Cardiomyopathy and elevated troponin in sickle cell disease

To highlight troponin elevation associated with non-coronary causes during hemolytic crises in patients with sickle cell disease (SCD), examine the impact of these crises on cardiac function, and determine the prevalence of cardiomyopathy and valvular abnormalities during stable periods. This retrospective study included 41 patients with SCD who presented to the emergency department with hemolytic crises between May 18, 2023, and July 30, 2024. Transthoracic echocardiography (TTE) was performed during the emergency visit and repeated at the 1-month outpatient follow-up. TTE assessments included left ventricular ejection fraction (EF), the presence of dilated cardiomyopathy (DCM), valvular pathologies, and cardiac chamber dimensions. DCM was defined as an EF <40% with left ventricular dilatation. Blood tests during hemolytic crises measured troponin T, creatine kinase-MB, and other laboratory markers. The median age of the patients was 32 years (range: 18–68), and 92.7% had positive troponin T levels. Tricuspid regurgitation was detected in 45% of patients, mitral regurgitation in 30%, aortic regurgitation in 2.5%, and left ventricular dilatation in 47.5%. DCM was identified in 6 patients (15%). Coronary computed tomography angiography performed in patients with DCM revealed no coronary obstruction. Among 5 patients with chest pain, invasive coronary angiography showed no evidence of coronary artery disease. Pulmonary hypertension was diagnosed in 61.1% of patients with tricuspid regurgitation. Cardiac changes observed during hemolytic crises in SCD patients are likely due to chronic processes. The development of left ventricular dilatation and DCM in this population necessitates investigation of non-SCD-related causes. Troponin positivity and valvular pathologies underscore the need for close monitoring and comprehensive management in these patients.