ABSTRACT
Sickle cell disease [SCD] is a chronic, inherited haemoglobin disorder, associated with recurrent vaso-occlusive and haemolytic crises and chronic tissue ischemia which may adversely affect any organ system. Our objectives were to evaluate the left ventricular [LV] systolic and diastolic functions in Saudi patients with SCD originally from the Eastern Province of Saudi Arabia. Design and setting: Prospective hospital based echocardiography study on adolescent and adult patients with SCD. Forty-five patients with SCD were recruited for echocardiographic study while 45 patients, matched for age and sex, served as controls. Left and right ventricular dimensions and LV wall thicknesses, LV mass index [LVMI] and LV contractility variables were obtained. Left atrial dimension and volume and pulmonary artery systolic pressure [PASP] were also estimated. We also evaluated parameters of LV diastolic function, including early and late mitral flow velocities [E and A wave respectively], E/A ratio, deceleration time [MVDT], A wave duration [MVA D], LV isovolumic relaxation time [IVRT], and tissue Doppler velocities, such as lateral annular e' wave, a' wave, e'/a' ratio and E/e' ratio. There were increases in the LV dimensions, LV volumes, stroke volume, and LVMI of the SCD patients. The preload was increased [LV diastolic volume] and afterload was decreased [low diastolic blood pressure]. The LVEF was equivalent, though there was evidence of LV diastolic dysfunction in 24%, and pulmonary hypertension [PH] in 40% of the SCD patients. The mean left atrial volume [LAV] was also increased in the SCD patients. LV diastolic dysfunction [heart failure with preserved ejection fraction] and PH may complicate cases of the Arab-Indian haplotype of SCD.
ABSTRACT
Acute rheumatic fever [ARF] and its sequel, chronic valvular heart disease are the most important causes for cardiovascular morbidity and mortality worldwide and mainly in developing countries. However, the incidence of ARF has declined in developed countries during the second half of 20th century. The case files of all patients admitted as new cases of ARF over -11 years and 8 months, both in pediatric and medical departments of a university hospital located in the eastern region of Saudi Arabia were reviewed. The demographic and clinical data and the frequency of the new cases were compared with the data that have been published by us 10 years ago from the same hospital during a similar period of time [11 years and 8 months]. In the current study there was a significant decline in the frequency of admission of cases of ARF as compared to our previous study during a similar period of time, with a frequency rate of 12 cases per 100.000 hospitalizations versus 45 cases per 100.000 hospitalizations, respectively, P < 0.001. Dyspnea and chest pain as clinical features of acute rheumatic carditis [ARC] were less frequent in the current study as compared to the previous study [35% versus 44%, P = 0.02 and 10% versus 28.6%, P = 0.031]. The subgroup analysis revealed also a decreased frequency of the clinical features of ARC in pediatric age group in the current study as compared to our previous study. There is a significant decline in the frequency of new hospital admissions due to ARF. This decline was associated with similar decline in the frequency of the manifestations of ARC especially in pediatric age group [1-12 years]