title: Left ventricular myocardial performance assessed by 2-dimensional speckle tracking echocardiography in patients with sickle cell crisis.
abstract: BACKGROUND
  The status of left ventricle in sickle cell anemia presenting in sickle crisis and follow up has been minimally studied in past. To determine the left ventricular (LV) myocardial performance in these patients, we performed the study to assess two dimensional strains imaging which allowed a rapid and an accurate analysis of global and regional LV myocardial performance in longitudinal, radial, and circumferential directions.
  
  
  METHODS
  In this prospective study, 2-dimensional echocardiography (2DE) images of the LV were obtained in 52 subjects which included 32 patients (23 ± 8yrs, 16 male) with homozygous sickle cell anemia (SCA) in sickle cell crisis and 20 healthy controls (23 ± 5 yrs, 11 male) using apical 4-chamber and parasternal short-axis at the basal, mid, and apical levels. Of these 32 patients, 2DE was performed again in 18 patients in follow up (8 months ± 5 days). Longitudinal, circumferential and radial strains (LS, CS and RS respectively) were quantified and compared in an 18-segment model using a novel speckle tracking system (2D Cardiac Performance Analysis, TomTec Imaging System, Munich, Germany).
  
  
  RESULTS
  There was no significant difference in LV ejection fraction between both the groups (59.32 ± 12.6 vs. 52.3 ± 7.9; p-value > 0.05). In comparison with normal controls and follow up of sickle cell patients, peak LS was significantly attenuated in the subendocardial and subepicardial regions during sickle cell crisis (p < 0.05). However, a significant reduction in circumferential strain was evident only in subepicardial region (p < 0.001). Also patients in sickle cell crisis showed significantly higher radial strain parameters than controls (p < 0.001).
  
  
  CONCLUSIONS
  Patients with SCA presenting in sickle cell crisis have reduced longitudinal shortening. LV myocardial performance remains unaltered due to relatively preserved circumferential shortening and increased radial thickening.
authors.affiliation: Sengupta Hospital and Research Institute, Nagpur, India. senguptasp@gmail.com
authors.forename: Shantanu P
authors.initials: SP
authors.lastname: Sengupta
authors.forename: Rahul
authors.initials: R
authors.lastname: Jaju
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Nugurwar
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caracciolo
authors.forename: Partho P
authors.initials: PP
authors.lastname: Sengupta
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*