increased in the cases compared  with the controls. The end systolic stress – end systolic volume index ratio (ESS/ESVI) was significantly lower in cases than  controls. There were strong positive correlation between the ejection phase indices (ejection fraction and fractional shortening) and end systolic stress and ESS/ESVI.

Conclusion:The study findings suggest the presence of left ventricular systolic dysfunction in adult sickle cell anaemia. This is  best detected using the loading-pressures independent force-length relationship expressed in ESS/ESVI ratio.

Keywords:Left ventricular systolic function, sickle cell anaemia, echocardiographic evaluation, adult Nigerian patients