ABSTRACT
The aim of this study was to investigate cardiac abnormalities in Kuwaiti sickle cell disease [SCD] patients using markers such as tricuspid regurgitant jet velocity [TRJV], pulmonary artery systolic pressure [PASP], and the 6-minute walk [6MW] test and correlate these findings with clinical, hematological, and biochemical parameters. Seventy-three patients with SCD and 70 matched controls were studied. The cardiac status was investigated using transthoracic echocardiography in 57 patients; the 6MW test was carried out in patients and controls. Complete blood counts and hemolytic parameters were assessed. Reticulocytes, bilirubin, and lactate dehydrogenase were significantly higher [p < 0.0001] in patients, while hemoglobin [Hb] and haptoglobin were lower [p < 0.0001] than in controls. The mean fetal Hb among patients was 15.85 +/- 8.7%. Of the 57 patients, 14 [24.5%] and 15 [26%] had mild tricuspid and mitral regurgitation, respectively. The mean ejection fraction, TRJV, and PASP were 63.9 +/- 6.3%, 1.7 +/- 0.5 m/s, and 23.0 +/- 7.3 mm Hg, respectively. Three [5.2%] patients had mildly raised TRJV [2.6-2.97 m/s, normal range <2.5 m/s] while 8 [14%] had high PASP [mean 35.3 +/- 5.1 mm Hg, normal range <30 mm Hg]. Hb, hematocrit, and reticulocytes were different [p = 0.010, p = 0.006, and p = 0.011, respectively] between patients with normal and high PASP. All 3 patients who had a high TRJV had a high PASP, and 2 of these patients died during follow-up. The systolic and diastolic blood pressure, oxygen saturation before and after the 6MW test, and distance walked were lower [p = 0.006, p = 0.000, p = 0.002, p = 0.000, and p = 0.000, respectively] in patients compared to controls. Raised PASP was common in Kuwaiti SCD patients while raised TRJV was not
ABSTRACT
The objective ofthis study was to evaluate the determinants and associations of some prothrombotic risk factors in patients with cerebrovascular accidents [CVAs]. In this case-control study, plasma total homocysteine [tHcy], lupus anticoagulant, protein C, protein S, activated protein C resistance [APC-R] and antithrombin were measured in 102 patients [60 males and 42 females] and 167 controls [87 males, 80 females]. Serum vitamin B[12], folate, red cell folate, creatinine, lipid profile and glucose were also determined. Glomerular filtration rate [GFR] was calculated.13 [22%] of the 60 male patients, and 16 [39%] of the 42 female patients had hyperhomocysteinemia. Median [interquartile range] tHcy was higher in male patients [11.22 Mu mol/l [9.60-15.40]] than female patients [10.05 Mu mol/l [8.72-17.54]]. On binary logistic regression analysis, the significant [p < 0.05] determinants of tHcy were urea, creatinine and GFR. Comparing patients with control subjects showed that tHcy, age, fasting glucose, urea, serum creatinine, white blood cell count, protein S, APC-R and factor VIII were significantly higher, while protein C, factor II, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were significantly lower in patients. Lupus anticoagulant was not associated with tHcy and not detected in patients and controls. Low concentrations of vitamins B[12] and folate were not associated with tHcy. Logistic regression analysis showed a significant association of tHcy with CVA [OR = 9.55; p = 0.047] in males in the presence of other traditional CVA risk factors but tHcy is not independently associated with CVA in females. Hyperhomocysteinemia is common in Kuwaiti patients with CVA and tHcy probably interacts with prothrombotic factors [protein C, APC-R and factor VIII] to increase CVA risk. The main determinants, age and GFR markers, should be kept in mind when determining the risk associated with tHcy