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Figliozzi S, Kollia E, Simistiras A, Camporeale A, Stankowski K, Masci PG, Mavraganis G, Lombardi M, Condorelli G, Francone M, Pieroni M, Georgiopoulos G. Effects of Enzyme Replacement Therapy on Cardiac MRI Findings in Fabry Disease: A Systematic Review and Meta-Analysis. Radiol Cardiothorac Imaging 2024; 6:e230154. [PMID: 38842453 PMCID: PMC11211942 DOI: 10.1148/ryct.230154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 04/03/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
Purpose To perform a systematic review and meta-analysis to assess the effect of enzyme replacement therapy on cardiac MRI parameters in patients with Fabry disease. Materials and Methods A systematic literature search was conducted from January 1, 2000, through January 1, 2024, in PubMed, ClinicalTrials.gov, Embase, and Cochrane Library databases. Study outcomes were changes in the following parameters: (a) left ventricular wall mass (LVM), measured in grams; (b) LVM indexed to body mass index, measured in grams per meters squared; (c) maximum left ventricular wall thickness (MLVWT), measured in millimeters; (d) late gadolinium enhancement (LGE) extent, measured in percentage of LVM; and (e) native T1 mapping, measured in milliseconds. A random-effects meta-analysis of the pooled mean differences between baseline and follow-up parameters was conducted. The study protocol was registered in PROSPERO (CRD42022336223). Results The final analysis included 11 studies of a total of 445 patients with Fabry disease (mean age ± SD, 41 years ± 11; 277 male, 168 female). Between baseline and follow-up cardiac MRI, the following did not change: T1 mapping (mean difference, 6 msec [95% CI: -2, 15]; two studies, 70 patients, I2 = 88%) and LVM indexed (mean difference, -1 g/m2 [95% CI: -6, 3]; four studies, 290 patients, I2 = 81%). The following measures minimally decreased: LVM (mean difference, -18 g [95% CI: -33, -3]; seven studies, 107 patients, I2 = 96%) and MLVWT (mean difference, -1 mm [95% CI: -2, -0.02]; six studies, 151 patients, I2 = 90%). LGE extent increased (mean difference, 1% [95% CI: 1, 1]; three studies, 114 patients, I2 = 85%). Conclusion In patients with Fabry disease, enzyme replacement therapy was associated with stabilization of LVM, MLVWT, and T1 mapping values, whereas LGE extent mildly increased. Keywords: Fabry Disease, Enzyme Replacement Therapy (ERT), Cardiac MRI, Late Gadolinium Enhancement (LGE) Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
| | | | - Alexandros Simistiras
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - Antonia Camporeale
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - Kamil Stankowski
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - Pier Giorgio Masci
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - George Mavraganis
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - Massimo Lombardi
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - Gianluigi Condorelli
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - Marco Francone
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
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Forleo C, Carella MC, Basile P, Mandunzio D, Greco G, Napoli G, Carulli E, Dicorato MM, Dentamaro I, Santobuono VE, Memeo R, Latorre MD, Baggiano A, Mushtaq S, Ciccone MM, Pontone G, Guaricci AI. The Role of Magnetic Resonance Imaging in Cardiomyopathies in the Light of New Guidelines: A Focus on Tissue Mapping. J Clin Med 2024; 13:2621. [PMID: 38731153 PMCID: PMC11084160 DOI: 10.3390/jcm13092621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/27/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Cardiomyopathies (CMPs) are a group of myocardial disorders that are characterized by structural and functional abnormalities of the heart muscle. These abnormalities occur in the absence of coronary artery disease (CAD), hypertension, valvular disease, and congenital heart disease. CMPs are an increasingly important topic in the field of cardiovascular diseases due to the complexity of their diagnosis and management. In 2023, the ESC guidelines on cardiomyopathies were first published, marking significant progress in the field. The growth of techniques such as cardiac magnetic resonance imaging (CMR) and genetics has been fueled by the development of multimodal imaging approaches. For the diagnosis of CMPs, a multimodal imaging approach, including CMR, is recommended. CMR has become the standard for non-invasive analysis of cardiac morphology and myocardial function. This document provides an overview of the role of CMR in CMPs, with a focus on tissue mapping. CMR enables the characterization of myocardial tissues and the assessment of cardiac functions. CMR sequences and techniques, such as late gadolinium enhancement (LGE) and parametric mapping, provide detailed information on tissue composition, fibrosis, edema, and myocardial perfusion. These techniques offer valuable insights for early diagnosis, prognostic evaluation, and therapeutic guidance of CMPs. The use of quantitative CMR markers enables personalized treatment plans, improving overall patient outcomes. This review aims to serve as a guide for the use of these new tools in clinical practice.
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Affiliation(s)
- Cinzia Forleo
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Maria Cristina Carella
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Paolo Basile
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Donato Mandunzio
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Giulia Greco
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Gianluigi Napoli
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Eugenio Carulli
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Marco Maria Dicorato
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Ilaria Dentamaro
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Vincenzo Ezio Santobuono
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Riccardo Memeo
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Michele Davide Latorre
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
| | - Marco Matteo Ciccone
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20138 Milan, Italy
| | - Andrea Igoren Guaricci
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
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Lo Monaco M, Stankowski K, Figliozzi S, Nicoli F, Scialò V, Gad A, Lisi C, Marchini F, Dellino CM, Mollace R, Catapano F, Stefanini GG, Monti L, Condorelli G, Bertella E, Francone M. Multiparametric Mapping via Cardiovascular Magnetic Resonance in the Risk Stratification of Ventricular Arrhythmias and Sudden Cardiac Death. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:691. [PMID: 38792874 PMCID: PMC11122968 DOI: 10.3390/medicina60050691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
Risk stratification for malignant ventricular arrhythmias and sudden cardiac death is a daunting task for physicians in daily practice. Multiparametric mapping sequences obtained via cardiovascular magnetic resonance imaging can improve the risk stratification for malignant ventricular arrhythmias by unveiling the presence of pathophysiological pro-arrhythmogenic processes. However, their employment in clinical practice is still restricted. The present review explores the current evidence supporting the association between mapping abnormalities and the risk of ventricular arrhythmias in several cardiovascular diseases. The key message is that further clinical studies are needed to test the additional value of mapping techniques beyond conventional cardiovascular magnetic resonance imaging for selecting patients eligible for an implantable cardioverter defibrillator.
