학술논문
Cardiac diastolic maladaptation is associated with the severity of exercise intolerance in sickle cell anemia patients
Document Type
article
Author
Thomas d’Humières; Antoine Bouvarel; Laurent Boyer; Laurent Savale; Henri Guillet; Lara Alassaad; Gonzalo de Luna; Enora Berti; Sihem Iles; Anne Laure Pham Hung d’Alexandry d’Orengiani; Etienne Audureau; Marie-Joelle Troupe; Reine-Claude Schlatter; Anaïs Lamadieu; Frédéric Galactéros; Geneviève Derumeaux; Laurent A. Messonnier; Pablo Bartolucci
Source
Scientific Reports, Vol 14, Iss 1, Pp 1-13 (2024)
Subject
Language
English
ISSN
2045-2322
Abstract
Abstract This pilot study focusing on Sickle Cell Anemia (SCA) patients offers a comprehensive and integrative evaluation of respiratory, cardiovascular, hemodynamic, and metabolic variables during exercise. Knowing that diastolic dysfunction is frequent in this population, we hypothesize that a lack of cardiac adaptation through exercise might lead to premature increase in blood lactate concentrations in SCA patients, a potential trigger for acute disease complication. SCA patients were prospectively included in PHYSIO-EXDRE study and underwent a comprehensive stress test with a standardized incremental exercise protocol up to 4 mmol L−1 blood lactate concentration (BL4). Gas exchange, capillary lactate concentration and echocardiography were performed at baseline, during stress test (at ∼ 2 mmol L−1) and BL4. The population was divided into two groups and compared according to the median value of percentage of theoretical peak oxygen uptake (% $${\dot{\text{V}}\text{O}}_{2peakth}$$ V ˙ O 2 p e a k t h ) at BL4. Twenty-nine patients were included (42 ± 12 years old, 48% of women). Most patients reached BL4 at low-intensity exercise [median value of predicted power output (W) was 37%], which corresponds to daily life activities. The median value of % $${\dot{\text{V}}\text{O}}_{2peakth}$$ V ˙ O 2 p e a k t h at BL4 was 39%. Interestingly, diastolic maladaptation using echocardiography during stress test along with hemoglobin concentration were independently associated to early occurrence of BL4. As BL4 occurs for low-intensity exercises, SCA patients may be subject to acidosis-related complications even during their daily life activities. Beyond assessing physical capacities, our study underlines that diastolic maladaptation during exercise is associated with an early increase in blood lactate concentration.