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Abnormal submaximal cardiopulmonary exercise parameters predict impaired peak exercise performance in sickle cell anemia patients
Author(s) -
Powell Adam W.,
Alsaied Tarek,
Niss Omar,
Fleck Robert J.,
Malik Punam,
Quinn Charles T.,
Mays Wayne A.,
Taylor Michael D.,
Chin Clifford
Publication year - 2019
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.27703
Subject(s) - medicine , exercise intolerance , cardiology , anaerobic exercise , hematocrit , ejection fraction , vo2 max , sickle cell anemia , diastole , physical therapy , heart failure , heart rate , blood pressure , disease
Purpose Sickle cell anemia (SCA) patients frequently have many comorbidities, including diastolic dysfunction (DD) and exercise intolerance. SCA patients often cannot reach maximal effort on exercise testing; little is known regarding whether submaximal exercise parameters can predict abnormal maximal exercise results in SCA patients and if there are any possible associations with DD. Methods A prospective longitudinal study was performed in SCA patients. All patients had a resting cardiac MRI (CMR), cardiopulmonary exercise test (CPET) with cycle ergometry using a ramp protocol, and an echocardiogram. Exercise data were compared with age‐, gender‐, and size‐matched normal controls. Results Compared with normal controls, the SCA group ( n = 19) had lower mean max oxygen consumption (VO 2 ; 1378 ± 412 mL/min vs 2237 ± 580, P < 0.01) and workload (117 ± 37.6 watts vs 175 ± 50.5 watts, P = 0.0003). When evaluating the submaximal exercise parameters, there was lower VO 2 at the anaerobic threshold (AT; 950 ± 311.7 vs 1460 ± 409.9, P < 0.01) and oxygen uptake efficiency slope (OUES) at AT (1512 ± 426.2 vs 2080 ± 339, P < 0.01). The max VO 2 strongly correlated with VO 2 at AT ( r = 0.9, P < 0.01) and OUES ( r = 0.83, P < 0.01) at AT. The VO 2 at AT correlated with hematocrit ( r = 0.77, P < 0.05). The OUES correlated with left ventricular ejection fraction by CMR ( r = 0.55, P = 0.01), hematocrit ( r = 0.52, P = 0.02), and lateral E/e’ ( r = −0.54, P = 0.01). Conclusions SCA patients have abnormal submaximal exercise measures compared with controls, which is strongly associated with abnormal maximal exercise results. The degree of submaximal abnormality correlates with DD abnormalities by echocardiography. These data expand the scope of functional cardiovascular abnormalities in SCA.