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Affiliation(s)
| | - Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Stefano Figliozzi
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | | | - Vincenzo Scialò
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | | | - Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
| | - Federico Marchini
- Humanitas Gavazzeni, 24125 Bergamo, Italy
- Centro Cardiologico Universitario, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, 44124 Ferrara, Italy
| | - Carlo Maria Dellino
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | | | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Giulio Giuseppe Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | | | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
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Pieroni M, Namdar M, Olivotto I, Desnick RJ. Anderson-Fabry disease management: role of the cardiologist. Eur Heart J 2024; 45:1395-1409. [PMID: 38486361 DOI: 10.1093/eurheartj/ehae148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/04/2024] [Accepted: 02/27/2024] [Indexed: 04/22/2024] Open
Abstract
Anderson-Fabry disease (AFD) is a lysosomal storage disorder characterized by glycolipid accumulation in cardiac cells, associated with a peculiar form of hypertrophic cardiomyopathy (HCM). Up to 1% of patients with a diagnosis of HCM indeed have AFD. With the availability of targeted therapies for sarcomeric HCM and its genocopies, a timely differential diagnosis is essential. Specifically, the therapeutic landscape for AFD is rapidly evolving and offers increasingly effective, disease-modifying treatment options. However, diagnosing AFD may be difficult, particularly in the non-classic phenotype with prominent or isolated cardiac involvement and no systemic red flags. For many AFD patients, the clinical journey from initial clinical manifestations to diagnosis and appropriate treatment remains challenging, due to late recognition or utter neglect. Consequently, late initiation of treatment results in an exacerbation of cardiac involvement, representing the main cause of morbidity and mortality, irrespective of gender. Optimal management of AFD patients requires a dedicated multidisciplinary team, in which the cardiologist plays a decisive role, ranging from the differential diagnosis to the prevention of complications and the evaluation of timing for disease-specific therapies. The present review aims to redefine the role of cardiologists across the main decision nodes in contemporary AFD clinical care and drug discovery.
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Affiliation(s)
- Maurizio Pieroni
- Cardiovascular Department, San Donato Hospital, Via Pietro Nenni 22, 52100 Arezzo, Italy
| | - Mehdi Namdar
- Cardiology Division, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi Hospital and Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Del Franco A, Iannaccone G, Meucci MC, Lillo R, Cappelli F, Zocchi C, Pieroni M, Graziani F, Olivotto I. Clinical staging of Anderson-Fabry cardiomyopathy: An operative proposal. Heart Fail Rev 2024; 29:431-444. [PMID: 38006470 DOI: 10.1007/s10741-023-10370-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/27/2023]
Abstract
As a slowly progressive form of hypertrophic cardiomyopathy (HCM), Anderson-Fabry disease (FD) resembles the phenotype of the most common sarcomeric forms, although significant differences in presentation and long-term progression may help determine the correct diagnosis. A variety of electrocardiographic and imaging features of FD cardiomyopathy have been described at different times in the course of the disease, and considerable discrepancies remain regarding the assessment of disease severity by individual physicians. Therefore, we here propose a practical staging of FD cardiomyopathy, in hopes it may represent the standard for cardiac evaluation and facilitate communication between specialized FD centres and primary care physicians. We identified 4 main stages of FD cardiomyopathy of increasing severity, based on available evidence from clinical and imaging studies: non-hypertrophic, hypertrophic - pre-fibrotic, hypertrophic - fibrotic, and overt dysfunction. Each stage is described and discussed in detail, following the principle that speaking a common language is critical when managing such complex patients in a multi-disciplinary and sometimes multi-centre setting.
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Affiliation(s)
| | - Giulia Iannaccone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Meucci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Lillo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Chiara Zocchi
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | | | - Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Cardiology Unit, Meyer University Hospital, Florence, Italy
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Iorio A, Lucà F, Pozzi A, Rao CM, Chimenti C, Di Fusco SA, Rossini R, Caretta G, Cornara S, Giubilato S, Di Matteo I, Di Nora C, Pilleri A, Gelsomino S, Ceravolo R, Riccio C, Grimaldi M, Colivicchi F, Oliva F, Gulizia MM. Anderson-Fabry Disease: Red Flags for Early Diagnosis of Cardiac Involvement. Diagnostics (Basel) 2024; 14:208. [PMID: 38248084 PMCID: PMC10814042 DOI: 10.3390/diagnostics14020208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
Anderson-Fabry disease (AFD) is a lysosome storage disorder resulting from an X-linked inheritance of a mutation in the galactosidase A (GLA) gene encoding for the enzyme alpha-galactosidase A (α-GAL A). This mutation results in a deficiency or absence of α-GAL A activity, with a progressive intracellular deposition of glycosphingolipids leading to organ dysfunction and failure. Cardiac damage starts early in life, often occurring sub-clinically before overt cardiac symptoms. Left ventricular hypertrophy represents a common cardiac manifestation, albeit conduction system impairment, arrhythmias, and valvular abnormalities may also characterize AFD. Even in consideration of pleiotropic manifestation, diagnosis is often challenging. Thus, knowledge of cardiac and extracardiac diagnostic "red flags" is needed to guide a timely diagnosis. Indeed, considering its systemic involvement, a multidisciplinary approach may be helpful in discerning AFD-related cardiac disease. Beyond clinical pearls, a practical approach to assist clinicians in diagnosing AFD includes optimal management of biochemical tests, genetic tests, and cardiac biopsy. We extensively reviewed the current literature on AFD cardiomyopathy, focusing on cardiac "red flags" that may represent key diagnostic tools to establish a timely diagnosis. Furthermore, clinical findings to identify patients at higher risk of sudden death are also highlighted.
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Affiliation(s)
- Annamaria Iorio
- Cardiology Department, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy;
| | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Andrea Pozzi
- Cardiology Department, Valduce Hospital, 23845 Como, Italy
| | - Carmelo Massimiliano Rao
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Cristina Chimenti
- Department of Clinic, Internistic, Cardiovascular, Anesthesiologic and Geriatric Sciences, La Sapienza University of Rome, 00142 Rome, Italy
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Rome 1, 00135 Rome, Italy
| | - Roberta Rossini
- Cardiology Unit, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy
| | - Giorgio Caretta
- Levante Ligure Sant’Andrea Hospital, ASL 5 Liguria, 19121 La Spezia, Italy
| | - Stefano Cornara
- Arrhytmia Unit, Division of Cardiology, Ospedale San Paolo, Azienda Sanitaria Locale 2, 17100 Savona, Italy
| | - Simona Giubilato
- Cardiology Department, Cannizzaro Hospital, 95126 Catania, Italy
| | - Irene Di Matteo
- Cardiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Concetta Di Nora
- Department of Cardiothoracic Science, Azienda Sanitaria Universitaria Integrata di Udine, 33100 Udine, Italy
| | - Anna Pilleri
- Cardiology Brotzu Hospital, 09121 Cagliari, Italy
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Roberto Ceravolo
- Cardiology Unit, Giovanni Paolo II Hospital, 88046 Lamezia, Italy
| | - Carmine Riccio
- Cardiovascular Department, Sant’Anna e San Sebastiano Hospital, 81100 Caserta, Italy
| | - Massimo Grimaldi
- Cardiology Department, F. Miulli Hospital, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Rome 1, 00135 Rome, Italy
| | - Fabrizio Oliva
- Cardiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
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7
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Carrabba N, Amico MA, Guaricci AI, Carella MC, Maestrini V, Monosilio S, Pedrotti P, Ricci F, Monti L, Figliozzi S, Torlasco C, Barison A, Baggiano A, Scatteia A, Pontone G, Dellegrottaglie S. CMR Mapping: The 4th-Era Revolution in Cardiac Imaging. J Clin Med 2024; 13:337. [PMID: 38256470 PMCID: PMC10816333 DOI: 10.3390/jcm13020337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Cardiac magnetic resonance (CMR) imaging has witnessed substantial progress with the advent of parametric mapping techniques, most notably T1 and T2 mapping. These advanced techniques provide valuable insights into a wide range of cardiac conditions, including ischemic heart disease, cardiomyopathies, inflammatory cardiomyopathies, heart valve disease, and athlete's heart. Mapping could be the first sign of myocardial injury and oftentimes precedes symptoms, changes in ejection fraction, and irreversible myocardial remodeling. The ability of parametric mapping to offer a quantitative assessment of myocardial tissue properties addresses the limitations of conventional CMR methods, which often rely on qualitative or semiquantitative data. However, challenges persist, especially in terms of standardization and reference value establishment, hindering the wider clinical adoption of parametric mapping. Future developments should prioritize the standardization of techniques to enhance their clinical applicability, ultimately optimizing patient care pathways and outcomes. In this review, we endeavor to provide insights into the potential contributions of CMR mapping techniques in enhancing the diagnostic processes across a range of cardiac conditions.
