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Vijapurapu R, Geberhiwot T, Jovanovic A, Baig S, Nordin S, Kozor R, Leyva F, Kotecha D, Wheeldon N, Deegan P, Rusk RA, Moon JC, Hughes DA, Woolfson P, Steeds RP. Study of indications for cardiac device implantation and utilisation in Fabry cardiomyopathy. Heart 2019; 105:1825-1831. [PMID: 31446426 PMCID: PMC6900228 DOI: 10.1136/heartjnl-2019-315229] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/25/2019] [Accepted: 07/03/2019] [Indexed: 12/11/2022] Open
Abstract
Background Fabry disease is a treatable X-linked condition leading to progressive cardiomyopathy, arrhythmia and premature death. Atrial and ventricular arrhythmias contribute significantly to adverse prognosis; however, guidance to determine which patients require cardiovascular implantable electronic devices (CIEDs) is sparse. We aimed to evaluate indications for implantation practice in the UK and quantify device utilisation. Methods In this retrospective study, we included demographic, clinical and imaging data from patients in four of the largest UK Fabry centres. Ninety patients with Fabry disease were identified with CIEDs implanted between June 2001 and February 2018 (FD-CIED group). To investigate differences in clinical and imaging markers between those with and without devices, these patients were compared with 276 patients without a CIED (FD-control). Results In the FD-CIED group, 92% of patients with permanent pacemakers but only 28% with implantable cardioverter-defibrillators had a class 1 indication for implantation. A further 44% of patients had defibrillators inserted for primary prevention outside of current guidance. The burden of arrhythmia requiring treatment in the FD-CIED group was high (asymptomatic atrial fibrillation: 29%; non-sustained ventricular tachycardia requiring medical therapy alone: 26%; sustained ventricular tachycardia needing anti-tachycardia pacing/defibrillation: 28%). Those with devices were older, had greater LV mass, more scar tissue and larger atrial size. Conclusions Arrhythmias are common in Fabry patients. Those with cardiac devices had high rates of atrial fibrillation requiring anticoagulation and ventricular arrhythmia needing device treatment. These are as high as those in hypertrophic cardiomyopathy, supporting the need for Fabry-specific indications for device implantation.
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Affiliation(s)
- Ravi Vijapurapu
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Tarekegn Geberhiwot
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham, UK .,Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK
| | - Ana Jovanovic
- Mark Holland Metabolic Unit, Salford Royal Hospitals NHS Trust, Salford, UK
| | - Shanat Baig
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sabrina Nordin
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Rebecca Kozor
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Francisco Leyva
- Aston Medical Research Institute, Aston Medical School, Birmingham, UK
| | - Dipak Kotecha
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Nigel Wheeldon
- South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK
| | - Patrick Deegan
- Department of Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rosemary A Rusk
- Department of Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James C Moon
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Derralynn A Hughes
- Lysosomal Storage Disorder Unit, Royal Free London NHS Foundation Trust, London, UK
| | - Peter Woolfson
- Department of Cardiology, Salford Royal Hospitals NHS Trust, Salford, UK
| | - Richard P Steeds
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Kotecha T, Martinez-Naharro A, Treibel TA, Francis R, Nordin S, Abdel-Gadir A, Knight DS, Zumbo G, Rosmini S, Maestrini V, Bulluck H, Rakhit RD, Wechalekar AD, Gilbertson J, Sheppard MN, Kellman P, Gillmore JD, Moon JC, Hawkins PN, Fontana M. Myocardial Edema and Prognosis in Amyloidosis. J Am Coll Cardiol 2019; 71:2919-2931. [PMID: 29929616 DOI: 10.1016/j.jacc.2018.03.536] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/26/2018] [Accepted: 03/26/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prognosis in light-chain (AL) and transthyretin (ATTR) amyloidosis is influenced by cardiac involvement. ATTR amyloidosis has better prognosis than AL amyloidosis despite more amyloid infiltration, suggesting additional mechanisms of damage in AL amyloidosis. OBJECTIVES The aim of the study was to assess the presence and prognostic significance of myocardial edema in patients with amyloidosis. METHODS The study recruited 286 patients: 100 with systemic AL amyloidosis, 163 with cardiac ATTR amyloidosis, 12 with suspected cardiac ATTR amyloidosis (grade 1 on 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid), 11 asymptomatic individuals with amyloidogenic TTR gene mutations, and 30 healthy volunteers. All subjects underwent cardiovascular magnetic resonance with T1 and T2 mapping and 16 underwent endomyocardial biopsy. RESULTS Myocardial T2 was increased in amyloidosis with the degree of elevation being highest in untreated AL patients (untreated AL amyloidosis 56.6 ± 5.1 ms; treated AL amyloidosis 53.6 ± 3.9 ms; ATTR amyloidosis 54.2 ± 4.1 ms; each p < 0.01 compared with control subjects: 48.9 ± 2.0 ms). Left ventricular (LV) mass and extracellular volume fraction were higher in ATTR amyloidosis compared with AL amyloidosis while LV ejection fraction was lower (p < 0.001). Histological evidence of edema was present in 87.5% of biopsy samples ranging from 5% to 40% myocardial involvement. Using Cox regression models, myocardial T2 predicted death in AL amyloidosis (hazard ratio: 1.48; 95% confidence interval: 1.20 to 1.82) and remained significant after adjusting for extracellular volume fraction and N-terminal pro-B-type natriuretic peptide (hazard ratio: 1.32; 95% confidence interval: 1.05 to 1.67). CONCLUSIONS Myocardial edema is present in cardiac amyloidosis by histology and cardiovascular magnetic resonance T2 mapping. T2 is higher in untreated AL amyloidosis compared with treated AL and ATTR amyloidosis, and is a predictor of prognosis in AL amyloidosis. This suggests mechanisms additional to amyloid infiltration contributing to mortality in amyloidosis.
