In patients with sickle cell disease (SCD), researchers found that cardiac magnetic resonance (CMR) had prognostic value as a tool for screening those who may be at higher risk of cardiopulmonary and vascular conditions, according to results of a recent study. Study findings were reported in the journal Annals of Hematology.

Patients with SCD are at risk of cardiovascular complications due to processes that occur with hemolysis and vaso-occlusive crises that accompany SCD. In this study, the prognostic value of multiparametric CMR, with right ventricular mass assessment, was examined in patients with SCD.

Patients in this multicenter, prospective study had been enrolled in the Myocardial Iron Overload in Thalassemia Network, and the study included only participants who had SCD. Magnetic resonance imaging was performed to assess iron burden in both the heart and liver tissue. Iron overload was evaluated using the T2* technique, and other assessments were also performed. The main outcome of interest in the study was the incidence of cardiovascular complications.


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There were 102 patients with SCD evaluated in this study. Patients had a mean age of 34.38 + 12.67 years at baseline. At baseline, hepatic iron overload was identified in 54.9% of patients, and myocardial iron overload was detected in 2.0%.

The median study follow-up time was 64.71 months. During the study, 10.8% of patients had cardiovascular events, with a mean age at first complication of 45.86 + 10.21 years. These events spanned a broad range of types, with pulmonary hypertension being the most common, occurring in 3 patients. There was a patient who died of heart failure and 1 patient died after acute chest syndrome.

Among factors that were evaluable using CMR, a multivariate analysis revealed left ventricular (LV) ejection fraction (hazard ratio [HR], 0.88; 95% CI, 0.79-0.98; P =0.025) and right ventricular (RV) mass index (HR, 1.09; 95% CI, 1.01-1.18; P =.047) to be independent predictors of cardiovascular events.

An LV ejection fraction below 58.9%, and an RV mass index of more than 31 g/m2 were found to be optimal threshold values for use in prediction of future cardiovascular events, based on receiver operating characteristic curve analyses. Values for the area under the curve for these factors were 0.71 (95% CI, 0.63-0.81) for LV ejection fraction and 0.74 (95% CI, 0.62-0.84) for RV mass index.

The researchers concluded that in SCD, a reduced LF ejection fraction and an increased RV mass index had value in prognostic assessment. “This finding suggests that multiparametric CMR may be added as a screening tool for identifying SCD patients at high risk for cardiopulmonary and vascular diseases,” they wrote in their report.

Reference

Meloni A, Pistola L, Quota A, et al. Prognostic value of multiparametric cardiac magnetic resonance in sickle cell patients. Ann Hematol. Published online December 2, 2022. doi:10.1007/s00277-022-05057-6