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Affiliation(s)
- Nazario Carrabba
- Cardio-Thoraco-Vascular Department, Careggi Hospital, 50134 Florence, Italy;
| | - Mattia Alexis Amico
- Cardio-Thoraco-Vascular Department, Careggi Hospital, 50134 Florence, Italy;
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Maria Cristina Carella
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Viviana Maestrini
- Department of Clinical, Anestesiological and Cardiovascular Science, Sapienza University of Rome, 00185 Rome, Italy (S.M.)
- Institute of Sports Medicine and Science of Rome, Comitato Olimpico Nazionale Italiano (CONI), 00197 Rome, Italy
| | - Sara Monosilio
- Department of Clinical, Anestesiological and Cardiovascular Science, Sapienza University of Rome, 00185 Rome, Italy (S.M.)
- Institute of Sports Medicine and Science of Rome, Comitato Olimpico Nazionale Italiano (CONI), 00197 Rome, Italy
| | - Patrizia Pedrotti
- S.S. Cardiologia Diagnostica per Immagini—RM Cardiaca; S.C. Cardiologia 4 Diagnostica-Riabilitativa Dipartimento CardioToracoVascolare “De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Lorenzo Monti
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.)
| | - Stefano Figliozzi
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.)
| | - Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, 20165 Milan, Italy;
| | - Andrea Barison
- Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20133 Milan, Italy
| | - Alessandra Scatteia
- Cardiovascular MRI Laboratory, Unit of Advanced Cardiovascular Imaging, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80011 Acerra, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20133 Milan, Italy
| | - Santo Dellegrottaglie
- Cardiovascular MRI Laboratory, Unit of Advanced Cardiovascular Imaging, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80011 Acerra, Italy
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8
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Moroni A, Tondi L, Milani V, Pieroni M, Pieruzzi F, Bevilacqua F, Pasqualin G, Chow K, Pica S, Lombardi M, Camporeale A. Left atrial remodeling in hypertrophic cardiomyopathy and Fabry disease: A CMR-based head-to-head comparison and outcome analysis. Int J Cardiol 2023; 393:131357. [PMID: 37696360 DOI: 10.1016/j.ijcard.2023.131357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/19/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) and Fabry disease cardiomyopathy (FD) are phenocopies, as they show left ventricular hypertrophy (LVH). The left atrium (LA) is emerging as a potential marker of disease severity in both cardiomyopathies. The present study compares HCM and FD cardiomyopathy with similar degree of LVH, exploring LA morpho-functional parameters and the correlates of clinical outcome. METHODS We performed a comprehensive CMR-based comparison between 30 HCM and 30 FD patients matched on age, sex, BSA, LV mass and major cardiovascular risk factors affecting LA remodeling (arterial hypertension and diabetes). 30 healthy controls were also included. CMR feature tracking (CMR-FT) analysis, T1 mapping and conventional parameters were evaluated. Patients also underwent transthoracic echocardiography for LV diastolic function assessment. Clinical events at follow-up were collected (atrial and ventricular events, bradyarrhythmia, heart failure (HF) hospitalization and death). RESULTS HCM patients showed greater LA remodeling compared to FD patients, namely higher LA end-systolic volume index (LAVi max), lower LA-ejection fraction (LA-EF) and worse reservoir (εs) and booster function (εa) (all p < 0.05). Accordingly, these parameters have demonstrated good potential for distinguishing between FD and HCM (AUC 0.68-0.73, all p < 0.05), with LAVi max being an independent predictor for HCM diagnosis (OR 1.07, 95%CI 1.011-1.132, p 0.02). Moreover, in HCM patients a significant association between εs and HF occurrence was observed at 2-year follow-up (OR 0.85, 95%CI 0.72-0.99, p 0.04). CONCLUSIONS In HCM, LA remodeling is greater than in FD cardiomyopathy with similar LVH, and reservoir strain is associated with HF at follow-up.
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Affiliation(s)
- Alice Moroni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Federico Pieruzzi
- Department of Medicine and Surgery, University of Milano Bicocca, Nephrology and Dialysis Unit, ASST-Monza San Gerardo Hospital, Monza, Italy
| | - Francesca Bevilacqua
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giulia Pasqualin
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Kelvin Chow
- Siemens Medical Solutions USA, Inc., Chicago, United States
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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9
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Ditaranto R, Leone O, Lovato L, Niro F, Cenacchi G, Papa V, Baldovini C, Ferracin M, Salamon I, Kurdi H, Parisi V, Capelli I, Pession A, Liguori R, Potena L, Seri M, Martin Suarez S, Galiè N, Moon JC, Biagini E. Correlations Between Cardiac Magnetic Resonance and Myocardial Histologic Findings in Fabry Disease. JACC Cardiovasc Imaging 2023; 16:1629-1632. [PMID: 37542504 DOI: 10.1016/j.jcmg.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 05/08/2023] [Accepted: 06/15/2023] [Indexed: 08/07/2023]
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10
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Stankowski K, Figliozzi S, Battaglia V, Catapano F, Francone M, Monti L. Fabry Disease: More than a Phenocopy of Hypertrophic Cardiomyopathy. J Clin Med 2023; 12:7061. [PMID: 38002674 PMCID: PMC10671939 DOI: 10.3390/jcm12227061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Fabry disease (FD) is a genetic lysosomal storage disease with frequent cardiovascular involvement, whose presence is a major determinant of adverse clinical outcomes. As a potentially treatable cause of left ventricular hypertrophy (LVH) and heart failure with preserved ejection fraction, the early recognition of FD is crucial to initiate enzyme replacement therapy and improve long-term prognosis. Multimodality imaging plays a central role in the evaluation of patients with FD and helps in the differential diagnosis of other conditions presenting with LVH. In the present review, we explore the current applications of multimodality cardiac imaging, in particular echocardiography and cardiovascular magnetic resonance, in the diagnosis, prognostic assessment, and follow-up of patients with FD.
