title: Exercise-Induced Abnormal Increase of Systolic Pulmonary Artery Pressure in Adult Patients With Sickle Cell Anemia: An Exercise Stress Echocardiography Study.
abstract: BACKGROUND
  Pulmonary hypertension (PH) at rest is a risk factor for death in patients with sickle cell anemia (SCA). Exercise echocardiography (EE) can detect latent PH. We sought to investigate the occurrence of exercise-induced abnormal response of systolic pulmonary artery pressure (SPAP) in adult patients with SCA and normal SPAP at rest, and to identify the independent predictors of this abnormal response.
  
  
  RESULTS
  Forty-four adult patients with SCA and normal SPAP at rest (tricuspid regurgitant jet flow velocity [TRV] <2.5 m/sec) were studied and divided into 2 groups: exhibiting normal SPAP after treadmill EE (TRV ≤ 2.7 m/sec) (G1), and exhibiting abnormal exercise-induced increase of SPAP (TRV > 2.7 m/sec) (G2). TRV cutoff points at rest and during EE were based on data from healthy-matched control subjects. Abnormal response of SPAP with exercise occurred in 57% of the sample (G2), with mean TRV level of 3.39 ± 0.41 m/sec (range 2.8-4.5 m/sec), significantly higher than those of G1 (2.29 ± 0.25 m/sec, range 2.0-2.7 m/sec; P < 0.001). Multivariate analysis identified TRV value in resting conditions ≥2.25 m/sec (P < 0.05), left atrial volume index ≥41 mL/m2(P < 0.05), and a E/e'-waves ratio ≥6.3 (P < 0.05) as independent predictors of exercise-induced increase of SPAP.
  
  
  CONCLUSIONS
  We concluded that adult patients with SCA and normal SPAP at rest may exhibit abnormal exercise-induced increase in SPAP, which was independently related to resting TRV levels, and indices of diastolic impairment and left ventricular filling pressure.
authors.affiliation: Cardiology Division, Paulista School of Medicine-Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors.forename: Newton Nunes
authors.initials: NN
authors.lastname: de Lima-Filho
authors.affiliation: Hematology Division of Paulista School of Medicine-Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Figueiredo
authors.affiliation: Hematology Division of Paulista School of Medicine-Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors.forename: Perla
authors.initials: P
authors.lastname: Vicari
authors.affiliation: Hematology Division, Holy House of Mercy of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Cançado
authors.affiliation: Cardiology Division, Paulista School of Medicine-Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors.forename: Antonio Carlos de Camargo
authors.initials: AC
authors.lastname: Carvalho
authors.affiliation: Hematology Division of Paulista School of Medicine-Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors.forename: José Orlando
authors.initials: JO
authors.lastname: Bordin
authors.affiliation: Cardiology Division, Paulista School of Medicine-Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
authors.forename: Orlando
authors.initials: O
authors.lastname: Campos
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000503:physiopathology; D025401:Echocardiography, Stress / Q000379:methods*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D055815:Young Adult
keywords: exercise echocardiography; pulmonary hypertension; sickle cell anemia