Right ventricular abnormalities in sickle cell anemia: Evidence of a progressive increase in pulmonary vascular resistance

Objective To assess the effects of sickle cell anemia (SCA) on the right ventricle (RV). Study design Echocardiograms of 32 children with SCA were compared with age-matched healthy controls. RV measurements included diastolic area index, fractional area change. free-wall mass index, ejection time corrected for heart rate (ET.), and tricuspid regurgitation (TR) gradient. Results SCA subjects had elevated RV ETc (mean +/- standard deviation, 0.369 +/- 0.030 see vs 0.351 +/- 0.022 see; P <.01), diastolic area index (19.9 +/- 2.4 cm(2)/m(2) vs 13.2 +/- 2.1 cm(2)/m(2); P <.01) and free-wall mass index (33.2 +/- 4.4 g/m(2) vs 23.9 +/- 4.3 g/m(2): p <.01), whereas RV fractional area change (37 +/- 8% vs 36 +/- 4%) was not different from controls. Although RV diastolic area index in SCA paralleled the normal range over time, RV free-wall mass index continued to gradually throughout childhood (r =.42: P <.05). TR gradients > 2.5 m/sec, consistent with pulmonary hypertension, were found in 5 (16%) of SCA subjects, all older than 9 years. Conclusions RV preload mid systolic function do not worsen during childhood in SCA; however, RV mass index and the prevalence of pulmonary hypertension increase consistent with rising pulmonary vascular resistance.