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Affiliation(s)
- Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Stefano Figliozzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Vincenzo Battaglia
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
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11
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Sunder-Plassmann G, Graf S, Gatterer C. Staging of Fabry Cardiomyopathy by Echocardiography: Back to the Roots? J Am Coll Cardiol 2023; 82:1535-1537. [PMID: 37793751 DOI: 10.1016/j.jacc.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Gere Sunder-Plassmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
| | - Senta Graf
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Constantin Gatterer
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
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12
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Faro DC, Losi V, Rodolico MS, Torrisi EM, Colomba P, Duro G, Monte IP. Sex Differences in Anderson-Fabry Cardiomyopathy: Clinical, Genetic, and Imaging Analysis in Women. Genes (Basel) 2023; 14:1804. [PMID: 37761944 PMCID: PMC10531426 DOI: 10.3390/genes14091804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Anderson-Fabry Disease (AFD) is a rare, systemic lysosomal storage disease triggered by mutations in the GLA gene, leading to α-galactosidase A (α-Gal A) deficiency. The disease's X-linked inheritance leads to more severe, early-onset presentations in males, while females exhibit variable, often insidious, manifestations, notably impacting cardiac health. This study aims to examine gender-based AFD cardiac manifestations in correlation with the variant type: classical (CL), late-onset (LO), or variants of uncertain significance (VUS). We analyzed data from 72 AFD patients (53 females, 19 males) referred to the "G. Rodolico" University Hospital, employing enzyme activity measurements, genetic analysis, periodic lyso-Gb3 monitoring, comprehensive medical histories, and advanced cardiac imaging techniques. Statistical analysis was performed using SPSS version 26. Our AFD cohort, with an average age of 45 ± 16.1 years, comprised 12 individuals with hypertrophy (AFD-LVH) and 60 without (AFD-N). Women, representing about 75% of the subjects, were generally older than men (47.2 ± 16.2 vs. 38.8 ± 14.6, p = 0.046). In the female group, 17% had CL variants, 43.3% LO, and 39.6% had VUS, compared to 21.1%, 36.8%, and 31.6% in the male group, respectively. Females exhibited significantly higher α-Gal A values (median 7.9 vs. 1.8 nmol/mL/h, p < 0.001) and lower lyso-Gb3 levels (1.5 [IQR 1.1-1.7] vs. 1.9 [1.5-17.3] nmol/L, p = 0.02). Regarding the NYHA class distribution, 70% of women were in class I and 28% in class II, compared to 84% and 16% of men, respectively. Among women, 7.5% exhibited ventricular arrhythmias (10.5% in men), and 9.4% had atrial fibrillation (10.5% in men). Cardiac MRIs revealed fibrosis in 57% of examined women, compared to 87% of men. Even among patients without LVH, significant differences persisted in α-Gal A and lyso-Gb3 levels (p = 0.003 and 0.04), as well as LVMi (61.5 vs. 77.5 g/sqm, p = 0.008) and GLS values (-20% vs. -17%, p = 0.01). The analysis underscored older age, decreased lyso-Gb3 deposition, reduced hypertrophy, and lesser GLS compromise in females, suggesting later disease onset. Severe cardiac patterns were associated with classic variants, while more nuanced manifestations were noted in those with VUS. Early GLS impairment in males, irrespective of hypertrophy, emphasized the role of subclinical damage in AFD.
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Affiliation(s)
- Denise Cristiana Faro
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Valentina Losi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Margherita Stefania Rodolico
- Institute for Biomedical Research and Innovation, National Research Council (IRIB-CNR), Section of Catania, Via P. Gaifami 18, 95126 Catania, Italy
| | - Elvira Mariateresa Torrisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Paolo Colomba
- Institute for Biomedical Research and Innovation, National Research Council (IRIB-CNR), Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Giovanni Duro
- Institute for Biomedical Research and Innovation, National Research Council (IRIB-CNR), Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Ines Paola Monte
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
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13
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Camporeale A, Bandera F, Pieroni M, Pieruzzi F, Spada M, Bersano A, Econimo L, Lanzillo C, Rubino M, Mignani R, Motta I, Olivotto I, Tanini I, Valaperta R, Chow K, Baroni I, Boveri S, Graziani F, Pica S, Tondi L, Guazzi M, Lombardi M. Effect of Migalastat on cArdiac InvOlvement in FabRry DiseAse: MAIORA study. J Med Genet 2023; 60:850-858. [PMID: 36669872 DOI: 10.1136/jmg-2022-108768] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND A small but significant reduction in left ventricular (LV) mass after 18 months of migalastat treatment has been reported in Fabry disease (FD). This study aimed to assess the effect of migalastat on FD cardiac involvement, combining LV morphology and tissue characterisation by cardiac magnetic resonance (CMR) with cardiopulmonary exercise testing (CPET). METHODS Sixteen treatment-naïve patients with FD (4 women, 46.4±16.2 years) with cardiac involvement (reduced T1 values on CMR and/or LV hypertrophy) underwent ECG, echocardiogram, troponin T and NT-proBNP (N-Terminal prohormone of Brain Natriuretic Peptide) assay, CMR with T1 mapping, and CPET before and after 18 months of migalastat. RESULTS No change in LV mass was detected at 18 months compared to baseline (95.2 g/m2 (66.0-184.0) vs 99.0 g/m2 (69.0-121.0), p=0.55). Overall, there was an increase in septal T1 of borderline significance (870.0 ms (848-882) vs 860.0 ms (833.0-875.0), p=0.056). Functional capacity showed an increase in oxygen consumption (VO2) at anaerobic threshold (15.50 mL/kg/min (13.70-21.50) vs 14.50 mL/kg/min (11.70-18.95), p=0.02), and a trend towards an increase in percent predicted peak VO2 (72.0 (63.0-80.0) vs 69.0 (53.0-77.0), p=0.056) was observed. The subset of patients who showed an increase in T1 value and a reduction in LV mass (n=7, 1 female, age 40.5 (28.6-76.0)) was younger and at an earlier disease stage compared to the others, and also exhibited greater improvement in exercise tolerance. CONCLUSION In treatment-naïve FD patients with cardiac involvement, 18-month treatment with migalastat stabilised LV mass and was associated with a trend towards an improvement in exercise tolerance. A tendency to T1 increase was detected by CMR. The subset of patients who had significant benefits from the treatment showed an earlier cardiac disease compared to the others. TRIAL REGISTRATION NUMBER NCT03838237.
