Electrocardiographic abnormalities among children with sickle cell anaemia at steady state and crises attending federal teaching Hospital, Owerri, South East Nigeria

Abstract

Cardiovascular complications of sickle cell anaemia contribute significantly to the mortality associated with the disease. Some of these complications are obvious on the electrocardiogram. The aim of this study was to determine the electrocardiographic findings of pediatric sickle cell anemia patients in crises and steady states seen at the Federal Teaching Hospital, Owerri, and to compare them with those of healthy genotype AA controls. One hundred thirty-five children aged 2–17 years were consecutively recruited between the 1st of February and the 4th of October, 2023; forty-five children each at steady state and crisis and forty-five Hb AA controls were included. All the patients underwent electrocardiography, and a full blood count was performed. ECG abnormalities were recorded in 33/45 (73.3%) of those in crisis, 22/45 (48.9%) in the steady state, and 17/45 (37.8%) in the control. The most common ECG abnormality recorded for the SCA patients was left ventricular hypertrophy (LVH), characterized by tall RV6, and this was observed more often in those with vaso-occlusive crises (10/45 (55.6%) and 7/45 (38.9%) in hyperhemolytic crises, 1/45 (5.6%) in sequestration crises and only 2/45 (6.7%) in the control, with a p value of 0.001. The mean± SD haemoglobin level was 7.7± 1.5 for the steady state, 6.8 ± 1.6 for the crisis state and 11.7 ±1.1 for the control state. p = 0.001. LVH was observed in 42.3% of those with severe anaemia and in 32.3% of those with moderate anaemia. p=0.388. LVH was observed in 18/45 (40.0%) of the crisis cases and in 13/45 (28.9%) of the steady state cases. p= 0.375. The most common ECG abnormality seen in children with SCA attending Federal University Teaching Hospital Owerri is left ventricular hypertrophy seen in 36.9% of the subjects while left atrial enlargement was the most common ECG finding seen in 32% of the control with left ventricular hypertrophy, bradycardia and Tachycardia statistically significant. The level of anaemia is not statistically related to the ECG findings in SCA. Left Ventricular hypertrophy is more common in SCA age group 14-17yr and there is no gender predilection for the ECG findings of SCA. This may help guide decisions on the need or otherwise of routine ECGs in children with sickle cell anaemia, especially those in crises.