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Affiliation(s)
- Tushar Kotecha
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom; Royal Free Hospital, London, United Kingdom
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, London, United Kingdom
| | - Rohin Francis
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Sabrina Nordin
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, London, United Kingdom
| | - Amna Abdel-Gadir
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, London, United Kingdom
| | - Daniel S Knight
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom; Royal Free Hospital, London, United Kingdom
| | - Giulia Zumbo
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | | | - Viviana Maestrini
- Barts Heart Centre, London, United Kingdom; Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology & Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Heerajnarain Bulluck
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Roby D Rakhit
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Royal Free Hospital, London, United Kingdom
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom; Royal Free Hospital, London, United Kingdom
| | - Janet Gilbertson
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Mary N Sheppard
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, United Kingdom
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom; Royal Free Hospital, London, United Kingdom
| | | | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom; Royal Free Hospital, London, United Kingdom
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom; Royal Free Hospital, London, United Kingdom.
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Nordin S, Kozor R, Baig S, Abdel-Gadir A, Medina-Menacho K, Rosmini S, Captur G, Tchan M, Geberhiwot T, Murphy E, Lachmann R, Ramaswami U, Edwards NC, Hughes D, Steeds RP, Moon JC. Cardiac Phenotype of Prehypertrophic Fabry Disease. Circ Cardiovasc Imaging 2019; 11:e007168. [PMID: 29853467 PMCID: PMC6023585 DOI: 10.1161/circimaging.117.007168] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fabry disease (FD) is a rare and treatable X-linked lysosomal storage disorder. Cardiac involvement determines outcomes; therefore, detecting early changes is important. Native T1 by cardiovascular magnetic resonance is low, reflecting sphingolipid storage. Early phenotype development is familiar in hypertrophic cardiomyopathy but unexplored in FD. We explored the prehypertrophic cardiac phenotype of FD and the role of storage. METHODS AND RESULTS A prospective, international multicenter observational study of 100 left ventricular hypertrophy-negative FD patients (mean age: 39±15 years; 19% male) and 35 age- and sex-matched healthy volunteers (mean age: 40±14 years; 25% male) who underwent cardiovascular magnetic resonance, including native T1 and late gadolinium enhancement, and 12-lead ECG. In FD, 41% had a low native T1 using a single septal region of interest, but this increased to 59% using a second slice because early native T1 lowering was patchy. ECG abnormalities were present in 41% and twice as common with low native T1 (53% versus 24%; P=0.005). When native T1 was low, left ventricular maximum wall thickness, indexed mass, and ejection fraction were higher (maximum wall thickness 9±1.5 versus 8±1.4 mm, P<0.005; indexed left ventricular mass 63±10 versus 58±9 g/m2, P<0.05; and left ventricular ejection fraction 73±8% versus 69±7%, P<0.01). Late gadolinium enhancement was more likely when native T1 was low (27% versus 6%; P=0.01). FD had higher maximal apical fractal dimensions compared with healthy volunteers (1.27±0.06 versus 1.24±0.04; P<0.005) and longer anterior mitral valve leaflets (23±2 mm versus 21±3 mm; P<0.005). CONCLUSIONS There is a detectable prehypertrophic phenotype in FD consisting of storage (low native T1), structural, functional, and ECG changes.
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Affiliation(s)
- Sabrina Nordin
- Cardiology Department, Barts Heart Centre, London, United Kingdom (S.N., A.A.-G., K.M.-M., S.R., G.C., J.C.M.).,Institute of Cardiovascular Science, University College London, United Kingdom (S.N., A.A.-G., K.M.-M., G.C., J.C.M.)
| | - Rebecca Kozor
- Sydney Medical School, University of Sydney, Australia (R.K.)
| | - Shanat Baig
- Cardiology Department (S.B., N.C.E., R.P.S.)
| | - Amna Abdel-Gadir
- Cardiology Department, Barts Heart Centre, London, United Kingdom (S.N., A.A.-G., K.M.-M., S.R., G.C., J.C.M.).,Institute of Cardiovascular Science, University College London, United Kingdom (S.N., A.A.-G., K.M.-M., G.C., J.C.M.)
| | - Katia Medina-Menacho
- Cardiology Department, Barts Heart Centre, London, United Kingdom (S.N., A.A.-G., K.M.-M., S.R., G.C., J.C.M.).,Institute of Cardiovascular Science, University College London, United Kingdom (S.N., A.A.-G., K.M.-M., G.C., J.C.M.)
| | - Stefania Rosmini
- Cardiology Department, Barts Heart Centre, London, United Kingdom (S.N., A.A.-G., K.M.-M., S.R., G.C., J.C.M.)
| | - Gabriella Captur
- Cardiology Department, Barts Heart Centre, London, United Kingdom (S.N., A.A.-G., K.M.-M., S.R., G.C., J.C.M.).,Institute of Cardiovascular Science, University College London, United Kingdom (S.N., A.A.-G., K.M.-M., G.C., J.C.M.)
| | - Michel Tchan
- Department of Genetic Medicine, Westmead Hospital, Australia (M.T.)
| | - Tarekegn Geberhiwot
- Inherited Metabolic Disorders Unit (T.H.), University Hospitals Birmingham, United Kingdom
| | - Elaine Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, United Kingdom (E.M., R.L.)
| | - Robin Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, United Kingdom (E.M., R.L.)
| | - Uma Ramaswami
- Lysosomal Storage Disorder Unit, Royal Free Hospital, London, United Kingdom (U.R., D.H.)
| | | | - Derralynn Hughes
- Lysosomal Storage Disorder Unit, Royal Free Hospital, London, United Kingdom (U.R., D.H.)
| | | | - James C Moon
- Cardiology Department, Barts Heart Centre, London, United Kingdom (S.N., A.A.-G., K.M.-M., S.R., G.C., J.C.M.). .,Institute of Cardiovascular Science, University College London, United Kingdom (S.N., A.A.-G., K.M.-M., G.C., J.C.M.)
