- Many young adults with sickle cell show early signs of heart strain
- Helps explain why some feel tired or short of breath
- Not a new treatment — but a vital screening clue for clinics now
This could change how doctors check heart health in sickle cell patients.
You’re 24 years old. You manage your sickle cell disease with regular care. But lately, you’ve been more tired than usual. Climbing stairs leaves you winded. Your doctor checks your lungs, your blood — everything seems okay. But what if the answer isn’t in your blood vessels… but in your heart?
That’s what researchers in Colombia started asking. And what they found could help thousands of young adults with sickle cell who feel unwell — even when tests look normal.
Sickle cell disease affects millions worldwide. It changes red blood cells into rigid, C-shaped “sickles.” These cells get stuck, causing pain, organ damage, and fatigue. Most people know it for painful crises. But there’s another danger — one that builds quietly: heart stress.
Over time, the heart works harder. Blood flows poorly. Oxygen drops. One serious result? Pulmonary hypertension — high blood pressure in the lungs. It’s deadly if missed. Yet symptoms like shortness of breath are often blamed on anemia or deconditioning.
In wealthier countries, doctors use echocardiograms (heart ultrasounds) to catch early signs. But in many low- and middle-income regions, these scans aren’t routine. Some believe they’re too costly or complex. So patients go unmonitored — until it’s too late.
The hidden strain
For years, experts thought heart damage in sickle cell only happened later in life. Older patients? Yes. Young adults in their 20s? Unlikely.
But here’s the twist: this study shows that even young, stable patients can have warning signs — especially in the right side of the heart.
Researchers looked at 57 adults with sickle cell in Cali, Colombia. All were over 18. Most were in their mid-20s. They weren’t in crisis. They were being followed regularly. Yet nearly 30% had tricuspid regurgitation velocity over 2.5 m/s — a red flag for possible lung pressure issues.
Even more striking: 1 in 10 had values over 3.0 m/s — a level linked to higher risk of pulmonary hypertension.
That’s not supposed to happen in young, stable patients. But it is.
How the heart gets stressed
Think of your lungs like a delicate network of straws. Blood flows through them easily when they’re open and flexible.
But in sickle cell, damaged red blood cells clog tiny vessels. It’s like pouring thick sludge through a straw. The heart has to push harder to get blood through.
Over time, the right ventricle — the chamber that pumps blood to the lungs — thickens and strains. It’s like a car engine revving nonstop on a steep hill.
Eventually, this leads to pulmonary hypertension. And once it sets in, it’s hard to reverse.
But here’s the good news: if you catch it early, you can slow it down.
The team reviewed medical records and echocardiograms from a single clinic in Colombia. All patients had confirmed sickle cell disease. Most had the severe SS genotype. About 70% were taking hydroxyurea, a common medication.
They excluded people with other heart diseases, pregnancy, or poor-quality scans. The final group? 57 adults — young, relatively healthy, and under routine care.
Most patients had normal heart size and strong pumping function — good news. The left side of the heart, which sends blood to the body, looked healthy in most.
But the right side told a different story.
Nearly 30% had elevated tricuspid regurgitation velocity — a key marker for possible pulmonary hypertension. That’s higher than expected in such a young group.
Also, about half had some form of abnormal heart structure:
- 24.6% had concentric remodelling (heart walls thickening)
- 21.1% had concentric hypertrophy (thicker walls, smaller chamber)
- 12.3% had eccentric hypertrophy (enlarged chamber)
These changes mean the heart is adapting to stress — even if the patient feels fine.
NT-proBNP, a blood marker for heart strain, was also elevated in many. This supports the echo findings.
This doesn’t mean this treatment is available yet.
But there’s a catch
The study was small — just 57 patients. And it was done at one center in Colombia. Results might differ in other regions.
Also, echocardiography isn’t perfect. Tricuspid regurgitation velocity can vary. The best way to confirm pulmonary hypertension is right heart catheterization — an invasive test not used here.
So while the findings raise concern, they don’t prove these patients have full-blown pulmonary hypertension. They show risk — not diagnosis.
Still, in places where advanced tests aren’t available, echo may be the best tool we have.
Why this changes things
Experts say this study highlights a blind spot. In many parts of the world, heart screening in sickle cell is not routine. Doctors focus on pain, infections, and blood counts.
But heart strain can be silent. By the time symptoms appear, damage may already be advanced.
This research suggests that even young, stable patients should get regular heart ultrasounds — especially in regions where sickle cell is common but resources are limited.
Echo machines are becoming more portable and affordable. Training staff to use them is possible. And catching heart strain early could prevent deaths.
If you or a loved one has sickle cell, this isn’t a reason to panic. But it is a reason to talk to your doctor about heart health.
Ask: Have I had an echocardiogram? What did it show? Was my lung pressure checked?
It may not be standard everywhere — but this study suggests it should be.
And if you live in a region with limited access, share this research with your care team. It supports making heart screening part of routine care.
The study’s limits
Only 57 patients were included. That’s small. Many people were excluded — so results may not reflect all sickle cell patients.
Also, no follow-up data. We don’t know how many of these patients will develop actual pulmonary hypertension.
And since it’s a single-center study, findings may not apply everywhere.
More research is needed — especially long-term studies tracking patients over time. Can early echo findings predict future heart problems? Can treatment prevent them?
But for now, this study makes a strong case: even young adults with sickle cell need heart checkups. And in places where high-tech tools aren’t available, a simple ultrasound may be one of the best ways to protect lives.