Ventricular hypertrophy and ischaemic changes in Children with Sickle Cell Anaemia and its relationship with the Haemoglobin Concentration in Steady State

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Charles Ikegwuonu
Obumneme Ezeanosike
Chuka Manyike
Fortune Ujunwa
Cordis Ikegwuonu

Abstract

Objective:  The prevalence and burden of Sickle Cell Anaemia (SCA) in Nigeria are high and they contribute to childhood morbidity and mortality. Chronic anaemia and vaso-occlusion usually involve different organs. The involvement of the heart is a common complication of SCA, thus the need for early detection of cardiac abnormalities in children with SCA. To assess cardiac structure using ECG in children with SCA in steady-state and to determine the relationship between abnormal ECG findings and the participants’ haemoglobin concentration.


Material and Method: It was a cross-sectional study done in one of the tertiary hospitals in southeast Nigeria. The study participants were 164 children with SCA in steady state within the ages of 2 -17 years. A 12-lead ECG was carried out on the participants and their haemoglobin concentrations determined. The relationship between the presence of cardiac abnormality and independent variables like haemoglobin concentration, age and gender were analyzed.


Result: The prevalence of cardiac abnormality was 59.1%. The commonest cardiac structure abnormality was Left ventricular hypertrophy (LVH) (39.6%). Abnormality in the P-R interval was seen in 14.6%, while ST segment abnormality was seen in 18.3%. The mean Hb of those with abnormal ECG was lower than that of those without abnormal ECG, across each age group. Severe anaemia was a significant (p< 0.01) predictor of LVH. However, there was no significant association between the degree of anaemia and the occurrence of ST-segment (p: 0.26) and PR interval abnormalities     (p: 0.52).


Conclusion:  Cardiac anomalies are common findings in SCA children. 

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How to Cite
Ikegwuonu, C., Ezeanosike, O., Manyike, C., Ujunwa, F., & Ikegwuonu, C. (2021). Ventricular hypertrophy and ischaemic changes in Children with Sickle Cell Anaemia and its relationship with the Haemoglobin Concentration in Steady State. Medical Science and Discovery, 8(1), 1-8. https://doi.org/10.36472/msd.v8i1.458
Section
Research Article

References

1. Adekile AD, Adeodu OO, Adegoke SA. Haemoglobinopathies. In Azubuike JC, Nkangineme KEO (editors). Paediatrics and Child Health in a Tropical Region, 3rd ed. Lagos: Educational printing and publishing; 2016. p.1051-1062

2. Weatherall DJ, Clegg JB. Inherited haemoglobin disorders: an increasing global health problem. Bull. World Health Organ. 2001;79:704–712

3. Anie KA, Egunjobi FE, Akinyanju OO. Psychosocial impact of sickle cell disorder: perspectives from a Nigerian setting. Global. Health. 2010;6:1–6.

4. Morris CR. Mechanisms of vasculopathy in sickle cell disease and thalassemia. Hematology Am Soc Hematol Educ Program. 2008;2008:177–185

5. Weatheral DJ. Genetic disorders of hemoglobin. In Hoffbrand AV, Lewis SM, Tuddenham EG, editors. Postgraduate Hematology, 14th ed: Oxford. Butterworth Heinemann; 1999. p.111-118

6. Gladwin MT, Sachdev V. Cardiovascular abnormalities in sickle cell disease. J Am Coll Cardiol 2012;59:1123-1133

7. Fitzhugh CD, Lauder N, Jonassaint JC,Telen MJ, Zhao X, Wright EC, et al. Cardiopulmonary Complications Leading to Premature Deaths in Adult Patients with Sickle Cell Disease. Am J Hematol. 2010;85:36-40

8. Makani J, Cox SE, Soka D, Komba AN, Oruo J, et al. Mortality in sickle cell anaemia in Africa: A prospective Cohort study in Tanzania. PLosONE 2011;6:e14699-e14704

9. Chacko P, Kraut EH, Zweier J, Hitchcock C, Raman SV. Myocardial Infarction in Sickle Cell Disease: Use of Translational Imaging to Diagnose an Under-Recognized Problem. J Cardiovasc Transl Res. 2013;6:752–761.

10. Gacon PH, Elhraiech A, Jourdain P, Heba N, Amara W. Transient atrioventricular block associated with sickle cell disease: a French survey.Eur. Heart J. 2013;34:5577 (https://doi.org/10.1093/eurheartj/eht310.P5577)

11. Kleber AG. ST-segment elevation in the electrocardiogram: a sign of myocardial ischemia. Cardiovasc. Res.2000;45:111-118

12. Schwartzman D. Atrioventricular block and atrioventricular dissociation. In Zipes D, Jalife J (editors.). Cardiac Electrophysiology: From cell to bedside, 4th ed. Philadelphia, PA: WB Saunders; 2004. p. 485-489

13. Odike AI, Omokhodion SI, Akpede GO. The electrocardiographic profile in non-sickle cell anaemia children and sickle cell anaemia children. Indian J Basic Appl Med Res 2018;7:68-76

