Cardiovascular Abnormalities and N-terminal pro–B-type natriuretic Levels Among Adolescents and Young Adults with Sickle Cell Disease at Mulago National Referral Hospital in Uganda: A Cross-sectional Study

Background Cardiovascular abnormalities are a leading contributor to morbidity and mortality in people living with sickle cell disease, particularly adolescents and young adults. Elevated N-terminal pro–B–type natriuretic peptide levels are associated with an increased risk of cardiovascular abnormalities related to Sickle Cell Disease. While echocardiography remains the gold standard for cardiac evaluation, the role of N-terminal pro–B–type natriuretic peptide as a potential surrogate biomarker is not well established in low-income countries, such as Uganda. Objective To determine the frequency and spectrum of cardiovascular abnormalities, measure NT-proBNP levels, and assess their associations among adolescents and young adults with SCD at Mulago National Referral Hospital. Methods A hospital-based cross-sectional study was conducted among 60 clinically stable adolescents and young adults (13–30 years) with SCD. Participants underwent NT-proBNP assay, electrocardiography, and transthoracic echocardiography. Associations between NT-proBNP and cardiovascular abnormalities were analyzed using regression models. Results Among 60 participants (56.7% female; median age 15 years, IQR 4), 78.3% had at least one cardiovascular abnormality. The most common findings were T-wave abnormalities (46.7%), left ventricular diastolic dysfunction (31.7%), and probable pulmonary hypertension (11.7%). Left ventricular systolic dysfunction was rare (1.7%). Elevated NT-proBNP (≥ 160 pg/mL) occurred in 8.3% of participants and was not significantly associated with cardiovascular abnormalities. Conclusion Cardiovascular abnormalities are frequent among Ugandan Adolescents and young adults with sickle cell disease. NT-proBNP showed a limited association with echocardiographic or electrocardiographic abnormalities. Larger longitudinal studies are warranted to validate NT-proBNP as a biomarker for early cardiac dysfunction in thispopulation