title: Relationship between pulmonary and cardiac abnormalities in sickle cell disease: implications for the management of patients.
abstract: OBJECTIVE
  To evaluate the association between clinical, pulmonary, and cardiovascular findings in patients with sickle cell disease and, secondarily, to compare these findings between sickle cell anemia patients and those with other sickle cell diseases.
  
  
  METHODS
  Fifty-nine adults were included in this cross-sectional study; 47 had sickle cell anemia, and 12 had other sickle cell diseases. All patients underwent pulmonary function tests, chest computed tomography, and echocardiography.
  
  
  RESULTS
  Abnormalities on computed tomography, echocardiography, and pulmonary function tests were observed in 93.5%, 75.0%; and 70.2% of patients, respectively. A higher frequency of restrictive abnormalities was observed in patients with a history of acute chest syndrome (85% vs. 21.6%; p-value<0.0001) and among patients with increased left ventricle size (48.2% vs. 22.2%; p-value=0.036), and a higher frequency of reduced respiratory muscle strength was observed in patients with a ground-glass pattern (33.3% vs. 4.3%; p-value=0.016). Moreover, a higher frequency of mosaic attenuation was observed in patients with elevated tricuspid regurgitation velocity (61.1% vs. 24%; p-value=0.014). Compared to patients with other sickle cell diseases, sickle cell anemia patients had suffered increased frequencies of acute pain episodes, and acute chest syndrome, and exhibited mosaic attenuation on computed tomography, and abnormalities on echocardiography.
  
  
  CONCLUSIONS
  A significant interrelation between abnormalities of the pulmonary and cardiovascular systems was observed in sickle cell disease patients. Furthermore, the severity of the cardiopulmonary parameters among patients with sickle cell anemia was greater than that of patients with other sickle cell diseases.
authors.affiliation: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Maria Christina Paixão
authors.initials: MC
authors.lastname: Maioli
authors.affiliation: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Andrea Ribeiro
authors.initials: AR
authors.lastname: Soares
authors.affiliation: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Bedirian
authors.affiliation: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Ursula David
authors.initials: UD
authors.lastname: Alves
authors.affiliation: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Cirlene
authors.initials: C
authors.lastname: de Lima Marinho
authors.affiliation: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. Electronic address: agnaldolopes.uerj@gmail.com.
authors.forename: Agnaldo José
authors.initials: AJ
authors.lastname: Lopes
keywords: Computed tomography; Echocardiography; Respiratory function tests; Sickle cell disease