14. Ali GOM. AbdalGader YS, Abuzeid ES, Attalla BAI. Cardiac manifestations of sickle cell anemia n Sudanese children. Sudan J Paediatr2012;12:70-78

15. Dosunmu A, Akinbami A, Uche E, Adediran A, John-Olabode S. Electrocardiographic Study in Adult Homozygous Sickle Cell Disease Patients in Lagos, Nigeria. J Trop Med 2016;2016:4214387-4214392

16. Serjeant GR, Serjeant BE. Cardiovascular system. In Serjeant GR, Serjeant BE (editors).Sickle Cell Disease, 3rd ed. Oxford: Oxford University Press; 2001. p.194-208

17. Adebayo RA, Balogun MO, Akinola NO, Akintomide AO, Asaleye C.M. Non-invasive assessment of cardiac function in patients with sickle cell anaemia. Trop Cardiol. 2004;30:51–55

18. Voskaridou E, Christoulas D, Terpos E. Sickle-cell disease and the heart: review of the current literature. Br. J Haematol 2012;157:664–673

19. Bluemke DA, Kronmal RA, Lima JA,Liu K, Olson J, Burke GL, et al. The relationship of left ventricular mass and geometry to incident cardiovascular events; the MESA (Multi- Ethnic study of Atherosclerosis) Study. J Am Coll Cardiol 2008;52:2148-2155

20. Naburi HED, Lwakatare JM, Kalokola FM, Mpembeni R, Kubojha S. Cardiovascular Abnormalities in Children and Adolescents with Sickle Cell Anemia at Muhimbili National
21. Hospital, Dar Es Salaam, Tanzania. Tanzania Medical Journal 2012;26:22-28

22. Kligfield P, Gettes LS, Bailey JJ, Childers R, Deal BJ, Hancock EW, et al. American Heart Association Committee Report: Recommendations for the Standardizationand interpretation of the electrocardiogram, Part1. J Am Coll Cardiol 2007;49:1109-1127












23. Afolabi JK, Oloko GYA. Pediatrics electrocardiography. Niger J Paed 2012;39:84-89

24. Afolabi JK, Omokhodion SI. Normal limits for pediatrics electrocardiogram in Ilorin, Nigeria. Nig J Cardiol 2014;11:112-123

25. Hampton JR. What the ECG is about. In Gale A (editor). The ECG made easy, 8th ed. Nottingham UK: Churchill Livingstone Elsevier; 2013. p.22-97

26. Bernstein D. Evaluation of the cardiovascular system. In Kliegman RM, Stanton BF, St. Geme JW, Schor NF, Behrman RE (editors). Nelson textbook of paediatrics, 20th ed. Philadelphia: Elsevier; 2016. p.2163-2178

27. Parab S, Bhalerao S. Choosing Statistical Test. Int J Ayurveda Res. 2010;1:187-191

28. Ratner B. The correlation Coefficient: its values range between +1/˗1, or do they? J. Target Meas Anal Mark 2009;17:139-142

29. Janz KF, Dawson JD, Mahoney LT. Predicting heart growth during puberty: The Muscatine study. Pediatrics 2000;105:e63-e72

30. Hall A, Bobrow E, Brooker SJ, Jukes MCH, Nokes K, Lambo A, et al. Anemia in school children in eight countries in Africa and Asia. Public Health Nutr 2001;4:749-756

31. Adegoke SA, Okeniyi JAO, Akintunde AA. Electrocardiographic abnormalities and dyslipidaemic syndrome in children with sickle cell anaemia. Cardiovasc J Afr 2016;27:16-20.

32. Bode-Thomas F, Hyacinth HI, Ogunkunle O, Omotosa A. Myocardial ischemia in sickle cell anaemia: evaluation using a new scoring system. Ann Trop Paediatr 2011;31:67-74

33. Bode-Thomas F, Ogunkunle OO, Omotoso ABO. Cardiac arrhythmias in children with sickle cell anaemia. Niger J Paediatr 2003;30:13-17

34. Evans RW. The sickling phenomenon in the blood of the West African natives. Trans R Soc Trop Med Hyg. 1944;37:281-286

35. Davignon A, Rautaharju P, Boisselle E, Soumis F, Mégélas M, Choquette A. Normal ECG standards for infants and children. Pediatr Cardiol 1979;1:123-131


36. Dickson DF. The normal ECG in childhood and adolescence. Heart. 2005;91:1626–1630

37. Odia K, Dapper V, George I, Olorunfemi OJ. Changes in Some Electrocardiographic Parameters amongst Children with Sickle Cell Anemia in Port Harcourt, Nigeria. J Med Dent Sci 2016;15:69-72

38. Adewoyin AS. Management of Sickle Cell Disease: A Review for Physician Education in Nigeria (Sub-Saharan Africa). Anemia 2015;2015:1-21

39. Anjan SB, Ruben JA, Wing-yen W,Wood JC, Chan LS, Ramicone E, et al. Cardiac abnormalities in children with sickle cell anemia. Am J Hematol 2002;70:306-312

40. De Montalembert M, Maunoury C, Acar P, Brousse V, Sidi D, LenoirG. Myocardial ischaemia in children with sickle cell disease. Arch Dis Child 2004;89:359-362