Abstract
Background
There is a lack of data on the relationship between cardiovascular autonomic neuropathy (CAN) and electrocardiographic parameters in sickle cell anaemia.
Aims and objectives
The purpose of the study was to compare the electrocardiographic findings in adult sickle cell anaemia patients with CAN with those of patients without this complication.
Methods
A cross sectional study was done using 62 consecutively recruited sickle cell anaemia patients who met the inclusion criteria for the study. Cardiovascular autonomic dysfunction was determined based on abnormal values in at least two of five non-invasive tests: Valsalva manoeuver, heart rate variation during deep breathing, heart rate response to standing, blood pressure response to sustained hand grip, and blood pressure response to standing. The subjects were subsequently evaluated with electrocardiography.
Results
Sickle cell anaemia patients with CAN had statistically significantly increased P-wave duration (p < 0.001), PR-interval (p < 0.05) and QTc dispersion (p < 0.05) compared with patients without CAN. Significantly increased frequencies of Q waves and first degree atrio-ventricular block were found in patients with CAN than in those without CAN (p = 0.026, p = 0.014, respectively). Significant correlations were noted between the severity of CAN [number of abnormal autonomic function tests (AFT)] and (1) P-wave duration (p = 0.008), (2) PR- interval (p = 0.013). Significant association was found between the number of abnormal AFT and (1) presence of Q-waves, and (2) degree of anaemia (haematocrit class).
Conclusion
Electrocardiographic features consistent with atrio-ventricular and ventricular repolarization abnormalities are associated with CAN in sickle cell anaemia. Further studies are required to evaluate the prognostic implications of these findings in sickle cell patients with cardiovascular autonomic dysfunction.
Similar content being viewed by others
References
Romero-Vecchione E, Perez O, Wessolosky M, Roas F, Liberator S, Vesquez J (1995) Abnormal autonomic cardiovascular responses in patients with sickle cell anaemia. Sangre 40(5):393–399
Romero CR, Johnson CS, Cobb C et al (1999) Cardiovascular autonomic dysfunction in sickle cell anaemia: a possible risk factor for sudden death? Clin Auton Res 7:121–125
Bilchick KC, Fetics B, Djoukeng R, Fisher SG, Fletcher RD, Singh SN, Nevo E, Berger RD (2002) Prognostic value of heart rate variability in chronic congestive heart failure (Veterans affairs’ survival trial of antiarrhythmic therapy in congestive heart failure). Am J Cardiol 90:24–28
Bonaduce D, Petretta M, Marciano F, Vicario ML, Apicella C, Rao MA, Nicolai E, Volpe M (1999) Independent and incremental prognostic value of heart rate variability in patients with chronic heart failure. Am Heart J 138:273–284
Galinier M, Pathak A, Fourcade J, Androdias C, Curnier D, Varnous S, Boveda S, Massabuau P, Fauvel M, Senard JM, Bounhoure JP (2000) Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure. Eur Heart J 21:475–482
Hadase M, Azuma A, Zen K, Asada S, Kawasaki T, Kamitani T, Kawasaki S, Sugihara H, Matsubara H (2004) Very low frequency power of heart rate variability is a powerful predictor of clinical prognosis in patients with congestive heart failure. Circ J 68:343–347
Hume L, Oakley GD, Boulton AJ, Ward JD (1986) Asymptomatic myocardial ischaemia in diabetes and its relationship to diabetic neuropathy: an exercise electrocardiography study in middle-aged diabetic men. Diabetes Care 9:384–388
Valensi P, Sachs RN, Harfouche B, Lormeau B, Paries J, Cosson E, Paycha F, Leutenegger M, Attali JR (2001) Predictive value of cardiac autonomic neuropathy in diabetic patients with or without silent myocardial ischaemia. Diabetes Care 24:339–343
Charache S (1988) Sudden death in sickle cell trait. Am J Med 84:459–461
Kark JA, Posey DM, Schumacher HR, Ruehle CJ (1987) Sickle cell trait as a risk factor for sudden death in physical training. N Engl J Med 317:781–787
Liesner RT, Vandenberghe EA (1993) Sudden death in sickle cell disease. J.R. Soc. Med. 86:484–485
Clinicopathologic conference (1992) Sudden death in a young woman with sickle cell anaemia. Am J Med 92:556–560
