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Subclinical myocardial injury during vaso-occlusive crisis in pediatric sickle cell disease

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Abstract

Acute painful crisis is the most frequent complication of sickle cell disease (SCD) in children. Recurrent vaso-occlusion may be associated with cardiac injury. The study aimed to assess silent myocardial injuries for sickle cell children during acute painful crisis by measuring serum level of troponin I and galectin-3. The study included 87 participates; study group (n = 44) sickle cell children presented at Jeddah hospitals in Saudi Arabia by painful crisis or acute illness as fever or cough (2017–2018). The controls were healthy children (n = 43). Demographic and history data were collected from the cases. Troponin I and galectin-3 were measured. Galectin-3 values were higher among cases with significant difference when compared to controls (7.5 ± 3.1 versus 3.2 ± 1.6, < 0.001). Galectin-3 at a cutoff > 5.1 ng/ml, the sensitivity was 88.64 and specificity was 88.37. Galectin-3 levels were higher for the pain crisis subgroup in comparison to acute illness group with significant difference (r 0.551*, p < 0.001*). Galectin-3 values were higher among troponin-positive cases with significant difference (p = 0.046) to troponin-negative cases.

Conclusion: Positive results of troponin I and high levels of galectin-3 in sickle cell children during acute painful crisis were potent indicators for subclinical myocardial injury.

What is Known:

• The hallmark of sickle cell disease is recurrent episodes of vaso-occlusive crisis which had deleterious effects on many organs.

• Cardiac changes in pediatric sickle cell disease whether structural or functional are mainly attributed to chronic anemia and or pulmonary hypertension.

What is New:

• The observed positive results of cardiac troponin I and high values of galectin-3 in sickle cell children during vaso-occlusive crisis are strong indicator of myocardial ischemia and ongoing cardiac fibrosis respectively.

• The observed correlation between biological markers (positive troponin and high galectin-3) could be an indication of subclinical cardiac injury.

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Abbreviations

CTnI:

Cardiac troponin I

EF:

Ejection fraction

FS:

Fraction shortening

Gal-3:

Galectin-3

SCD:

Sickle cell disease

VOCs:

Vaso-occlusive crisis

ng:

nanogram

References

  1. Acar P, Maunoury C, de Montalembert M, Dulac Y (2003) Abnormalities of myocardial perfusion in sickle cell disease in childhood: a study of myocardial scintigraphy. Arch Mal Coeur Vaiss 96(5):507–510

    CAS  PubMed  Google Scholar 

  2. Adegoke OAAS, Okeniyi JAO, Smith OS (2013) Serum cardiac troponin T (cTnT) in Nigerian children with sickle cell anaemia: an index of myocardial injury? Int J Med Med Sci 3(2):376–380

    Google Scholar 

  3. Akinola NO, Stevens SME, Franklin IM, Nash GB, Stuart J (1992) Subclinical ischaemic episodes during the steady state of sickle cell anaemia. Clin Pathol 45:902–906

    Article  CAS  Google Scholar 

  4. Aloni MN, Kadima BT, Ekulu PM, Budiongo AN, Ngiyulu RM, Gini-Ehungu JL (2017) Acute crises and complications of sickle cell anemia among patients attending a pediatric tertiary unit in Kinshasa, Democratic Republic Of Congo. Hematol Rep 9(2):6952. https://doi.org/10.4081/hr.2017.6952

    Article  PubMed  PubMed Central  Google Scholar 

  5. Alotaibi MM (2017) Sickle cell disease in Saudi Arabia: a challenge or not. J Epidemiol Glob Health 7(2):99–101. https://doi.org/10.1016/j.jegh.2016.12.006

    Article  PubMed  Google Scholar 

  6. Al-Qurashi MM, El-Mouzan MI, Al-Herbish AS, Al-Salloum AA, Al-Omar AA (2008) The prevalence of sickle cell disease in Saudi children and adolescents. A community-based survey. Saudi Med J 29(10):1480–1483

    PubMed  Google Scholar 

  7. Animasahun BA, Omokhodion SI, Okoromah CA, Njokanma OF, Ekure EN (2010) Echocardiographic findings among children with sickle cell anaemia at the Lagos University Teaching Hospital. Niger Postgrad Med J 17 (2):107–112

