Pulmonary Hypertension in Sickle Cell Disease Patients: Correlation of TRV Jet with Serum NT-Pro BNP Concentration

Abstract

ABSTRACT: Objectives: The aim of this study was to determine the prevalence of pulmonary hypertension [PH] and correlate it with the laboratory markers of hemolysis and serum NT-pro brain natriuretic peptide [BNP] concentrations in Sickle cell disease [SCD] patients from Oman. Methods: A cohort of 115 SCD patients was investigated with complete blood counts, blood chemistry, Serum NT-proBNP levels, imaging studies and cardiac evaluation with a 12-lead electrocardiogram and Doppler echocardiogram. They were prospectively screened for pulmonary hypertension [PH] with echocardiography, defined as a tricuspid regurgitation flow velocity of > or =2.5 m/sec. Results: Amongst the 73 evaluable patients, those with PH [n=7] had a median age of 32 years with an interquartile range (IQR) of 25.5-34 years, and a prevalence of 9.6%. No statistically significant differences were detected in the haematological parameters, serum blood chemistry and ECG parameters in patients with and without PH. However, in the PH patients, there was an increased plasma NT pro-BNP levels [p<0.006], and serum CRP levels [p<0.003][Mann Whitney U test]. Furthermore, the differences in the indirect bilirubin levels were statistically significant for one tailed comparison [p<0.04, Mann Whitney U test]. The serum NT-pro BNP levels were also significantly correlated with PH[r=0.368, p<0.025]. Conclusions: The median age of PH patients was decade higher with median serum NT-pro BNP levels being two-fold higher and significantly correlated with PH. The significant correlation between serum indirect bilirubin and PH may implicate haemolytic parameters in the pathogenesis of PH.