Prevalence of Anderson-Fabry disease in a cohort with unexplained late gadolinium enhancement on cardiac MRI

Cardiac Magnetic Resonance Imaging (CMRI) Applications in Patients with Chest Pain in the Emergency Department: A Narrative Review

CMRI is the exclusive imaging technique capable of identifying myocardial edema, endomyocardial fibrosis, pericarditis accompanied by pericardial effusions, and apical thrombi within either the left or right ventricle. In this work, we examine the research literature on the use of CMRI in the diagnosis of chest discomfort, employing randomized controlled trials (RCTs) to evaluate its effectiveness. The research outlines the disorders of the chest and the machine learning approaches for detecting them. In conclusion, the study ends with an examination of a fundamental illustration of CMRI analysis. To find a comprehensive review, the Scopus scientific resource is analyzed. The issue, based on the findings, is to distinguish ischemia from non-ischemic cardiac causes of chest pain in individuals presenting with sudden chest pain or discomfort upon arrival at the emergency department (ED). Due to the failure of conventional methods in accurately diagnosing acute cardiac ischemia, individuals are still being inappropriately discharged from the ED, resulting in a heightened death rate.

Rare Metabolic and Endocrine Diseases with Cardiovascular Involvement: Insights from Cardiovascular Magnetic Resonance - A Review

The identification of rare diseases with cardiovascular involvement poses significant diagnostic challenges due to the rarity of the diseases, but also due to the lack of knowledge and expertise. Most of them remain underrecognized and undiagnosed, leading to clinical mismanagement and affecting the patients' prognosis, as these diseases are per definition life-threatening or chronic debilitating. This article reviews the cardiovascular involvement of the most well-known rare metabolic and endocrine diseases and their diagnostic approach through the lens of cardiovascular magnetic resonance (CMR) imaging and its prognostic role, highlighting its fundamental value compared to other imaging modalities.

Fabry Disease and the Heart: A Comprehensive Review

Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations of the GLA gene that result in a deficiency of the enzymatic activity of α-galactosidase A and consequent accumulation of glycosphingolipids in body fluids and lysosomes of the cells throughout the body. GB3 accumulation occurs in virtually all cardiac cells (cardiomyocytes, conduction system cells, fibroblasts, and endothelial and smooth muscle vascular cells), ultimately leading to ventricular hypertrophy and fibrosis, heart failure, valve disease, angina, dysrhythmias, cardiac conduction abnormalities, and sudden death. Despite available therapies and supportive treatment, cardiac involvement carries a major prognostic impact, representing the main cause of death in FD. In the last years, knowledge has substantially evolved on the pathophysiological mechanisms leading to cardiac damage, the natural history of cardiac manifestations, the late-onset phenotypes with predominant cardiac involvement, the early markers of cardiac damage, the role of multimodality cardiac imaging on the diagnosis, management and follow-up of Fabry patients, and the cardiac efficacy of available therapies. Herein, we provide a comprehensive and integrated review on the cardiac involvement of FD, at the pathophysiological, anatomopathological, laboratory, imaging, and clinical levels, as well as on the diagnosis and management of cardiac manifestations, their supportive treatment, and the cardiac efficacy of specific therapies, such as enzyme replacement therapy and migalastat.

Mono-symptomatic Fabry disease in a population with mild-to-moderate left ventricular hypertrophy

Fabry disease (FD) results from a deficiency in the exoglycohydrolase, α-galactosidase A (AGA), an enzyme required for the sequential degradation of glycosphingolipids, which consequently accumulate in the lysosomes of affected cells. An X-linked inherited metabolic disorder, FD has a high incidence of a later onset phenotype that is under-diagnosed and under-recognised in adulthood despite the availability of specific treatment. As the first presenting feature in adults is often left ventricular hypertrophy (LVH), we hypothesized that testing patients with an attenuated echocardiographic phenotype of unexplained hypertrophic cardiomyopathy, might identify cases of undiagnosed FD. We employed a simple screening test by measuring AGA activity in dried blood spots collected from a finger-prick of blood in a cohort of 511 individuals aged between 18 and 75 with LVH between 1.2 and 1.5 cm. Two males were identified with AGA activity below the reference interval and subsequent molecular testing confirmed the commonly reported genetic variants, p.Ala143Thr in one individual and p.Asn215Ser, in the other. Additional biochemical measurement of plasma, lyso-Gb1 was normal in both patients. Of the 179 females screened, one individual returned AGA activity slightly below the reference interval but was lost to further follow-up. This pilot study suggests that screening patients with mild-to-moderate LVH of unknown aetiology does indeed identify undiagnosed cases of FD.