  8. Aslam AK, Rodriguez C, Aslam AF, Vasavada BC, Khan IA (2009) Cardiac troponin I in sickle cell crisis. Int J Cardiol 133(1):138–139. https://doi.org/10.1016/j.ijcard.2007.08.135

    Article  PubMed  Google Scholar 

  9. Charan J, Biswas T (2013) How to calculate sample size for different study designs in medical research? Indian J Psychol Med 35(2):121–126. https://doi.org/10.4103/0253-7176.116232

    Article  PubMed  PubMed Central  Google Scholar 

  10. de Montalembert M, Maunoury C, Acar P, Brousse V, Sidi D, Lenoir G (2004) Myocardial ischaemia in children with sickle cell disease. Arch Dis Child 89(4):359–362

    Article  Google Scholar 

  11. Dong R, Zhang M, Hu Q, Zheng S, Soh A, Zheng Y, Yuan H (2018) Galectin-3 as a novel biomarker for disease diagnosis and a target for therapy. Int J Mol Med 41(2):599–614. https://doi.org/10.3892/ijmm.2017.3311

    Article  CAS  PubMed  Google Scholar 

  12. Gladwin MT, Sachdev V (2012) Cardiovascular abnormalities in sickle cell disease. J Am Coll Cardiol 59(13):1123–1133. https://doi.org/10.1016/j.jacc.2011.10.900

    Article  PubMed  Google Scholar 

  13. Gurkan F, Alkaya A, Ece A, Haspolat K, Bosnak M, Bilici M, Kervancioglu M, Ariturk Z (2004) Cardiac troponin-I as a marker of myocardial dysfunction in children with septic shock. Swiss Med Wkly 134(39–40):593–596

  14. Hassan MBHN, Fuad AR, Bakr HA, Abdulrhman Ahmed G (2017) Measuring the percentage of consanguinity in sickle cell patients and its effect on the prognosis of the disease. Prim Health Care 7(1):2–4

    Google Scholar 

  15. Ho JE, Liu C, Lyass A, Courchesne P, Pencina MJ, Vasan RS, Larson MG, Levy D (2012) Galectin-3, a marker of cardiac fibrosis, predicts incident heart failure in the community. J Am Coll Cardiol 60(14):1249–1256. https://doi.org/10.1016/j.jacc.2012.04.053

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Jastaniah W (2011) Epidemiology of sickle cell disease in Saudi Arabia. Ann Saudi Med 31(3):289–293. https://doi.org/10.4103/0256-4947.81540

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kato GJ, Hebbel RP, Steinberg MH, Gladwin MT (2009) Vasculopathy in sickle cell disease: biology, pathophysiology, genetics, translational medicine, and new research directions. Am J Hematol 84(9):618–625. https://doi.org/10.1002/ajh.21475

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Manwani D, Frenette PS (2013) Vaso-occlusion in sickle cell disease: pathophysiology and novel targeted therapies. Blood 122(24):3892–3898. https://doi.org/10.1182/blood-2013-05-498311

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Muhammad Sohaib Ejaz Khan AS, Rizwan Aziz Qazi SAS (2014) Spectrum of clinical presentation in sickle cell disease patients. Ann Pak Inst Med Sci 10(2):67–70

    Google Scholar 

  20. National Health System (NHS). Sickle cell disease in childhood. Standard and guidelines for clinical care. 2nd Edition 2010. Available at: https://assets.publishing.service.gov.uk/government /uploads/system/uploads/attachment_data/file/408961/1332-SC-Clinical-Standards-WEB.pdf

  21. Numano F, Shimizu C, Jimenez-Fernandez S, Vejar M, Oharaseki T, Takahashi K, Salgado A, Tremoulet AH, Gordon JB, Burns JC, Daniels LB (2015) Galectin-3 is a marker of myocardial and vascular fibrosis in Kawasaki disease patients with giant aneurysms. Int J Cardiol 201:429–437. https://doi.org/10.1016/j.ijcard.2015.07.063

    Article  PubMed  Google Scholar 

  22. Olukemi T, JAO B-T, Omokhodion SI, Adeodu OO, Elusiyan JB (2015) Cardiac dimensions and functional parameters in Nigerian children with homozygous sickle cell anaemia using echocardiography. J Clin Exp Cardiolog 6(4):2–6

