Echocardiographic findings in adult Nigerian sickle cell patients with cardiovascular autonomic dysfunction
More details
Hide details
Department of Medicine, University of Nigeria Teaching Hospital in Enugu, Nigeria
Department of Haematology, University of Nigeria Teaching Hospital in Enugu, Nigeria
Submission date: 2014-09-17
Acceptance date: 2015-04-29
Online publication date: 2015-07-07
Publication date: 2020-03-26
Corresponding author
Nelson I. Oguanobi   

Department of Medicine, University of Nigeria Teaching Hospital, UNTH Road, Enugu, Nigeria. Tel.: +234 80 33 738 753; fax: +234 80 33 738 753.
Pol. Ann. Med. 2015;22(2):86-91
Involvement of the cardiovascular autonomic nervous system in various diseases is often associated with increased morbidity and mortality.

This study was aimed at determining the relationship between cardiovascular autonomic dysfunction (CAD) and echocardiographic indices of cardiac function in adult Nigerian sickle cell anaemia patients.

Material and methods:
A cross sectional study was done using 62 sickle cell anaemia patients and 62 age and sex matched normal controls. CAD was determined based on abnormal values in at least two of five non-invasive tests: Valsalva manoeuver, heart rate variation during deep breathing, heart rate response to standing, blood pressure response to sustained hand grip, and blood pressure response to standing. The subjects were subsequently evaluated with echocardiography.

Results and discussion:
Significant increases in left ventricular posterior wall thickness, left ventricular mass as well as left ventricular mass index were found in patients with CAD. Indices of left ventricular diastolic and systolic functions were comparable in patients with and without CAD, however patients with CAD had lower peak aortic systolic velocity (P = 0.038). Valsalva ratio correlated significantly with right ventricular internal diameter (r = –0.388; P = 0.009), left ventricular posterior wall diameter (r = –0.352; P = 0.019), left ventricular end systolic stress/end systolic dimension ratio (r = 0.512; P < 0.001), and pulmonary artery flow acceleration time (r = 0.499; P = 0.001).

CAD is a serious complication of sickle cell anaemia. All the patients should be routinely evaluated for CAD.

Orchard TJ, Lloyd CE, Maser RE, Kuller LH. Why does diabetes autonomic neuropathy predict IDDM mortality? An analysis from the Pittsburgh epidemiology of diabetes complications study. Diabetes Res Clin Pract. 1996;34(Suppl):S165–S171.
Hume L, Oakley GD, Boulton AJ, Ward JD. Asymptomatic myocardial ischaemia in diabetes and its relationship to diabetic neuropathy: an exercise electrocardiography study in middle-aged diabetic men. Diabetes Care. 1986;9(4):384–388.
Valensi P, Sachs RN, Harfouche B, et al. Predictive value of cardiac autonomic neuropathy in diabetic patients with or without silent myocardial ischaemia. Diabetes Care. 2001;24(2):339–343.
Oguanobi NI, Ejim EC, Onwubere BJC, Ike SO, Anisiuba BC, Ibegbulam OG. Electrocardiographic findings in sickle cell cardiovascular autonomic neuropathy. Clin Auton Res. 2012;22(3):137–145.
Sahn D, De Maria A, Kisslo J, Weyman A. Recommendations regarding quantification in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978;58(6):1072–1081.
Henry WL, Demaria A, Gramial R, et al. Report of the American Society of Echocardiography Committee on nomenclature and standards in two-dimensional echocardiography. Circulation. 1980;62(2):212–217.
Reichek N, Wilson J, St John Sutton M, Plappert TA, Goldberg S, Hirshfeld JW. Noninvasive determination of left ventricular end-systolic stress: validation of the method and initial application. Circulation. 1982;65(1):99–108.
WHO. Declaration of Helsinki. BMJ. 1996;313(7070):1448–1449.
Gerry JL, Baird MG, Fortuin NJ. Evaluation of left ventricular function in-patient with sickle cell anaemia. Am J Med. 1976;60(7):968–972.
Simmons BE, Santhanam V, Castaner A, Rao KR, Sachdev N, Cooper R. Sickle cell heart disease. Two-dimensional echo and Doppler ultrasonographic findings in the hearts of adult patients with sickle cell anaemia. Arch Intern Med. 1988;148(7):1526–1528.
Adebiyi AA, Falase AO, Aken'ova YA. Left ventricular systolic function of Nigerians with sickle cell anaemia. Tropical Cardiol. 1999;25(98):27–32.
Covit W, Espeland M, Gallagher D, Hillenbrand W, Leff S, Talner N. The heart in sickle cell anaemia. The Cooperative Study of Sickle Cell Disease (CSSCD). Chest. 1995;108(5):1214–1219.
Gujja P, Rosing DR, Tripodi DJ, Shizukuda Y. Iron overload cardiomyopathy: better understanding of an increasing disorder. J Am Coll Cardiol. 2010;56(13):1001–1012.
Wood JC. Cardiac iron across different transfusion- dependent diseases. Blood Rev. 2008;22(suppl 2):S14–S21.
European Society of Cardiology (ESC) and European Society of Hypertension (ESH). 2007 guidelines for the management of arterial hypertension. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105–1187.
Balfour IC, Covitz W, Arensman FW, Eubig C, Garrido M, Jones C. Left ventricular filling in sickle cell anaemia. Am J Cardiol. 1988;61(4):395–399.
Colan SD, Borow KM, Neumann A. Left ventricular endsystolic wall stress - velocity of fibre shortening relation: a load-independent index of myocardial contractility. J Am Coll Cardiol. 1984;4(4):4715–4724.
Sagawa K. The end-systolic pressure-volume relation of the ventricle; definition, modifications and clinical use. Circulation. 1981;63(6):1223–1227.
Roy TM, Peter HR, Snider HL, et al. Autonomic influence on cardiovascular performance in diabetic subjects. Am J Med. 1989;87(4):382–388.
Journals System - logo
Scroll to top