Echocardiographic determinants of ventricular arrhythmia in sickle cell disease adults. (14th October 2021)

• Record Type: Journal Article
• Authors: Dupuy, M; Saba, J; Codiat, R; Derumeaux, G; Alassaad, L; Abou Chakra, L; Odouard, S; Deux, J.F; Guillet, H; Savale, L; De Luna, G; Bartolucci, P; D'Humieres, T
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Other Nonischaemic Cardiomyopathies (Valvular, Neuromuscular, Infectious, Infiltrative, etc.); Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.0629
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Unexplained sudden death remains one of the leading causes of death in sickle cell disease (SCD) adults. Ventricular arrhythmia is a well-known risk factor for sudden death but its prevalence and determinants in the context of SCD remain understudied. Purpose: The aim of this study was to identify echocardiographic predictors of ventricular arrhythmia in SCD. Methods: From January 2019 to March 2021, consecutive adult patients with SCD referred to ambulatory cardiology department for possible cardiac involvement were prospectively included (Drepacoeur cohort). All patients that had 24-hour ECG monitoring (24h-holter) and thransthoracic echocardiography (TTE) on the same day were analysed in this study. The primary end point was the occurrence of ventricular arrhythmia, defined as sustained or non-sustained ventricular tachycardia (VT), more than 500 premature ventricular contractions (PVC) on 24h-holter, or history of VT ablation. Results: Overall, 90 patients were included and 54 (60%) were analysed. Mean age was 47.6±11.6 years (range 21–69), 53% were male. Heart function was mainly preserved with a mean left ventricular ejection fraction (LVEF) of 57.9±4.9% and a mean global longitudinal strain (GLS) of −18±2.8%. Mean tricuspid regurgitation velocity was 2.6±0.4m/s. Ventricular arrhythmia was observed in 13 (24.1%) patients (4 non-sustained VT [range 4–121 consecutive PVC], 9 with more than 500 PVC [range 500–13000 PVC/24h] and 1 history of VT ablation). Regarding echocardiographic parameters, ventricular arrhythmia was associated with lower GLS (−15.8±1.8% vs. −19±2.7%, P<0, 001), lower tricuspid annular plane systolic excursion (TAPSE, 23±5.7mm vs. 26.9±4.6mm, P=0, 02) and more dilated right ventricle assessed by tricuspid annulus diameter (38.2±6.1mm vs. 34.2±4.5mm, P=0, 02). In multivariate analysis, GLS was independently associated with ventricular arrhythmia (OR=2, 1 CI95% [1, 3; 3, 3], P=0, 004) with a moderate exponential correlation with PVC load on 24h-holter (R=0, 5, P<0, 001). Interestingly, ventricular arrhythmia was not associated with corrected QT interval nor with age or hemoglobin serum level. Conclusion: In SCD adults with preserved LVEF, GLS was the only independent echocardiographic predictor of ventricular arrhythmia. Funding Acknowledgement: Type of funding sources: None.