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54
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Nordin S, Kozor R, Medina-Menacho K, Abdel-Gadir A, Baig S, Sado DM, Lobascio I, Murphy E, Lachmann RH, Mehta A, Edwards NC, Ramaswami U, Steeds RP, Hughes D, Moon JC. Proposed Stages of Myocardial Phenotype Development in Fabry Disease. JACC Cardiovasc Imaging 2019; 12:1673-1683. [DOI: 10.1016/j.jcmg.2018.03.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/11/2018] [Accepted: 03/30/2018] [Indexed: 11/25/2022]
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Knott KD, Augusto JB, Nordin S, Kozor R, Camaioni C, Xue H, Hughes RK, Manisty C, Brown LAE, Kellman P, Ramaswami U, Hughes D, Plein S, Moon JC. Quantitative Myocardial Perfusion in Fabry Disease. Circ Cardiovasc Imaging 2019; 12:e008872. [PMID: 31269811 DOI: 10.1161/circimaging.119.008872] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fabry disease (FD) is an X-linked lysosomal storage disease resulting in tissue accumulation of sphingolipids. Key myocardial processes that lead to adverse outcomes in FD include storage, hypertrophy, inflammation, and fibrosis. These are quantifiable by multiparametric cardiovascular magnetic resonance. Recent developments in cardiovascular magnetic resonance perfusion mapping allow rapid in-line perfusion quantification permitting broader clinical application, including the assessment of microvascular dysfunction. We hypothesized that microvascular dysfunction in FD would be associated with storage, fibrosis, and edema. METHODS A prospective, observational study of 44 FD patients (49 years, 43% male, 24 [55%] with left ventricular hypertrophy [LVH]) and 27 healthy controls with multiparametric cardiovascular magnetic resonance including vasodilator stress perfusion mapping. Myocardial blood flow (MBF) was measured and its associations with other processes investigated. RESULTS Compared with LVH- FD, LVH+ FD had higher left ventricular ejection fraction (73% versus 68%), more late gadolinium enhancement (85% versus 15%), and a lower stress MBF (1.76 versus 2.36 mL/g per minute). The reduction in stress MBF was more pronounced in the subendocardium than subepicardium. LVH- FD had lower stress MBF than controls (2.36 versus 3.00 mL/g per minute; P=0.002). Across all FD, late gadolinium enhancement and low native T1 were independently associated with reduced stress MBF. On a per-segment basis, stress MBF was independently associated with wall thickness, T2, extracellular volume fraction, and late gadolinium enhancement. CONCLUSIONS FD patients have reduced perfusion, particularly in the subendocardium with greater reductions with LVH, storage, edema, and scar. Perfusion is reduced even without LVH suggesting it is an early disease marker.
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Affiliation(s)
- Kristopher D Knott
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., J.B.A., S.N., R.K.H., C.M., J.C.M.).,Advanced Cardiac Imaging, Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (K.D.K., J.B.A., S.N., C.C., R.K.H., C.M., J.C.M.)
| | - Joao B Augusto
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., J.B.A., S.N., R.K.H., C.M., J.C.M.).,Advanced Cardiac Imaging, Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (K.D.K., J.B.A., S.N., C.C., R.K.H., C.M., J.C.M.)
| | - Sabrina Nordin
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., J.B.A., S.N., R.K.H., C.M., J.C.M.).,Advanced Cardiac Imaging, Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (K.D.K., J.B.A., S.N., C.C., R.K.H., C.M., J.C.M.)
| | - Rebecca Kozor
- Sydney Medical School, University of Sydney, Australia (R.K.)
| | - Claudia Camaioni
- Advanced Cardiac Imaging, Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (K.D.K., J.B.A., S.N., C.C., R.K.H., C.M., J.C.M.)
| | - Hui Xue
- Medical Signal and Image Processing, National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD (H.X., P.K.)
| | - Rebecca K Hughes
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., J.B.A., S.N., R.K.H., C.M., J.C.M.).,Advanced Cardiac Imaging, Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (K.D.K., J.B.A., S.N., C.C., R.K.H., C.M., J.C.M.)
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., J.B.A., S.N., R.K.H., C.M., J.C.M.).,Advanced Cardiac Imaging, Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (K.D.K., J.B.A., S.N., C.C., R.K.H., C.M., J.C.M.)
| | - Louise A E Brown
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, United Kingdom (L.A.E.B., S.P.)
| | - Peter Kellman
- Medical Signal and Image Processing, National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD (H.X., P.K.)
| | - Uma Ramaswami
- Lysosomal Storage Disorder Unit, Royal Free Hospital, London, United Kingdom (U.R., D.H.)
| | - Derralyn Hughes
- Lysosomal Storage Disorder Unit, Royal Free Hospital, London, United Kingdom (U.R., D.H.)
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, United Kingdom (L.A.E.B., S.P.)
| | - James C Moon
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., J.B.A., S.N., R.K.H., C.M., J.C.M.).,Advanced Cardiac Imaging, Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (K.D.K., J.B.A., S.N., C.C., R.K.H., C.M., J.C.M.)