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Affiliation(s)
- Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy
- University Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Federico Pieruzzi
- Nephrology and Dialysis Unit, San Gerardo Hospital, Monza, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | - Marco Spada
- Department of Pediatrics, University of Turin, Torino, Italy
| | - Anna Bersano
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Laura Econimo
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Marta Rubino
- Inherited and Rare Cardiovascular Disease, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Renzo Mignani
- Nephrology and Dialysis Department, Infermi Hospital, Rimini, Italy
| | - Irene Motta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, University Hospital Careggi, Firenze, Italy
| | - Ilaria Tanini
- Cardiomyopathy Unit, University Hospital Careggi, Firenze, Italy
| | - Rea Valaperta
- Operative Unit of Laboratory Medicine 1 - Clinical Pathology, Department of Pathology and Laboratory Medicine, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Kelvin Chow
- Siemens Medical Solutions USA, Malvern, Pennsylvania, USA
| | - Irene Baroni
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Marco Guazzi
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy
- Cardiology Division, San Paolo Hospital, Milan, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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14
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Ivanova MM, Dao J, Slayeh OA, Friedman A, Goker-Alpan O. Circulated TGF-β1 and VEGF-A as Biomarkers for Fabry Disease-Associated Cardiomyopathy. Cells 2023; 12:2102. [PMID: 37626912 PMCID: PMC10453505 DOI: 10.3390/cells12162102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Fabry disease (FD) is a lysosomal disorder caused by α-galactosidase A deficiency, resulting in the accumulation of globotriaosylceramide (Gb-3) and its metabolite globotriaosylsphingosine (Lyso-Gb-3). Cardiovascular complications and hypertrophic cardiomyopathy (HCM) are the most frequent manifestations of FD. While an echocardiogram and cardiac MRI are clinical tools to assess cardiac involvement, hypertrophic pattern variations and fibrosis make it crucial to identify biomarkers to predict early cardiac outcomes. This study aims to investigate potential biomarkers associated with HCM in FD: transforming growth factor-β1 (TGF-β1), TGF-β active form (a-TGF-β), vascular endothelial growth factor (VEGF-A), and fibroblast growth factor (FGF2) in 45 patients with FD, categorized into cohorts based on the HCM severity. TGF-β1, a-TGF-β, FGF2, and VEGF-A were elevated in FD. While the association of TGF-β1 with HCM was not gender-related, VEGF was elevated in males with FD and HCM. Female patients with abnormal electrocardiograms but without overt HCM also have elevated TGF-β1. Lyso-Gb3 is correlated with TGF-β1, VEGF-A, and a-TGF-β1. Elevation of TGF-β1 provides evidence of the chronic inflammatory state as a cause of myocardial fibrosis in FD patients; thus, it is a potential marker of early cardiac fibrosis detected even prior to hypertrophy. TGF-β1 and VEGF biomarkers may be prognostic indicators of adverse cardiovascular events in FD.
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Affiliation(s)
- Margarita M. Ivanova
- Lysosomal & Rare Disorders Research and Treatment Center, 3702 Pender Drive, Ste 170, Fairfax, VA 22030, USA
| | | | | | | | - Ozlem Goker-Alpan
- Lysosomal & Rare Disorders Research and Treatment Center, 3702 Pender Drive, Ste 170, Fairfax, VA 22030, USA
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15
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Monda E, Falco L, Palmiero G, Rubino M, Perna A, Diana G, Verrillo F, Dongiglio F, Cirillo A, Fusco A, Caiazza M, Limongelli G. Cardiovascular Involvement in Fabry's Disease: New Advances in Diagnostic Strategies, Outcome Prediction and Management. Card Fail Rev 2023; 9:e12. [PMID: 37602190 PMCID: PMC10433112 DOI: 10.15420/cfr.2023.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/22/2023] [Indexed: 08/22/2023] Open
Abstract
Cardiovascular involvement is common in Fabry's disease and is the leading cause of morbidity and mortality. The research is focused on identifying diagnostic clues suggestive of cardiovascular involvement in the preclinical stage of the disease through clinical and imaging markers. Different pathophysiologically driven therapies are currently or will soon be available for the treatment of Fabry's disease, with the most significant benefit observed in the early stages of the disease. Thus, early diagnosis and risk stratification for adverse outcomes are crucial to determine when to start an aetiological treatment. This review describes the cardiovascular involvement in Fabry's disease, focusing on the advances in diagnostic strategies, outcome prediction and disease management.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
- Institute of Cardiovascular Science, University College LondonLondon, UK
| | - Luigi Falco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Alessia Perna
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Gaetano Diana
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
- Institute of Cardiovascular Science, University College LondonLondon, UK
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16
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Rashdan L, Hodovan J, Masri A. Imaging cardiac hypertrophy in hypertrophic cardiomyopathy and its differential diagnosis. Curr Opin Cardiol 2023:00001573-990000000-00084. [PMID: 37421401 DOI: 10.1097/hco.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to review imaging of myocardial hypertrophy in hypertrophic cardiomyopathy (HCM) and its phenocopies. The introduction of cardiac myosin inhibitors in HCM has emphasized the need for careful evaluation of the underlying cause of myocardial hypertrophy. RECENT FINDINGS Advances in imaging of myocardial hypertrophy have focused on improving precision, diagnosis, and predicting prognosis. From improved assessment of myocardial mass and function, to assessing myocardial fibrosis without the use of gadolinium, imaging continues to be the primary tool in understanding myocardial hypertrophy and its downstream effects. Advances in differentiating athlete's heart from HCM are noted, and the increasing rate of diagnosis in cardiac amyloidosis using noninvasive approaches is especially highlighted due to the implications on treatment approach. Finally, recent data on Fabry disease are shared as well as differentiating other phenocopies from HCM. SUMMARY Imaging hypertrophy in HCM and ruling out other phenocopies is central to the care of patients with HCM. This space will continue to rapidly evolve, as disease-modifying therapies are under investigation and being advanced to the clinic.
