Abstract：
BACKGROUND: Sickle cell disease (SCD) is characterized by microvascular occlusion which leads to multiorgan damage, including left ventricular diastolic dysfunction. Left ventricular diastolic dysfunction has been shown to be an independent risk factor for death in SCD patients. Left atrial dilation (LAD) has been used as a surrogate marker for identification of left ventricular diastolic dysfunction.
OBJECTIVE: Investigate the association of LAD, as determined by echocardiography, with increased disease burden in SCD as reflected by increased emergency department (ED) utilization, increased hemolysis markers, and worsening anemia.
METHODS: A retrospective cohort study of patients from a single university hospital were selected from a national registry. Age, sickle cell phenotype, echocardiogram findings, ED utilization, baseline hemoglobin, and lab values needed for calculation of hemolytic index were recorded for each patient. Patients were then stratified into two distinct groups based on the presence or absence of LAD to compare ED utilization, baseline hemoglobin and hemolytic index between the two groups.
RESULTS: 129 patients met the criteria for inclusion with 88 having normal left atrial volume and 41 with LAD. There was a higher percentage of high ED utilizers in the LAD group compared to the normal left atrial volume group [34% vs. 17%, p = 0.03]. Average hemoglobin was lower in the LAD group compared with the normal left atrial volume group [mean 8.57 g/dL vs. 9.47 g/dL, p = 0.011]. The mean hemolytic index was higher in the LAD group when compared with the normal left atrial volume group [0.44 vs. -0.21, p < 0.001].
CONCLUSIONS: LAD was associated with higher ED utilization, lower hemoglobin level, and more hemolysis in patients with SCD.
OBJECTIVE: Investigate the association of LAD, as determined by echocardiography, with increased disease burden in SCD as reflected by increased emergency department (ED) utilization, increased hemolysis markers, and worsening anemia.
METHODS: A retrospective cohort study of patients from a single university hospital were selected from a national registry. Age, sickle cell phenotype, echocardiogram findings, ED utilization, baseline hemoglobin, and lab values needed for calculation of hemolytic index were recorded for each patient. Patients were then stratified into two distinct groups based on the presence or absence of LAD to compare ED utilization, baseline hemoglobin and hemolytic index between the two groups.
RESULTS: 129 patients met the criteria for inclusion with 88 having normal left atrial volume and 41 with LAD. There was a higher percentage of high ED utilizers in the LAD group compared to the normal left atrial volume group [34% vs. 17%, p = 0.03]. Average hemoglobin was lower in the LAD group compared with the normal left atrial volume group [mean 8.57 g/dL vs. 9.47 g/dL, p = 0.011]. The mean hemolytic index was higher in the LAD group when compared with the normal left atrial volume group [0.44 vs. -0.21, p < 0.001].
CONCLUSIONS: LAD was associated with higher ED utilization, lower hemoglobin level, and more hemolysis in patients with SCD.
摘要：
背景：镰状细胞病（SCD）的特征是微血管闭塞，导致多器官损伤，包括左心室舒张功能障碍。左心室舒张功能障碍已被证明是SCD患者死亡的独立危险因素。左心房扩张（LAD）已被用作识别左心室舒张功能障碍的替代标记。
目的：研究LAD的关联，通过超声心动图确定，随着急诊科（ED）利用率的提高，SCD的疾病负担增加，溶血标志物增加，贫血恶化。
方法：从国家注册中选择来自一所大学医院的患者的回顾性队列研究。年龄,镰状细胞表型，超声心动图检查结果,ED利用率，基线血红蛋白,并记录每位患者计算溶血指数所需的实验室值.然后根据LAD的存在或不存在将患者分层为两个不同的组，以比较ED利用率。比较两组的基线血红蛋白和溶血指数。
结果：129例患者符合纳入标准，其中88例具有正常左心房容积，41例具有LAD。与正常左心房容量组相比，LAD组的高ED使用率更高[34％vs.17%,p=0.03]。与正常左心房容量组相比，LAD组的平均血红蛋白较低[平均8.57g/dL与9.47g/dL,p=0.011]。与正常左心房容积组相比，LAD组的平均溶血指数更高[0.44vs.-0.21，p<0.001]。
结论：LAD与较高的ED利用率相关，较低的血红蛋白水平，SCD患者溶血较多。
目的：研究LAD的关联，通过超声心动图确定，随着急诊科（ED）利用率的提高，SCD的疾病负担增加，溶血标志物增加，贫血恶化。
方法：从国家注册中选择来自一所大学医院的患者的回顾性队列研究。年龄,镰状细胞表型，超声心动图检查结果,ED利用率，基线血红蛋白,并记录每位患者计算溶血指数所需的实验室值.然后根据LAD的存在或不存在将患者分层为两个不同的组，以比较ED利用率。比较两组的基线血红蛋白和溶血指数。
结果：129例患者符合纳入标准，其中88例具有正常左心房容积，41例具有LAD。与正常左心房容量组相比，LAD组的高ED使用率更高[34％vs.17%,p=0.03]。与正常左心房容量组相比，LAD组的平均血红蛋白较低[平均8.57g/dL与9.47g/dL,p=0.011]。与正常左心房容积组相比，LAD组的平均溶血指数更高[0.44vs.-0.21，p<0.001]。
结论：LAD与较高的ED利用率相关，较低的血红蛋白水平，SCD患者溶血较多。