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Spinelli L, Imbriaco M, Nappi C, Nicolai E, Giugliano G, Ponsiglione A, Diomiaiuti TC, Riccio E, Duro G, Pisani A, Trimarco B, Cuocolo A. Early Cardiac Involvement Affects Left Ventricular Longitudinal Function in Females Carrying α-Galactosidase A Mutation: Role of Hybrid Positron Emission Tomography and Magnetic Resonance Imaging and Speckle-Tracking Echocardiography. Circ Cardiovasc Imaging 2019; 11:e007019. [PMID: 29626078 DOI: 10.1161/circimaging.117.007019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/06/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hybrid 18F-fluorodeoxyglucose (FDG) positron emission tomography and magnetic resonance imaging may differentiate mature fibrosis or scar from fibrosis associated to active inflammation in patients with Anderson-Fabry disease, even in nonhypertrophic stage. This study was designed to compare the results of positron emission tomography and magnetic resonance cardiac imaging with those of speckle-tracking echocardiography in heterozygous Anderson-Fabry disease females. METHODS AND RESULTS Twenty-four heterozygous females carrying α-galactosidase A mutation and without left ventricular hypertrophy underwent cardiac positron emission tomography and magnetic resonance using 18F-FDG for glucose uptake and 2-dimensional strain echocardiography. 18F-FDG myocardial uptake was quantified by measuring the coefficient of variation (COV) of the standardized uptake value using a 17-segment model. Focal 18F-FDG uptake with COV >0.17 was detected in 13 patients, including 2 patients with late gadolinium enhancement at magnetic resonance. COV was 0.30±0.14 in patients with focal 18F-FDG uptake and 0.12±0.03 in those without (P<0.001). Strain echocardiography revealed worse global longitudinal systolic strain in patients with COV >0.17 compared with those with COV ≤0.17 (-18.5±2.7% versus -22.2±1.8%; P=0.024). For predicting COV >0.17, a global longitudinal strain >-19.8% had 77% sensitivity and 91% specificity and a value >2 dysfunctional segments 92% sensitivity and 100% specificity. CONCLUSIONS In females carrying α-galactosidase A mutation, focal 18F-FDG uptake represents an early sign of disease-related myocardial damage and is associated with impaired left ventricular longitudinal function. These findings support the hypothesis that inflammation plays an important role in glycosphingolipids storage disorders.
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Affiliation(s)
- Letizia Spinelli
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.).
| | - Massimo Imbriaco
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Carmela Nappi
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Emanuele Nicolai
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Giuseppe Giugliano
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Andrea Ponsiglione
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Tommaso Claudio Diomiaiuti
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Eleonora Riccio
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Giovanni Duro
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Antonio Pisani
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Bruno Trimarco
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Alberto Cuocolo
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
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57
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Baig S, Edward NC, Kotecha D, Liu B, Nordin S, Kozor R, Moon JC, Geberhiwot T, Steeds RP. Ventricular arrhythmia and sudden cardiac death in Fabry disease: a systematic review of risk factors in clinical practice. Europace 2019; 20:f153-f161. [PMID: 29045633 DOI: 10.1093/europace/eux261] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/10/2017] [Indexed: 01/08/2023] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by deficiency of α-galactosidase A enzyme. Cardiovascular (CV) disease is a common cause of mortality in FD, in particular as a result of heart failure and arrhythmia, with a significant proportion of events categorized as sudden. There are no clear models for risk prediction in FD. This systematic review aims to identify the risk factors for ventricular arrhythmia (VA) and sudden cardiac deaths (SCD) in FD. A systematic search was performed following PRISMA guidelines of EMBASE, Medline, PubMed, Web of Science, and Cochrane from inception to August 2016, focusing on identification of risk factors for the development of VA or SCD. Thirteen studies were included in the review (n = 4185 patients) from 1189 articles, with follow-up of 1.2-10 years. Weighted average age was 37.6 years, and 50% were male. Death from any cause was reported in 8.3%. Of these, 75% was due to CV problems, with the majority being SCD events (62% of reported deaths). Ventricular tachycardia was reported in 7 studies, with an average prevalence of 15.3%. Risk factors associated with SCD events were age, male gender, left ventricular hypertrophy, late gadolinium enhancement on CV magnetic resonance imaging, and non-sustained ventricular tachycardia. Although a multi-system disease, FD is a predominantly cardiac disease from a mortality perspective, with death mainly from SCD events. Limited evidence highlights the importance of clinical and imaging risk factors that could contribute to improved decision-making in the management of FD.
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Affiliation(s)
- Shanat Baig
- Department of Cardiology, First Floor, Nuffield House, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Nicky C Edward
- Department of Cardiology, First Floor, Nuffield House, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Dipak Kotecha
- Department of Cardiology, First Floor, Nuffield House, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Boyang Liu
- Department of Cardiology, First Floor, Nuffield House, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Sabrina Nordin
- Barts Heart Centre, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Rebecca Kozor
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - James C Moon
- Barts Heart Centre, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Tarekegn Geberhiwot
- Centre for Rare Diseases, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Richard P Steeds
- Department of Cardiology, First Floor, Nuffield House, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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58
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Vijapurapu R, Kozor R, Hughes DA, Woolfson P, Jovanovic A, Deegan P, Rusk R, Figtree GA, Tchan M, Whalley D, Kotecha D, Leyva F, Moon J, Geberhiwot T, Steeds RP. A randomised controlled trial evaluating arrhythmia burden, risk of sudden cardiac death and stroke in patients with Fabry disease: the role of implantable loop recorders (RaILRoAD) compared with current standard practice. Trials 2019; 20:314. [PMID: 31151481 PMCID: PMC6544923 DOI: 10.1186/s13063-019-3425-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 05/11/2019] [Indexed: 01/13/2023] Open
Abstract
Background Fabry disease (FD) is a genetic disorder caused by a deficiency in the enzyme alpha-galactosidase A, leading to an accumulation of glycosphingolipids in tissues across the body. Cardiac disease is the leading cause of morbidity and mortality. Advanced disease, characterised by extensive left ventricular hypertrophy, ventricular dysfunction and fibrosis, is known to be associated with an increase in arrhythmia. Data identifying risk factors for arrhythmia are limited, and no Fabry-specific risk stratification tool is available to select those who may benefit from initiation of medical or device therapy (implantable cardiac defibrillators). Current monitoring strategies have a limited diagnostic yield, and implantable loop recorders (ILRs) have the potential to change treatment and clinical outcomes. Aim The aim of this study is to determine whether ILRs can (1) improve arrhythmia detection in FD and (2) identify risk predictors of arrhythmia. Methods A prospective, 5-year, open-label, international, multi-centre randomised controlled trial of a minimum of 164 participants with genetically or enzymatically confirmed FD (or both) who have evidence of cardiac disease will be recruited from five centres: Queen Elizabeth Hospital, Birmingham, UK; Salford Royal Hospital, Salford, UK; Royal Free Hospital, London, UK; Addenbrookes Hospital, Cambridge, UK; and Westmead Hospital, Sydney, Australia. Participants will be block-randomised (1:1) to two study arms for cardiac monitoring (i) control arm: standard of care with annual 24 h or 5-day Holter monitor or (ii) treatment arm: continuous cardiac monitoring with ILR implantation plus standard of care. Participants will undergo multiple investigations—blood/urine biomarkers, 12-lead and advanced electrocardiogram (ECG) recording, echocardiography and cardiovascular magnetic resonance (CMR) imaging—at baseline and 6–12 monthly follow-up visits. The primary endpoint is identification of arrhythmia requiring initiation or alteration in therapy. Secondary outcome measures include characterising the risk factors associated with arrhythmia and outcome data in the form of imaging, ECG and blood biomarkers. Discussion This is the first study evaluating arrhythmia burden and the use of ILR across the spectrum of risk profiles in Fabry cardiomyopathy. This will enable detailed characterisation of arrhythmic risk predictors in FD and ultimately support formulation of Fabry-specific guidance in this high-risk population. Trial registration ClinicalTrials.gov (NCT03305250). Registered on 9 October 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3425-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ravi Vijapurapu
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindlesohn Way, Birmingham, B15 2TH, UK. .,Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Mindlesohn Way, Birmingham, B15 2TH, UK.
