Cardiovascular complications in patients with sickle cell disease

Abstract

Sickle cell disease (SCD) is an autosomal recessive disease in which homozygosity for a single point mutation in the gene encoding theb-globin chain produces hemoglobinSmolecules that polymerizewithin the erythrocyte during deoxygenation; the result is sustained hemolytic anemia and vaso-occlusive events. As patients live to adulthood, the chronic impact of sustained hemolytic anemia and episodic vaso-occlusive episodes leads to progressive end-organ complications. This scenario culminates in the development of 1 or more major cardiovascular complications of SCD for which there are no approved or consensus therapies. These complications include elevated pulmonary artery systolic pressure, pulmonary hypertension, left ventricular diastolicheartdisease,dysrhythmia,suddendeath,andchronic kidneydiseasewithassociatedproteinuria,microalbuminuria,and hemoglobinuria. In patients with advancing age, cardiopulmonary organ dysfunction and chronic kidney injury have significant effects onmorbidity and premature mortality. Over the last 15 years, a number of tests have been validated in multiple replicate cohort studies that identify patientswithSCDat the highest risk of experiencing pulmonary and systemic vasculopathy and death, providing for screening strategies tied to targeted, more aggressive diagnostic and therapeutic interventions.