Abstract 16149: Pulse Wave Velocity and Augmentation Index as New Markers of Vasculopathy in Sickle Cell Disease: Preliminary Results of the CADRE Study
Introduction: Sickle cell disease (SCD) is now considered a vascular disease, involving many organs (pulmonary hypertension, nephropathy, stroke, leg ulcers...). We have settled a large cohort of SCD patients to estimate the incidence of cardiovascular complications in SCD and look for their predictive factors in five African countries: Cameroon, Senegal, Mali, Gabon and Ivory Coast.
Methods: Subjects have undergone clinical and biological examinations, pulse wave velocity (PWV) and augmentation index (AI) measures and echocardiography. We have compared PWD and AI in healthy controls and in two main SCD phenotype groups: SS or Sβ0 (severe SCD) and SC or Sβ+ (mild SCD) and looked for the clinical and biological markers associated.
Results: 3950 SCD patients (2792 SS-Sβ0 and 776 SC-Sβ+) and 800 controls of all ages have been recruited. As compared to controls, SCD patients have increased cardiac frequency, increased diameter of all cardiac cavities and decreased blood pressure (BP) (p<.001 for all) with similar left ventricular ejection function. Median [IQR] carotid-femoral PWV is 7.2 m/s [6.2-8.3] in SS-Sβ0, 7.9 m/s [6.7-9.3] in SC-Sβ+ and 8.7 m/s [7.6-10.2] in controls and is significantly different in the 3 groups after adjustment for sex, age, BP, cardiac frequency and BMI (p<.001). In multivariate analysis, PWD correlates positively with age, BP and hemoglobin, negatively with cardiac output (p<0.001 for all) and SS-Sβ0 phenotype (p=0.01). In contrast, AI increases more rapidly with age in SS-Sβ0 patients and is higher in SS-Sβ0 adults compared to SC-Sβ+ patients or to controls of the same age (figure).
Conclusion: PWD is inversely correlated to the severity of SCD, probably reflecting arterial dilatation secondary to high cardiac output. In contrast, AI is highest in SS-Sβ0 adults, maybe because of quicker reflection wave due to the alteration of microcirculation. The prognostic value of PWD and AI in SCD will be established during the follow-up of the study.
Author Disclosures: B. Ranque: None. A. Menet: None. I. Diop: None. S. Kingue: None. R. N’Guetta: None. M. Diarra: None. P. Boutouyrie: None. X. Jouven: None.
- © 2014 by American Heart Association, Inc.