| | - Rebecca Kozor
- Sydney Medical School, University of Sydney, Sydney, 2006, NSW, Australia.,Cardiology Department, Royal North Shore Hospital, Reserve Road, St. Leonards, NSW, 2065, Australia
| | - Derralynn A Hughes
- Lysosomal Storage Disorder Unit, Royal London NHS Foundation Trust, University College London, Pond Street, London, NW3 2QG, UK
| | - Peter Woolfson
- Department of Cardiology, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, UK
| | - Ana Jovanovic
- Mark Holland Metabolic Unit, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, UK
| | - Patrick Deegan
- Department of Medicine, Addenbrooke's Hospital, Hill Road, Cambridge, CB2 0QQ, UK
| | - Rosemary Rusk
- Department of Cardiology, Addenbrookes Hospital, Hill Road, Cambridge, CB2 0QQ, UK
| | - Gemma A Figtree
- Sydney Medical School, University of Sydney, Sydney, 2006, NSW, Australia.,Cardiology Department, Royal North Shore Hospital, Reserve Road, St. Leonards, NSW, 2065, Australia
| | - Michel Tchan
- Sydney Medical School, University of Sydney, Sydney, 2006, NSW, Australia.,Department of Genetics, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - David Whalley
- Sydney Medical School, University of Sydney, Sydney, 2006, NSW, Australia.,Cardiology Department, Royal North Shore Hospital, Reserve Road, St. Leonards, NSW, 2065, Australia
| | - Dipak Kotecha
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindlesohn Way, Birmingham, B15 2TH, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Francisco Leyva
- Aston Medical Research Institute, Aston Medical School, Birmingham, B4 7ET, UK
| | - James Moon
- Barts Heart Centre, Barts Health NHS Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Tarekegn Geberhiwot
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Mindlesohn Way, Birmingham, B15 2TH, UK.,Institute of Metabolism and System Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard P Steeds
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindlesohn Way, Birmingham, B15 2TH, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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59
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Contemporary View of Magnetic Resonance Imaging in Fabry Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9498-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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60
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Affiliation(s)
- João B. Augusto
- Cardiac Imaging Department, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom. Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - James C. Moon
- Cardiac Imaging Department, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom. Institute of Cardiovascular Science, University College London, London, United Kingdom
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61
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Serra W, Marziliano N. Role of cardiac imaging in Anderson-Fabry cardiomyopathy. Cardiovasc Ultrasound 2019; 17:1. [PMID: 30674321 PMCID: PMC6345038 DOI: 10.1186/s12947-019-0151-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
The Anderson-Fabry disease (AFD, or simply Fabry Disease, FD; MIM #301500) is a rare X-linked lysosomal storage disorder (Xq22.1) characterized by progressive renal failure, leading to morbidity through cardio- and cerebro-vascular involvement. Despite the classic phenotype, only cardiac involvement (cardiac variant of AFD; MIM 301500) is frequent in about 40% of male and 28% of female AFD patients, as reported by the Fabry Registry (https://www.registrynxt.com). Morphologically, the cardiac characteristic of the disease, occurs as left ventricular hypertrophy, is accompanied by myocardial fibrosis. Cardiologists may come across these patients during clinical and instrumental evaluation in individuals with non-specific symptoms such as chest pain and arrhythmias, or after instrumental evidence of left ventricular hypertrophy/hypertrophic cardiomyopathy (HCM; MIM 192600). A comprehensive cardiological work-up, including a cardiological visit, a baseline electrocardiogram (ECG) and imaging by both echocardiography (ECHO) and magnetic resonance (MRI) enables identification of the cardiac involvement in patients with a proven diagnosis of AFD. The heart involvement is present in up to 75% of AFD patients irrespective of their sex. Involvement includes ECG and echocardiography features which suggest AFD and not HCM. Cardiac imaging plays an important role in detecting this sub-type of cardiomyopathy, which, since 2001, has benefited from the introduction of the enzyme replacement therapy (ERT) in symptomatic and pre-symptomatic patients.
