Longitudinal study of echocardiography-derived tricuspid regurgitant jet velocity in sickle cell disease
Longitudinal study of echocardiography-derived tricuspid regurgitant jet velocity in sickle cell disease
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DOI：
10.1111/bjh.12453
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发表时间：
2013-09-01
影响因子：
6.5
通讯作者：
Ataga, Kenneth I.
中科院分区：
文献类型：
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作者：
Desai, Payal C.;May, Ryan C.;Ataga, Kenneth I.
虽然超声心动图得出的三尖瓣反流性射流速度（TRV）与镰状细胞病（SCD）死亡率增加有关，但其增加率和进展的预测标志物尚不清楚。我们在一项单中心前瞻性研究中评估了55例受试者（中位年龄：38岁，范围：20- 65岁），至少有两个可测量的TRV，随访时间中位数为45年（范围：1.0- 10.5年）。31例受试者（56%）显示TRV增加，而24例受试者（44%）显示TRV无变化或降低。线性混合效应模型表明TRV的总体增长率为每年0.02 m/s（P = 0.023）。该模型显示，使用羟基脲治疗与初始TRV相关，其比未使用此类治疗低0.20 m/s（P = 0.033），而使用血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂治疗与TRV增加相关（P = 0.006）。总之，尽管一些患者的TRV增加具有临床意义，但总体TRV增加速度缓慢。用羟基脲治疗可以减缓TRV的进展。需要进一步的研究来确定超声心动图筛查的最佳频率以及治疗干预对SCD中TRV进展的影响。
Although echocardiography-derived tricuspid regurgitant jet velocity (TRV) is associated with increased mortality in sickle cell disease (SCD), its rate of increase and predictive markers of its progression are unknown. We evaluated 55 subjects (median age: 38 years, range: 20-65years) with at least two measurable TRVs, followed for a median of 45 years (range: 1.0-10.5years) in a single-centre, prospective study. Thirty-one subjects (56%) showed an increase in TRV, while 24 subjects (44%) showed no change or a decrease in TRV. A linear mixed effects model indicated an overall rate of increase in the TRV of 0.02m/s per year (P = 0.023). The model showed that treatment with hydroxycarbamide was associated with an initial TRV that was 0.20m/s lower than no such treatment (P = 0.033), while treatment with angiotensin converting enzyme inhibitors and angiotensin receptor blockers was associated with an increase in the TRV (P = 0.006). In summary, although some patients have clinically meaningful increases, the overall rate of TRV increase is slow. Treatment with hydroxycarbamide may decrease the progression of TRV. Additional studies are required to determine the optimal frequency of screening echocardiography and the effect of therapeutic interventions on the progression of TRV in SCD.