James TN, Riddick L, Massing GK (1994) Sickle cells and sudden death: morphologic abnormalities of the cardiac conducting system. J Lab Clin Med 124:507–520
United Nations Organization (1989) United Nations Convention on the right of the child. General Assembly resolution 44/24. Geneva 2
Kumar PJ, Clark ML (eds) (2002) Alcoholic misuse and dependence. Elsevier, Edinburgh pp 1256–1258
DeMaeyer EM (1989) Preventing and controlling iron deficiency anaemia through primary health care. World Health Organization, Geneva
Ewing DJ, Campbell IW, Burt AA, Clarke BF (1973) Vascular reflexes in diabetic autonomic neuropathy. Lancet 2:1354–1356
Alagappan R (2002) Manual of practical medicine. 2nd edn. Jaypee, New Delhi pp 402-403
Ewing DJ, Campbell IW, Murray A, Neilson JMM, Clarke BF (1978) Immediate heart rate response to standing: simple test for autonomic neuropathy in diabetes. Br Med J 1:145–147
Ewing DJ, Campbell IW, Clark MB (1980) Assessment of cardiovascular effects in diabetic autonomic neuropathy and prognostic implications. Ann Int Med 92(2):308–311
Araoye M (2004) Basic electrocardiography. 1st edn. Nathadex, Ilorin, pp 14-52
Bazett H (1920) An analysis of time relations of electrocardiograms. Heart 7:353–370
Macruz R, Perloff JK, Case RB (1958) A method for the electocardiographic recognition of atrial enlargement. Circulation. 17:882–889
Araoye MA, Oladigo OG, Omotoso ABO (1999) Appraisal of the electrocardiographic signs of left a trial enlargement. Nig. Postgrad. Med. J. 6:161–166
Allenstein BJ, Mori H (1960) Evaluation of electrocardiographic diagnosis of ventricular hypertrophy based on autopsy comparison. Circulation 21:404–412
Sokolow M, Lyon TP (1949) The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial leads. Am Heart J 37:161–186
Dilveris P, Sedaris S, Theopistou A, Andrikopoulos G, Kyriakidis M, Gialafos J, Toutouzas P (1998) Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 135:733–738
Anastasiou-Nana MI, Nanas JN, Karagounis LA et al (2000) Relation of dispersion of QRS and QT in patients with advanced congestive heart failure to cardiac and sudden death mortality. Am J Cardiol 85:1212–1217
Oguanobi NI, Onwubere BJ, Ike SO, Anisiuba BC, Ejim EC, Ibegbulam OG (2010) Electrocardiographic findings in adult Nigerians with sickle cell anaemia. Afr Health Sci 10(3):235–241
Adebayo RA, Balogun MO, Akinola NO, Akintomide NO (2002) The clinical, electrocardiographic and self-paced walking exercise features of Nigerians with sickle cell anaemia at OAUTHC, Ile-Ife. Nig J Med 11:170–176
Odia OJ (1990) Electrocardiographic observations in patients with sickle cell disease. Trop cardiol 16:135–138
Glaney JM, Garratt CJ, Woods KL, de Bono DP (1995) QT dispersion and mortality after myocardial infarction. Lancet 345:945–948
Bogun F, Chan KK, Harvey M, Goyal R, Castellani M, Neibauer M, Daoud E, Man KC, Strickberger SA, Morady F (1996) QT dispersion in non sustained ventricular tarchycardia and coronary artery disease. Am J Cardiol 77:256–259
Lippman SM, Neimann JT, Thigpen T, Ginzto LE, Laks MM (1985) Abnormal septal Q waves in sickle cell disease. Chest 88:543–548
Martin CR, Cobb C, Tatter D et al (1983) Myocardial infarction in sickle cell anaemia. Arch Intern Med 143:830–831
Mc Cormick WK (1988) Massive non-atherosclerotic myocardial infarction in sickle cell anaemia. Am J Forensic Med Pathol 9(2):151–154
Goldberger AL (1991) Myocardial infarction: electrocardiographic differential diagnosis. 4th edn. Mosby-Year Book, St Louis
Maron BJ (1990) Q waves in hypertrophic cardiomyopathy: a reassessment. J Am Coll Cardiol 16:375–376
Ewing DJ (1996) Diabetic autonomic neuropathy and the heart. Diabetes Res Clin Pract 30(Suppl):S31–S36
Ewing DJ (1978) Cardiovascular reflexes and autonomic neuropathy. Clin Sci Mol Med 55:321–327
Gehi A, Ix J, Shlipak M, Pipkin SS, Whooley MA (2005) Relation of anemia to low heart rate variability in patients with coronary heart disease (from the Heart and Soul study). Am J Cardiol 95(12):1474–1477
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Oguanobi, N.I., Ejim, E.C., Anisiuba, B.C. et al. Electrocardiographic findings in sickle cell cardiovascular autonomic neuropathy. Clin Auton Res 22, 137–145 (2012). https://doi.org/10.1007/s10286-011-0156-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10286-011-0156-0