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Affiliation(s)
- Walter Serra
- Cardiology Division, Surgery Department, University Hospital-Parma, Via Antonio Gramsci 14, 43100, Parma, IT, Italy.
| | - Nicola Marziliano
- University of Molise, Health Sciences Department-Campobasso, Campobasso, IT, Italy.,Fondazione Floresta Longo, Catania, IT, Italy
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62
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Baig S, Vijapurapu R, Alharbi F, Nordin S, Kozor R, Moon J, Bembi B, Geberhiwot T, Steeds RP. Diagnosis and treatment of the cardiovascular consequences of Fabry disease. QJM 2019; 112:3-9. [PMID: 29878206 DOI: 10.1093/qjmed/hcy120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Fabry disease (FD) has been a diagnostic challenge since it was first recognized in 1898, with patients traditionally suffering from considerable delay before a diagnosis is made. Cardiac involvement is the current leading cause of death in FD. A combination of improved enzyme assays, availability of genetic profiling, together with more organized clinical services for rare diseases, has led to a rapid growth in the prevalence of FD. The earlier and more frequent diagnosis of asymptomatic individuals before development of the phenotype has focussed attention on early detection of organ involvement and closer monitoring of disease progression. The high cost of enzyme replacement therapy at a time of constraint within many health economies, moreover, has challenged clinicians to target treatment effectively. This article provides an outline of FD for the general physician and summarizes the aetiology and pathology of FD, the cardiovascular consequences thereof, modalities used in diagnosis and then discusses current indications for treatment, including pharmacotherapy and device implantation.
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Affiliation(s)
- S Baig
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - R Vijapurapu
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - F Alharbi
- Central Military Laboratory and Blood Bank, Riyadh, Saudi Arabia
| | - S Nordin
- Institute of Cardiovascular Science, University College London, London, UK
| | - R Kozor
- Sydney Medical School, University of Sydney, Camperdown, Australia
| | - J Moon
- Institute of Cardiovascular Science, University College London, London, UK
| | - B Bembi
- Centre for Rare Diseases, AMC Hospital of Udine, Udine, Italy
| | - T Geberhiwot
- Centre for Rare Diseases, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - R P Steeds
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
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63
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McConnell EJ, Every J, Tchan M, Kozor R. Progressive cardiac involvement in a compound heterozygote Fabry patient: a case report. Eur Heart J Case Rep 2018; 2:yty122. [PMID: 31020198 PMCID: PMC6426117 DOI: 10.1093/ehjcr/yty122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/27/2018] [Indexed: 11/14/2022]
Abstract
Background Case summary Discussion
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Affiliation(s)
| | - James Every
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michel Tchan
- Genetic Medicine, Westmead Hospital, Sydney, Australia
| | - Rebecca Kozor
- Cardiology Department, Royal North Shore Hospital, Sydney, Australia
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64
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Oder D, Wanner C, Nordbeck P. Letter by Oder et al Regarding Article, "Early Cardiac Involvement Affects Left Ventricular Longitudinal Function in Females Carrying α-Galactosidase A Mutation: Role of Hybrid Positron Emission Tomography and Magnetic Resonance Imaging and Speckle-Tracking Echocardiography. Circ Cardiovasc Imaging 2018; 11:e007896. [PMID: 30354498 DOI: 10.1161/circimaging.118.007896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel Oder
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, University Hospital Würzburg, Germany (D.O., C.W., P.N.).,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Germany (D.O., C.W., P.N.).,Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Germany (D.O., C.W., P.N.)
| | - Christoph Wanner
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, University Hospital Würzburg, Germany (D.O., C.W., P.N.).,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Germany (D.O., C.W., P.N.).,Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Germany (D.O., C.W., P.N.)
| | - Peter Nordbeck
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, University Hospital Würzburg, Germany (D.O., C.W., P.N.).,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Germany (D.O., C.W., P.N.).,Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Germany (D.O., C.W., P.N.)
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65
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Myocardial Imaging with CMR Parametric Mapping: Clinical Applications. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0306-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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66
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Vijapurapu R, Nordin S, Baig S, Liu B, Rosmini S, Augusto J, Tchan M, Hughes DA, Geberhiwot T, Moon JC, Steeds RP, Kozor R. Global longitudinal strain, myocardial storage and hypertrophy in Fabry disease. Heart 2018; 105:470-476. [PMID: 30282640 DOI: 10.1136/heartjnl-2018-313699] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Detecting early cardiac involvement in Fabry disease (FD) is important because therapy may alter disease progression. Cardiovascular magnetic resonance (CMR) can detect T1 lowering, representing myocardial sphingolipid storage. In many diseases, early mechanical dysfunction may be detected by abnormal global longitudinal strain (GLS). We explored the relationship of early mechanical dysfunction and sphingolipid deposition in FD. METHODS An observational study of 221 FD and 77 healthy volunteers (HVs) who underwent CMR (LV volumes, mass, native T1, GLS, late gadolinium enhancement), ECG and blood biomarkers, as part of the prospective multicentre Fabry400 study. RESULTS All FD had normal LV ejection fraction (EF 73%±8%). Mean indexed LV mass (LVMi) was 89±39 g/m2 in FD and 55.6±10 g/m2 in HV. 102 (46%) FD participants had left ventricular hypertrophy (LVH). There was a negative correlation between GLS and native T1 in FD patients (r=-0.515, p<0.001). In FD patients without LVH (early disease), as native T1 reduced there was impairment in GLS (r=-0.285, p<0.002). In the total FD cohort, ECG abnormalities were associated with a significant impairment in GLS compared with those without ECG abnormalities (abnormal: -16.7±3.5 vs normal: -20.2±2.4, p<0.001). CONCLUSIONS GLS in FD correlates with an increase in LVMi, storage and the presence of ECG abnormalities. In LVH-negative FD (early disease), impairment in GLS is associated with a reduction in native T1, suggesting that mechanical dysfunction occurs before evidence of sphingolipid deposition (low T1). TRIAL REGISTRATION NUMBER NCT03199001; Results.
