Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 15;14(1):11095.
doi: 10.1038/s41598-024-61689-w.

Cardiac diastolic maladaptation is associated with the severity of exercise intolerance in sickle cell anemia patients

Thomas d'Humières #  1   2   3 , Antoine Bouvarel #  4   5 , Laurent Boyer  4   5 , Laurent Savale  6   7   8 , Henri Guillet  9   10 , Lara Alassaad  4   5 , Gonzalo de Luna  9   10 , Enora Berti  4   5 , Sihem Iles  4   5 , Anne Laure Pham Hung d'Alexandry d'Orengiani  10 , Etienne Audureau  11   12 , Marie-Joelle Troupe  4   5 , Reine-Claude Schlatter  4   5 , Anaïs Lamadieu  4   5 , Frédéric Galactéros  9   10 , Geneviève Derumeaux  4   5 , Laurent A Messonnier #  13 , Pablo Bartolucci #  9   10
Affiliations

Cardiac diastolic maladaptation is associated with the severity of exercise intolerance in sickle cell anemia patients

Thomas d'Humières et al. Sci Rep. .

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 (% 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 % 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.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Experimental protocol.
Figure 2
Figure 2
Blood lactate concentration vs. exercise load curves. Each curve represents a patient. The effort load is expressed in % of the maximum theoretical value.
Figure 3
Figure 3
Representative example of physiological (Patient 1) vs. maladaptive (Patient 2) diastolic adaptation during exercise.
See this image and copyright information in PMC

References

    1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet(London,England). 388(10053), 1545–1602 (2016). - PMC - PubMed
    1. Gellen B, Messonnier LA, Galactéros F, Audureau E, Merlet AN, Rupp T, et al. Moderate-intensity endurance-exercise training in patients with sickle-cell disease without severe chronic complications (EXDRE): An open-label randomised controlled trial. Lancet Haematol. 2018;5(11):e554–e562. doi: 10.1016/S2352-3026(18)30163-7. - DOI - PubMed
    1. Halphen I, Elie C, Brousse V, Le Bourgeois M, Allali S, Bonnet D, et al. Severe nocturnal and postexercise hypoxia in children and adolescents with sickle cell disease. PLoS ONE. 2014;9(5):e97462. doi: 10.1371/journal.pone.0097462. - DOI - PMC - PubMed
    1. Moheeb H, Wali YA, El-Sayed MS. Physical fitness indices and anthropometrics profiles in schoolchildren with sickle cell trait/disease. Am. J. Hematol. 2007;82(2):91–97. doi: 10.1002/ajh.20755. - DOI - PubMed
    1. Messonnier LA, Bartolucci P, d’Humières T, Dalmais E, Lacour JR, Freund H, et al. Preventive measures for the critical postexercise period in sickle cell trait and disease. J. Appl. Physiol. 2021;130(2):485–490. doi: 10.1152/japplphysiol.00855.2020. - DOI - PubMed