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Affiliation(s)
- Lana Rashdan
- Hypertrophic Cardiomyopathy Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
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17
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Averbuch T, White JA, Fine NM. Anderson-Fabry disease cardiomyopathy: an update on epidemiology, diagnostic approach, management and monitoring strategies. Front Cardiovasc Med 2023; 10:1152568. [PMID: 37332587 PMCID: PMC10272370 DOI: 10.3389/fcvm.2023.1152568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Anderson-Fabry disease (AFD) is an X-linked lysosomal storage disorder caused by deficient activity of the enzyme alpha-galactosidase. While AFD is recognized as a progressive multi-system disorder, infiltrative cardiomyopathy causing a number of cardiovascular manifestations is recognized as an important complication of this disease. AFD affects both men and women, although the clinical presentation typically varies by sex, with men presenting at a younger age with more neurologic and renal phenotype and women developing a later onset variant with more cardiovascular manifestations. AFD is an important cause of increased myocardial wall thickness, and advances in imaging, in particular cardiac magnetic resonance imaging and T1 mapping techniques, have improved the ability to identify this disease non-invasively. Diagnosis is confirmed by the presence of low alpha-galactosidase activity and identification of a mutation in the GLA gene. Enzyme replacement therapy remains the mainstay of disease modifying therapy, with two formulations currently approved. In addition, newer treatments such as oral chaperone therapy are now available for select patients, with a number of other investigational therapies in development. The availability of these therapies has significantly improved outcomes for AFD patients. Improved survival and the availability of multiple agents has presented new clinical dilemmas regarding disease monitoring and surveillance using clinical, imaging and laboratory biomarkers, in addition to improved approaches to managing cardiovascular risk factors and AFD complications. This review will provide an update on clinical recognition and diagnostic approaches including differentiation from other causes of increased ventricular wall thickness, in addition to modern strategies for management and follow-up.
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Affiliation(s)
- Tauben Averbuch
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - James A. White
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Center, Alberta Health Services, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell M. Fine
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
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18
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Burlina A, Brand E, Hughes D, Kantola I, Krӓmer J, Nowak A, Tøndel C, Wanner C, Spada M. An expert consensus on the recommendations for the use of biomarkers in Fabry disease. Mol Genet Metab 2023; 139:107585. [PMID: 37207471 DOI: 10.1016/j.ymgme.2023.107585] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023]
Abstract
Fabry disease is an X-linked lysosomal storage disorder caused by the accumulation of glycosphingolipids in various tissues and body fluids, leading to progressive organ damage and life-threatening complications. Phenotypic classification is based on disease progression and severity and can be used to predict outcomes. Patients with a classic Fabry phenotype have little to no residual α-Gal A activity and have widespread organ involvement, whereas patients with a later-onset phenotype have residual α-Gal A activity and disease progression can be limited to a single organ, often the heart. Diagnosis and monitoring of patients with Fabry disease should therefore be individualized, and biomarkers are available to support with this. Disease-specific biomarkers are useful in the diagnosis of Fabry disease; non-disease-specific biomarkers may be useful to assess organ damage. For most biomarkers it can be challenging to prove they translate to differences in the risk of clinical events associated with Fabry disease. Therefore, careful monitoring of treatment outcomes and collection of prospective data in patients are needed. As we deepen our understanding of Fabry disease, it is important to regularly re-evaluate and appraise published evidence relating to biomarkers. In this article, we present the results of a literature review of evidence published between February 2017 and July 2020 on the impact of disease-specific treatment on biomarkers and provide an expert consensus on clinical recommendations for the use of those biomarkers.
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Affiliation(s)
- Alessandro Burlina
- Neurological Unit, St. Bassiano Hospital, Via dei Lotti 40, I-36061 Bassano del Grappa, Italy.
| | - Eva Brand
- Internal Medicine, Department of Nephrology, Hypertension and Rheumatology; Interdisciplinary Fabry Center Münster (IFAZ), University Hospital Münster, Münster, Germany
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust, University College London, United Kingdom
| | - Ilkka Kantola
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Johannes Krӓmer
- Pediatric Neurology and Metabolism, Department of Pediatrics and Adolescent Medicine, University of Ulm, Ulm, Germany
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
| | - Camilla Tøndel
- Department of Clinical Science, University of Bergen and Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | - Christoph Wanner
- Department of Internal Medicine, Division of Nephrology, Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital of Würzburg, Würzburg, Germany
| | - Marco Spada
- Department of Pediatrics, University of Torino, Torino, Italy
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19
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Tore D, Faletti R, Gaetani C, Bozzo E, Biondo A, Carisio A, Menchini F, Miccolis M, Papa FP, Trovato M, Fonio P, Gatti M. Cardiac magnetic resonance of hypertrophic heart phenotype: A review. Heliyon 2023; 9:e17336. [PMID: 37441401 PMCID: PMC10333467 DOI: 10.1016/j.heliyon.2023.e17336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
Hypertrophic heart phenotype is characterized by an abnormal left ventricular (LV) thickening. A hypertrophic phenotype can develop as adaptive response in many different conditions such as aortic stenosis, hypertension, athletic training, infiltrative heart muscle diseases, storage disorders and metabolic disorders. Hypertrophic cardiomyopathy (HCM) is the most frequent primary cardiomyopathy (CMP) and a genetical cause of cardiac hypertrophy. It requires the exclusion of any other cause of LV hypertrophy. Cardiac magnetic resonance (CMR) is a comprehensive imaging technique that allows a detailed evaluation of myocardial diseases. It provides reproducible measurements and myocardial tissue characterization. In clinical practice CMR is increasingly used to confirm the presence of ventricular hypertrophy, to detect the underlying cause of the phenotype and more recently as an efficient prognostic tool. This article aims to provide a detailed overview of the applications of CMR in the setting of hypertrophic heart phenotype and its role in the diagnostic workflow of such condition.
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Affiliation(s)
- Davide Tore
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Clara Gaetani
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Elena Bozzo
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Andrea Biondo
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Andrea Carisio
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesca Menchini
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Maria Miccolis
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Pio Papa
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Martina Trovato
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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20
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Ismail TF, Frey S, Kaufmann BA, Winkel DJ, Boll DT, Zellweger MJ, Haaf P. Hypertensive Heart Disease-The Imaging Perspective. J Clin Med 2023; 12:jcm12093122. [PMID: 37176563 PMCID: PMC10179093 DOI: 10.3390/jcm12093122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Hypertensive heart disease (HHD) develops in response to the chronic exposure of the left ventricle and left atrium to elevated systemic blood pressure. Left ventricular structural changes include hypertrophy and interstitial fibrosis that in turn lead to functional changes including diastolic dysfunction and impaired left atrial and LV mechanical function. Ultimately, these changes can lead to heart failure with a preserved (HFpEF) or reduced (HFrEF) ejection fraction. This review will outline the clinical evaluation of a patient with hypertension and/or suspected HHD, with a particular emphasis on the role and recent advances of multimodality imaging in both diagnosis and differential diagnosis.