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Affiliation(s)
- Ravi Vijapurapu
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Sabrina Nordin
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Shanat Baig
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Boyang Liu
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Joao Augusto
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Michel Tchan
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | - Tarekegn Geberhiwot
- Department of Inherited Metabolic Disorders, Queen Elizabeth Hospital, Birmingham, UK
| | - James C Moon
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Richard Paul Steeds
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Rebecca Kozor
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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67
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Militaru S, Ginghină C, Popescu BA, Săftoiu A, Linhart A, Jurcuţ R. Multimodality imaging in Fabry cardiomyopathy: from early diagnosis to therapeutic targets. Eur Heart J Cardiovasc Imaging 2018; 19:1313-1322. [DOI: 10.1093/ehjci/jey132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/23/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sebastian Militaru
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
- University of Medicine and Pharmacy, Craiova, Romania
| | - Carmen Ginghină
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
- University of Medicine and Pharmacy“Carol Davila”, Bucharest, Romania
| | - Bogdan A Popescu
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
- University of Medicine and Pharmacy“Carol Davila”, Bucharest, Romania
| | - Adrian Săftoiu
- University of Medicine and Pharmacy, Craiova, Romania
- Emergency County Hospital, Craiova, Romania
| | - Ales Linhart
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ruxandra Jurcuţ
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
- University of Medicine and Pharmacy“Carol Davila”, Bucharest, Romania
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68
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Frustaci A, Verardo R, Grande C, Galea N, Piselli P, Carbone I, Alfarano M, Russo MA, Chimenti C. Immune-Mediated Myocarditis in Fabry Disease Cardiomyopathy. J Am Heart Assoc 2018; 7:e009052. [PMID: 30371172 PMCID: PMC6201436 DOI: 10.1161/jaha.118.009052] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/25/2018] [Indexed: 12/21/2022]
Abstract
Background Glycosphingolipid accumulation in Fabry cells generates a proinflammatory response that may influence disease evolution and responsiveness to enzyme replacement therapy. This study evaluated incidence, mechanism, and impact of myocarditis in Fabry disease cardiomyopathy ( FDCM ). Methods and Results Myocarditis, defined as CD 3+ T lymphocytes >7/mm2 associated with necrosis of glycolipid-laden myocardiocytes, was retrospectively evaluated in endomyocardial biopsies from 78 patients with FDCM : 13 with maximal wall thickness (MWT) <11 mm (group 1), 17 with MWT 11 to 15 mm (group 2), 30 with MWT 16 to 20 mm (group 3), and 18 with MWT >20 mm (group 4). Myocarditis was investigated by polymerase chain reaction for cardiotropic viruses, by serum antiheart and antimyosin antibodies, and by cardiac magnetic resonance. Myocarditis was recognized at histology in 48 of 78 patients with FDCM (38% of group 1, 41% of group 2, 66% of group 3, and 72% of group 4). Myocarditis was characterized by positive antiheart and antimyosin antibodies and negative polymerase chain reaction for viral genomes. CD 3+ cells/mm2 correlated with myocyte necrosis, antimyosin autoantibody titer, and MWT ( P<0.001, r=0.79; P<0.001, r=0.84; P<0.001, r=0.61, respectively). Cardiac magnetic resonance showed myocardial edema in 24 of 78 patients (31%): 0% of group 1, 23% of group 2, 37% of group 3, and 50% of group 4. Conclusions Myocarditis is detectable at histology in up to 56% of patients with FDCM . It is immune mediated and correlates with disease severity. It can be disclosed by antiheart/antimyosin autoantibodies and in the advanced phase by cardiac magnetic resonance. It may contribute to progression of FDCM and resistance to enzyme replacement therapy.
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Affiliation(s)
- Andrea Frustaci
- Department of CardiovascularNephrologic, Anesthetic and Geriatric SciencesLa Sapienza University of RomeItaly
- Molecular and Cellular Cardiology LabIRCCS ‘L. Spallanzani’RomeItaly
| | - Romina Verardo
- Molecular and Cellular Cardiology LabIRCCS ‘L. Spallanzani’RomeItaly
| | - Claudia Grande
- Department of CardiovascularNephrologic, Anesthetic and Geriatric SciencesLa Sapienza University of RomeItaly
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological SciencesSapienza UniversityRomeItaly
| | - Pierluca Piselli
- Department of Epidemiology and Preclinical ResearchIRCCS ‘L. Spallanzani’RomeItaly
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological SciencesSapienza UniversityRomeItaly
| | - Maria Alfarano
- Department of CardiovascularNephrologic, Anesthetic and Geriatric SciencesLa Sapienza University of RomeItaly
| | | | - Cristina Chimenti
- Department of CardiovascularNephrologic, Anesthetic and Geriatric SciencesLa Sapienza University of RomeItaly
- Molecular and Cellular Cardiology LabIRCCS ‘L. Spallanzani’RomeItaly
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69
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Spinelli L, Imbriaco M, Cuocolo A. Response by Spinelli et al to Letter Regarding, “Early Cardiac Involvement Affects Left Ventricular Longitudinal Function in Females Carrying α-Galactosidase A Mutation: Role of Hybrid Positron Emission Tomography and Magnetic Resonance Imaging and Speckle-Tracking Echocardiography”. Circ Cardiovasc Imaging 2018; 11:e008133. [DOI: 10.1161/circimaging.118.008133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Letizia Spinelli
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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70
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Liu D, Oder D, Salinger T, Hu K, Müntze J, Weidemann F, Herrmann S, Ertl G, Wanner C, Frantz S, Störk S, Nordbeck P. Association and diagnostic utility of diastolic dysfunction and myocardial fibrosis in patients with Fabry disease. Open Heart 2018; 5:e000803. [PMID: 30018776 PMCID: PMC6045729 DOI: 10.1136/openhrt-2018-000803] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/21/2018] [Accepted: 06/13/2018] [Indexed: 01/10/2023] Open
Abstract
Objectives Current guidelines highlight important therapy implications of cardiac fibrosis in patients with Fabry disease (FD). However, association between morphological and functional impairments with cardiac fibrosis in hereditary cardiomyopathies remains elusive. We investigated the association between echocardiography-determined cardiac dysfunction and cardiac MRI (cMRI)-detected myocardial fibrosis (late gadolinium enhancement, LE) in patients with FD with preserved left ventricular ejection fraction (≥50%). Methods 146 patients with FD (aged 39±14 years, 57 men) were analysed, all receiving echocardiography and cMRI within a 1 week interval. Longitudinal systolic strain (LS_sys), strain rate (LSr_sys) and diastolic strain rate (LSr_E/LSr_A) were assessed using speckle-tracking imaging. Receiver operating characteristic (ROC) analysis was performed to identify the diagnostic performance of various markers for LE. Results LE was detected in 57 (39%) patients with FD. LV wall thickness, left atrial volume, septal E/e', diastolic dysfunction grade, global LS_sys and E/LSr_E, mid-lateral LS_sys and LSr_E, as well as N-terminal pro-brain natriuretic peptide were all associated with LE independent of age, sex, body mass index, New York Heart Association functional class and kidney function. In ROC curve analysis, septal E/e' performed best (area under the curve=0.86, 95% CI=0.79 to 0.92). Septal E/e'>14.8 was strongly associated with LE (specificity=97.8% and sensitivity=49.1%). In 9% of patients, localised LE was present even though no other cardiac or kidney abnormalities were detected. Conclusions Echocardiography-derived diastolic dysfunction is closely linked to LE in FD. Septal E/e' ratio is the best echocardiographic marker suggestive of LE. Diastolic dysfunction is not a prerequisite for LE in FD, since LE can be detected in the absence of measurable cardiac functional impairments. Trial registration number ClinicalTrials.gov Identifier (NCT03362164).
