Cardiovascular phenotypes predict clinical outcomes in sickle cell disease: An echocardiography‐based cluster analysis

d’Humières, Thomas; Savale, Laurent; Inamo, Jocelyn; Deux, Jean-François; Deswarte, S.; Lionnet, François; Loko, Gylna; Chantalat, Christelle; Damy, Thibaud; Guillet, Henri; d'Orengiani, Anne Laure Pham Hung d'Alexandry; Galactéros, Frédéric; Audureau, Étienne; Maître, Bernard; Humbert, Marc; Dérumeaux, Geneviève; Bartolucci, Pablo

doi:10.1002/ajh.26271

Cited by 10 publications

(6 citation statements)

References 43 publications

(59 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our data extend previous reports on an independent association between E/e′ at rest and % VO 2peakth or 6-min walk distance in SCA patients, suggestive of existing atrial cardiomyopathy 13,18,20 . However, we did not find such discriminant abnormalities on resting echocardiography, highlighting the challenge of diagnosing diastolic dysfunction in resting conditions in SCA population 15,16 . Thus, our results suggest that diastolic stress test during sub-maximal exercise is a valuable and safe tool in the early detection of subtle cardiac impairment in SCA patients.…”

Section: Stress-induced Diastolic Dysfunction Is Associated With Poor...contrasting

confidence: 78%

“…Indeed, cardiovascular abnormalities at rest, such as pulmonary hypertension (PH) and diastolic dysfunction, have been identified as the leading cause of mortality and impaired quality of life in SCA patients [10][11][12][13][14] . These disorders rely on complex mechanisms associating chronic anemia, hemolysis-induced vasculopathy and repeated vaso-occlusive episodes, contributing to a maladaptive cardiovascular remodeling [15][16][17] . While the diagnosis of cardiac dysfunction is extremely challenging considering the unique hemodynamic features of SCA, recent studies have reported the potential interest of investigating cardiovascular adaptation during exercise, to dynamically unmask latent heart dysfunction and its association with exercise limitation [18][19][20] .…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

d’Humières,

Bouvarel,

Boyer

et al. 2024

Sci Rep

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Stress-induced Diastolic Dysfunction Is Associated With Poor...contrasting

confidence: 78%

mentioning

confidence: 99%

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

d’Humières,

Bouvarel,

Boyer

et al. 2024

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…Currently, data-driven unsupervised clustering is more widely used in the medical field, for example, in electronic medical records [44,45], medical decision making [46,47], and medical image analysis [8,9,48]. Additionally, several digital pathology studies have adopted unsupervised clustering to represent various features [49][50][51][52].…”

Section: Discussionmentioning

confidence: 99%

“…Supervised learning as a mainstay has been leveraged to improve disease diagnosis and has achieved substantial advancements by taking advantage of hand-crafted pathomics features [4], end-to-end deep learning [5,6], or a combination of such approaches [7]. Unsupervised learning is increasingly employed as a knowledge discovery approach to find meaningful intrinsic patterns in data, complementing supervised learning and enhancing biomedical image diagnostic performance [8,9]. However, few studies have explored the potential role of machine learning algorithms in evaluating lymphomas [10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Chronic Lymphocytic Leukemia Progression Diagnosis with Intrinsic Cellular Patterns via Unsupervised Clustering

Chen

Hussein

Xing

et al. 2022

Cancers

View full text Add to dashboard Cite

Identifying the progression of chronic lymphocytic leukemia (CLL) to accelerated CLL (aCLL) or transformation to diffuse large B-cell lymphoma (Richter transformation; RT) has significant clinical implications as it prompts a major change in patient management. However, the differentiation between these disease phases may be challenging in routine practice. Unsupervised learning has gained increased attention because of its substantial potential in data intrinsic pattern discovery. Here, we demonstrate that cellular feature engineering, identifying cellular phenotypes via unsupervised clustering, provides the most robust analytic performance in analyzing digitized pathology slides (accuracy = 0.925, AUC = 0.978) when compared to alternative approaches, such as mixed features, supervised features, unsupervised/mixed/supervised feature fusion and selection, as well as patch-based convolutional neural network (CNN) feature extraction. We further validate the reproducibility and robustness of unsupervised feature extraction via stability and repeated splitting analysis, supporting its utility as a diagnostic aid in identifying CLL patients with histologic evidence of disease progression. The outcome of this study serves as proof of principle using an unsupervised machine learning scheme to enhance the diagnostic accuracy of the heterogeneous histology patterns that pathologists might not easily see.

show abstract

“…It is important to keep in mind that the present results have been obtained in patients without systemic complications, at steady state (see supplemental) and particularly without cardiovascular impairment. Indeed, cardiovascular complications are one of the leading causes of functional impairment and mortality in SCD [52][53][54] . Therefore, our results cannot be extended to more severe populations, requiring dedicated trials currently underway.…”

Section: Experimental Considerations and Future Directionsmentioning

confidence: 99%

Endurance training improves oxygen uptake/demand mismatch, metabolic flexibility and recovery in patients with sickle cell disease

Mougin,

Riccetti,

Merlet

et al. 2024

haematol

Self Cite

View full text Add to dashboard Cite

Patients with sickle cell disease (SCD) display lower slope coefficients of the oxygen uptake (V_O2) vs. work rate (W) relationship (delineating an O2 uptake/demand mismatch) and a poor metabolic flexibility. Because endurance training (ET) increases the microvascular network and oxidative enzymes activity including one involved in lipid oxidation, ET might improve the slope coefficient of the V_O2 vs. W curve and the metabolic flexibility of SCD patients. ET may also contribute to improve patient post-exercise cardiopulmonary and metabolic recovery. Fifteen patients with SCD performed a submaximal incremental test on a cycle ergometer before (SIT1) and after (SIT2) 8 weeks of ET. Minute ventilation, ventilation rate (VR), heart rate (HR), V_O2, CO2 production, respiratory exchange ratio, carbohydrate/lipid utilization and partitioning (including %Lipidox) and blood lactate concentration ([lactate]b) were measured during and after SIT1 and SIT2. At baseline, the slope coefficient of the V_O2 vs. W curve positively correlated with total hemoglobin, mean corpuscular hemoglobin and percentage of HbF. After training, the slope coefficient of the V_O2 vs. W curve was significantly higher and the [lactate]b increase was delayed. If patients’ energy metabolism apparently relied largely on carbohydrate sources during SIT1, %Lipidox tended to increase at low exercise intensities during SIT2, supporting a training-induced improvement of metabolic flexibility in patients with SCD. Post-exercise recovery of VR, V_E/V_CO2, HR and [lactate]b was faster after training. We concluded that ET in patients with SCD i) ameliorated the oxygen uptake/demand mismatch, ii) blunted the metabolic inflexibility, and iii) improved post-exercise cardiopulmonary and metabolic responses.

show abstract

Cardiovascular phenotypes predict clinical outcomes in sickle cell disease: An echocardiography‐based cluster analysis

Cited by 10 publications

References 43 publications

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

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

Chronic Lymphocytic Leukemia Progression Diagnosis with Intrinsic Cellular Patterns via Unsupervised Clustering

Endurance training improves oxygen uptake/demand mismatch, metabolic flexibility and recovery in patients with sickle cell disease

Contact Info

Product

Resources

About