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Affiliation(s)
- Tevfik F Ismail
- King's College London & Cardiology Department, School of Biomedical Engineering and Imaging Sciences, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Simon Frey
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Beat A Kaufmann
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - David J Winkel
- Department of Radiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Daniel T Boll
- Department of Radiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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21
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Hiestand R, Nowak A, Sokolska JM, Chan R, Ruschitzka F, Manka R, Gruner C. Clinical and CMR characteristics associated with cardiac events in patients with Fabry disease. Int J Cardiol 2023; 382:46-51. [PMID: 37044180 DOI: 10.1016/j.ijcard.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The assessment of late gadolinium enhancement (LGE) and left ventricular hypertrophy (LVH) by cardiac magnetic resonance (CMR) as diagnostic and prognostic maker in Fabry disease is advancing. We aimed to investigate the impact of clinical characteristics and CMR findings on cardiac outcome in patients with FD. METHODS In this study 55 patients with genetically confirmed FD and available CMR imaging were included. The primary endpoint was defined as a composite of cardiac events including cardiac death, new occurrence of atrial fibrillation, heart failure, ventricular tachycardia and bradycardia requiring device insertion. RESULTS During a median follow-up of 4.9 years (IQR 3.7-5.9), 9 patients (16.3%) reached the primary cardiac end point. The global amount of LGE was associated with an increased risk for primary endpoint in the univariate analysis (HR 1.4 per 10% increase in LGE, p = 0.002). However maximal wall thickness (MWT) was the sole independent predictor of the primary endpoint in a stepwise logistic regression model (HR 9.8 per mm increase in MWT, p < 0.0001). Kaplan-Meier analysis revealed significant difference in event free survival rate between patients with and without LVH (Long-rank p = 0.006) and in patients with and without LGE (Long-rank p < 0.001). Patients without LVH and LGE were free of adverse cardiac events. CONCLUSION LVH and LGE detected by CMR were associated with adverse cardiac events in FD. In particular maximal wall thickness can be useful in cardiac risk stratification of FD patients.
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Affiliation(s)
- Roxana Hiestand
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Switzerland; Department of Internal Medicine, Psychiatry University Hospital Zurich, Switzerland
| | - Justyna M Sokolska
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland; Department of Cardiovascular Imaging, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Raymond Chan
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Christiane Gruner
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
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22
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Avanesov M, Asgari A, Muschol N, Köhn AF, Tahir E, Adam G, Kirchhof P, Lund G, Cavus E, Patten M. Comparison of classical Fabry and its p.D313Y and p.A143T variants by cardiac T1 mapping, LGE and feature tracking myocardial strain. Sci Rep 2023; 13:5809. [PMID: 37037838 PMCID: PMC10086062 DOI: 10.1038/s41598-023-32464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023] Open
Abstract
Cardiac manifestation of classical Fabry disease (cFD) varies with sex and presence of left ventricular hypertrophy. p.D313Y/p.A143T variants (vFD) represent milder late-onset phenotypes, however, data on vFD are scarce. Patients with FD (cFD = 37;vFD = 14) and 14 healthy controls underwent 1.5 T CMR including Cine, LGE, native T1 mapping(nT1) and myocardial strain(CMR-FT). CMR-FT was assessed using ventricular longitudinal, circumferential, radial (LV-GLS/RV-GLS, LV-GCS/LV-GRS), and atrial longitudinal strain (LA/RATotal, LA/RAConduit, LA/RABooster). In cFD reduced myocardial strain (LV-GLS: -20 ± 4 vs. -24 ± 3%,p = 0.007; LV-GCS: -20 ± 4 vs. -26 ± 4%,p = 0.002, LA Total -GLS: 29 ± 10 vs. 37 ± 6%,p = 0.007; LA Conduit -GLS: 15 ± 10 vs. 23 ± 5%,p = 0.003) and nT1 values (951 ± 51 ms vs. 1036 ± 20 ms, p < 0.001) were observed compared to controls. In vFD findings were comparable to controls. LV-GCS provided the closest Area under the curve (AUC) to nT1 (0.84 vs. 0.92, p > 0.05) for discrimination of cFD versus controls. Significantly lower LV-GLS/LV-GCS was found in male compared to female cFD (-19 ± 4 vs. -22 ± 4%, p = 0.03). In six non-hypertrophied female cFD with normal nT1 LATotal -GLS was the only discriminating parameter with an accuracy of 86%. LV-GLS, LV-GCS and LATotal -GLS can detect impaired cardiac mechanics of cFD besides nT1. LATotal -GLS might identify non-hypertrophied female cFD. Variants p.D313Y/p.A143T did not reveal cardiac involvement by multiparametric CMR.
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Affiliation(s)
- Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Anahid Asgari
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Nicole Muschol
- Department of Pediatrics, International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Friederike Köhn
- Department of Pediatrics, International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, University Hospital Hamburg Eppendorf, 20246, Hamburg, Germany
- Deutsches Zentrum Für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Gunnar Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, University Hospital Hamburg Eppendorf, 20246, Hamburg, Germany.
- Deutsches Zentrum Für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany.
| | - Monica Patten
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, University Hospital Hamburg Eppendorf, 20246, Hamburg, Germany
- Deutsches Zentrum Für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
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23
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Giannopoulos AA, Buechel RR, Kaufmann PA. Coronary microvascular disease in hypertrophic and infiltrative cardiomyopathies. J Nucl Cardiol 2023; 30:800-810. [PMID: 35915323 PMCID: PMC10125945 DOI: 10.1007/s12350-022-03040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022]
Abstract
Pathologic hypertrophy of the cardiac muscle is a commonly encountered phenotype in clinical practice, associated with a variety of structural and non-structural diseases. Coronary microvascular disease is considered to play an important role in the natural history of this pathological phenotype. Non-invasive imaging modalities, most prominently positron emission tomography and cardiac magnetic resonance, have provided insights into the pathophysiological mechanisms of the interplay between hypertrophy and the coronary microvasculature. This article summarizes the current knowledge on coronary microvascular dysfunction in the most frequently encountered forms of pathologic hypertrophy.
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Affiliation(s)
- Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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24
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Perera K, Kashyap N, Wang K, Omar F, Prosia E, Thompson RB, Paterson DI, Fine NM, White JA, Khan A, Oudit GY. Integrating Cardiac MRI Imaging and Multidisciplinary Clinical Care is Associated With Improved Outcomes in Patients With Fabry Disease. Curr Probl Cardiol 2023; 48:101476. [PMID: 36328338 DOI: 10.1016/j.cpcardiol.2022.101476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 01/04/2023]
Abstract
Given the inherent complexities of Fabry disease (FD) and evolving landscape of cardiovascular clinical management, there is no established ideal clinical care model for these patients. We identified clinical factors predictive of increased risk of major adverse cardiac events (MACE) in patients with FD targeted to improve clinical outcomes. Ninety-five patients studied over a median follow-up time of 6.3 years, and 26 patients reached the composite endpoint with a high prevalence of heart failure and cerebrovascular events and no cardiac-related mortality. Patients with MACE had worse health-related quality of life scores. Hypertrophy and presence of myocardial fibrosis increase risk of MACE by 4-5 times, and dyslipidemia increases risk of MACE by 3 times. Early Fabry-specific treatment and close monitoring of comorbidities reduce cardiac complications and mortality. These findings highlight the importance of comprehensive multidisciplinary management to help improve outcomes in FD patients.