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Affiliation(s)
- Dan Liu
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Daniel Oder
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Tim Salinger
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Kai Hu
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Jonas Müntze
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Frank Weidemann
- Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany.,Medizinische Klinik I, Klinikum Vest, Recklinghausen, Germany
| | - Sebastian Herrmann
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Georg Ertl
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
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71
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Messroghli DR, Moon JC, Ferreira VM, Grosse-Wortmann L, He T, Kellman P, Mascherbauer J, Nezafat R, Salerno M, Schelbert EB, Taylor AJ, Thompson R, Ugander M, van Heeswijk RB, Friedrich MG. Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: A consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI). J Cardiovasc Magn Reson 2017; 19:75. [PMID: 28992817 PMCID: PMC5633041 DOI: 10.1186/s12968-017-0389-8] [Citation(s) in RCA: 969] [Impact Index Per Article: 138.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 09/25/2017] [Indexed: 12/14/2022] Open
Abstract
Parametric mapping techniques provide a non-invasive tool for quantifying tissue alterations in myocardial disease in those eligible for cardiovascular magnetic resonance (CMR). Parametric mapping with CMR now permits the routine spatial visualization and quantification of changes in myocardial composition based on changes in T1, T2, and T2*(star) relaxation times and extracellular volume (ECV). These changes include specific disease pathways related to mainly intracellular disturbances of the cardiomyocyte (e.g., iron overload, or glycosphingolipid accumulation in Anderson-Fabry disease); extracellular disturbances in the myocardial interstitium (e.g., myocardial fibrosis or cardiac amyloidosis from accumulation of collagen or amyloid proteins, respectively); or both (myocardial edema with increased intracellular and/or extracellular water). Parametric mapping promises improvements in patient care through advances in quantitative diagnostics, inter- and intra-patient comparability, and relatedly improvements in treatment. There is a multitude of technical approaches and potential applications. This document provides a summary of the existing evidence for the clinical value of parametric mapping in the heart as of mid 2017, and gives recommendations for practical use in different clinical scenarios for scientists, clinicians, and CMR manufacturers.
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Affiliation(s)
- Daniel R. Messroghli
- Department of Internal Medicine and Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - James C. Moon
- University College London and Barts Heart Centre, London, UK
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Lars Grosse-Wortmann
- Division of Cardiology in the Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Taigang He
- Cardiovascular Science Research Centre, St George’s, University of London, London, UK
| | | | - Julia Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Michael Salerno
- Departments of Medicine Cardiology Division, Radiology and Medical Imaging, and Biomedical Engineering, University of Virginia Health System, Charlottesville, VA USA
| | - Erik B. Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA USA
| | - Andrew J. Taylor
- The Alfred Hospital, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Richard Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ruud B. van Heeswijk
- Department of Radiology, Lausanne University Hospital (CHUV) and Lausanne University (UNIL), Lausanne, Switzerland
| | - Matthias G. Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, Montréal, Québec Canada
- Department of Medicine, Heidelberg University, Heidelberg, Germany
- Département de radiologie, Université de Montréal, Montréal, Québec Canada
- Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, Canada
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Abstract
Quantitative myocardial and blood T1 have recently achieved clinical utility in numerous pathologies, as they provide non-invasive tissue characterization with the potential to replace invasive biopsy. Native T1 time (no contrast agent), changes with myocardial extracellular water (edema, focal or diffuse fibrosis), fat, iron, and amyloid protein content. After contrast, the extracellular volume fraction (ECV) estimates the size of the extracellular space and identifies interstitial disease. Spatially resolved quantification of these biomarkers (so-called T1 mapping and ECV mapping) are steadily becoming diagnostic and prognostically useful tests for several heart muscle diseases, influencing clinical decision-making with a pending second consensus statement due mid-2017. This review outlines the physics involved in estimating T1 times and summarizes the disease-specific clinical and research impacts of T1 and ECV to date. We conclude by highlighting some of the remaining challenges such as their community-wide delivery, quality control, and standardization for clinical practice.
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Affiliation(s)
- Dina Radenkovic
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, UK
- University College London Medical School, Bloomsbury Campus, Gower Street, London, UK
| | - Sebastian Weingärtner
- Computer Assisted Clinical Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer, Mannheim, Germany
- Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Lewis Ricketts
- University College London Medical School, Bloomsbury Campus, Gower Street, London, UK
| | - James C Moon
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, UK
- NIHR University College London Hospitals Biomedical Research Center, Tottenham Court Road, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Gabriella Captur
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, UK.
- NIHR University College London Hospitals Biomedical Research Center, Tottenham Court Road, London, UK.
- UCL Institute of Cardiovascular Science, University College London, London, UK.
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