Exercise Testing is Viable for Stable Sickle Cell Patients

Adults living with sickle cell disease (SCD) have an increased risk of experiencing cardiovascular complications. While exercise testing is often used as a prognostic marker in cardiovascular disease, the evidence surrounding exercise in patients with SCD is lacking.

A team of investigators led by Christiano Goncalves de Araujo, Programa de Pós-graduação em Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, decided to evaluate the feasibility of exercise testing in the SCD population.

The study particularly focused on the safety of exercise testing for these patients and the potential to utilize it as a prognostic tool. Results showed that this testing is feasible in patients who were clinically stable.

Physical Exercise Evaluation

By using a maximal treadmill, factors associated with exercise duration, as well as the impact of exercise-induced changes on clinical outcomes were assessed. The comprehensive cardiovascular evaluation included echocardiography and B-type natriuretic peptide (BNP) levels.

Enrollment incorporated 113 patients with SCD who underwent exercise testing. Patients ranged in age from 18-65 with 52% of them being women.

The long-term outcome consisted of a composite endpoint of death, severe acute painful episodes, acute chest syndrome, or hospitalization for other complications related to sickle cell disease.

Response and Independent Predictors

In response to exercise, ischemic electrocardiogram occurred in 17% of patients and abnormal blood pressure (BP) was detected in 9%. Pain crises that required hospitalization were experienced by 2 patients within 48 hours following the exercise.

Investigators adjusted markers for disease severity and noted that multiple factors were associated with exercise duration including age, sex, tricuspid regurgitation (TR) maximal velocity, and mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (E') (E/E' ratio).

The endpoint was achieved in 27 patients (23%). The data revealed that hemoglobin concentration, late transmitral flow velocity (A wave), and blood pressure response to exercise were independent predictors of adverse events.

"Exercise testing in SCD patients who were clinically stable is feasible," investigators wrote. "Exercise duration was associated with diastolic function and pulmonary artery pressure. Abnormal BP response was an independent predictor of adverse events."

The study "Exercise Testing In Patients with Sickle Cell Disease: Safety, Feasibility and Potential Prognostic Implication" was published in ABC Cardiol.