    Google Scholar 

  23. Paolo Ricchi AM, Di Matola T, Spasiano A, Filosa A, Costantini S, Atripaldi L, Esposito S, Cinque P, De Franceschi L, Pepe A (2016) Galectin-3 and myocardial fibrosis by cardiac magnetic resonance in thalassaemia major. Blood 128(22):4832

    Google Scholar 

  24. Pugliese G, Iacobini C, Ricci C, Blasetti Fantauzzi C, Menini S (2014) Galectin-3 in diabetic patients. Clin Chem Lab Med 52(10):1413–1423. https://doi.org/10.1515/cclm-2014-0187

    Article  CAS  PubMed  Google Scholar 

  25. Ross G, Bever FN, Uddin Z, Hockman EM (2000) Troponin I sensitivity and specificity for the diagnosis of acute myocardial infarction. J Am Osteopath Assoc 100(1):29–32

    CAS  PubMed  Google Scholar 

  26. Saad ST, Arruda VR, Junqueira OO, Schelini FA, Coelho OB (1990) Acute myocardial infarction in sickle cell anaemia associated with severe hypoxia. Postgrad Med J 66(782):1068–1070

    Article  CAS  Google Scholar 

  27. Saccon F, Gatto M, Ghirardello A, Iaccarino L, Punzi L, Doria A (2017) Role of galectin-3 in autoimmune and non-autoimmune nephropathies. Autoimmun Rev 16(1):34–47. https://doi.org/10.1016/j.autrev.2016.09.023

    Article  CAS  PubMed  Google Scholar 

  28. Tidake A, Gangurde P, Taksande A, Mahajan A, Nathani P (2015) Left ventricular function by echocardiogram in children with sickle cell anaemia in Mumbai, Western India. Cardiol Young 25(7):1319–1325. https://doi.org/10.1017/S1047951114002455

    Article  PubMed  Google Scholar 

  29. Uluca U, Sen V, Ece A, Tan I, Karabel D, Aktar F, Karabel M, Balik H, Gunes A (2015) Serum galectin-3 levels in children with chronic hepatitis B infection and inactive hepatitis B carriers. Med Sci Monit 21:1376–1380. https://doi.org/10.12659/MSM.894035

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would particularly like to thank the staff of El Mosaeddyiha and El Azizyha hospitals at Jeddah for their cooperation during data collection and analysis with special thanks to lab facilities staff: Mr. Essa Arar Hamoud and Mrs. Doaa Abdullah Al-Maymani.

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Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Reham Wagdy

  2. Department of Biochemistry, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Howayda Suliman

  3. Batterjee Medical College for Science and Technology, 6231, Jeddah, 21442, Saudi Arabia

    Reham Wagdy, Howayda Suliman, Bashayer Bamashmose, Abrar Aidaroos, Zuhour Haneef, Arunima Samonti & Fatima Awn

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  1. Reham Wagdy
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Contributions

Dr. Reham Wagdy has the idea, concept, and design, collecting data of echocardiography, data analysis, interpretation of the results, writing the arrticle, editing and supervising the work, revision and final approval before submission.

Dr. Howayda practical part of biological markers, interpreting the data, revising the article.

Bashayer Bamashmaouse selecting patients at hospitals, taking history data, sharing in writing.

Arunima Samonti data collection from patients and controls and laboratory findings.

Abrar Aidaroos data collection from patients and controls and laboratory findings.

Zuhour Haneef and Fatima Awn interpretation of results, sharing in statistical analysis, and editing.

Corresponding author

Correspondence to Reham Wagdy.

Ethics declarations

The study was approved by the ethical review committee of Batterjee Medical College and Board of Research of Ministry of Health, Jeddah, Saudi Arabia (S.N: RES-2018-0040), and the ethical review board of the Faculty of Medicine, Alexandria University, Alexandria, Egypt.

Informed consent

Informed consent was obtained from the parents and legal guardians respectively.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Communicated by Peter de Winter

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Wagdy, R., Suliman, H., Bamashmose, B. et al. Subclinical myocardial injury during vaso-occlusive crisis in pediatric sickle cell disease. Eur J Pediatr 177, 1745–1752 (2018). https://doi.org/10.1007/s00431-018-3231-x

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  • DOI: https://doi.org/10.1007/s00431-018-3231-x

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