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Affiliation(s)
- Kevin Perera
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Niharika Kashyap
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kaiming Wang
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Fadya Omar
- School of Health and Public Safety, Southern Alberta Institute of Technology, Calgary, Alberta, Canada; Metabolics and Genetics in Canada (M.A.G.I.C.) Clinic Ltd., Calgary, Alberta, Canada
| | - Easter Prosia
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - D Ian Paterson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Nowell M Fine
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada
| | - James A White
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada
| | - Aneal Khan
- Metabolics and Genetics in Canada (M.A.G.I.C.) Clinic Ltd., Calgary, Alberta, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gavin Y Oudit
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
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25
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Bruno F, Frea S, Gatti M, Barreca A, Attanasio A, Pidello S, Raineri C, Imazio M, De Ferrari GM. Early stage Fabry cardiomyopathy misdiagnosed as perimyocarditis. J Cardiovasc Med (Hagerstown) 2023; 24:147-151. [PMID: 36583985 DOI: 10.2459/jcm.0000000000001405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital
| | - Simone Frea
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital
| | | | | | - Angelo Attanasio
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefano Pidello
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital
| | - Claudia Raineri
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital
| | - Massimo Imazio
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital
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26
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Imaging of metabolic and overload disorders in tissues and organs. Jpn J Radiol 2023; 41:571-595. [PMID: 36680702 DOI: 10.1007/s11604-022-01379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/24/2022] [Indexed: 01/22/2023]
Abstract
Metabolic and overload disorders are a heterogeneous group of relatively uncommon but important diseases. While imaging plays a key role in the early detection and accurate diagnosis in specific organs with a pivotal role in several metabolic pathways, most of these diseases affect different tissues as part of a systemic syndromes. Moreover, since the symptoms are often vague and phenotypes similar, imaging alterations can present as incidental findings, which must be recognized and interpreted in the light of further biochemical and histological investigations. Among imaging modalities, MRI allows, thanks to its multiparametric properties, to obtain numerous information on tissue composition, but many metabolic and accumulation alterations require a multimodal evaluation, possibly using advanced imaging techniques and sequences, not only for the detection but also for accurate characterization and quantification. The purpose of this review is to describe the different alterations resulting from metabolic and overload pathologies in organs and tissues throughout the body, with particular reference to imaging findings.
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El Sayed M, Postema PG, Datema M, van Dussen L, Kors JA, ter Haar CC, Bleijendaal H, Galenkamp H, van den Born BJH, Hollak CEM, Langeveld M. ECG Changes during Adult Life in Fabry Disease: Results from a Large Longitudinal Cohort Study. Diagnostics (Basel) 2023; 13:diagnostics13030354. [PMID: 36766461 PMCID: PMC9913957 DOI: 10.3390/diagnostics13030354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/07/2023] [Accepted: 01/14/2023] [Indexed: 01/21/2023] Open
Abstract
Background: Fabry disease (FD) is an X-linked, lysosomal storage disorder leading to severe cardiomyopathy in a significant proportion of patients. To identify ECG markers that reflect early cardiac involvement and disease progression, we conducted a long term retrospective study in a large cohort of FD patients. Methods: A total of 1995 ECGs from 133 patients with classical FD (64% females, 80% treated with enzyme replacement therapy), spanning 20 years of follow-up, were compared to ECGs from 3893 apparently healthy individuals. Generalized linear mixed models were used to evaluate the effect of age, FD and sex on: P-wave duration, PR-interval, QRS-duration, QTc, Cornell index, spatial QRS-T angle and frontal QRS-axis. Regression slopes and absolute values for each parameter were compared between FD patients and control subjects. Results: At a younger age (<40 years), the Cornell index was higher and frontal QRS-axis more negative in FD patients compared to controls (p < 0.05). For the other ECG parameters, the rate of change, more than the absolute value, was greater in FD patients compared to controls (p < 0.05). From the fifth decade (men) or sixth (women) onwards, absolute values for P-wave duration, QRS-duration, QTc and spatial QRS-T angle were longer and higher in FD patients compared to control subjects. Conclusions: ECG abnormalities indicative of FD are age and sex dependent. Tracking the rate of change in ECG parameters could be a good way to detect disease progression, guiding treatment initiation. Moreover, monitoring ECG changes in FD can be used to evaluate the effectiveness of treatment.
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Affiliation(s)
- Mohamed El Sayed
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Inborn Errors of Metabolism, 1105 AZ Amsterdam, The Netherlands
| | - Pieter G. Postema
- Department of Cardiology, Heart Center, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, 1105 AZ Amsterdam, The Netherlands
| | - Mareen Datema
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Inborn Errors of Metabolism, 1105 AZ Amsterdam, The Netherlands
| | - Laura van Dussen
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Inborn Errors of Metabolism, 1105 AZ Amsterdam, The Netherlands
| | - Jan A. Kors
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Cato C. ter Haar
- Department of Cardiology, Heart Center, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, 1105 AZ Amsterdam, The Netherlands
| | - Hidde Bleijendaal
- Department of Cardiology, Heart Center, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, 1105 AZ Amsterdam, The Netherlands
- Department of Biostatistics & Bioinformatics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Health Behaviors and Chronic Diseases, 1105 AZ Amsterdam, The Netherlands
| | - Bert-Jan H. van den Born
- Amsterdam Public Health, Health Behaviors and Chronic Diseases, 1105 AZ Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, 1105 AZ Amsterdam, The Netherlands
| | - Carla E. M. Hollak
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Inborn Errors of Metabolism, 1105 AZ Amsterdam, The Netherlands
| | - Mirjam Langeveld
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Inborn Errors of Metabolism, 1105 AZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-5663578; Fax: +31-20-6917682
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The Spanish Fabry women study: a retrospective observational study describing the phenotype of females with GLA variants. Orphanet J Rare Dis 2023; 18:8. [PMID: 36624527 PMCID: PMC9830917 DOI: 10.1186/s13023-022-02599-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Fabry disease (FD) is an X-linked condition caused by variants in the GLA gene. Since females have two X chromosomes, they were historically thought to be carriers. Although increased knowledge has shown that females often develop the disease, data from Spain and other countries reported that females were undertreated. The aim of this study was to provide a wider and more recent description of the disease characteristics and associated management of females with a GLA variant in a Spanish cohort. RESULTS Ninety-seven females from 12 hospitals were included in this retrospective study. Mean age was 50.1 ± 17.2 years. Median follow-up time from GLA variant identification was 36.1 months, and most (70.1%) were identified through family screening. Variants associated with classic/non-classic phenotypes were similarly distributed (40.2%/53.6%). Missense variants were the most prevalent (n = 84, 86.6%). In the overall group, 70.4% had major organ involvement (i.e., cardiac, renal, cerebrovascular, peripheral nervous system or gastrointestinal), and 47.3% also had typical Fabry signs (angiokeratoma, cornea verticillata or increased plasma lyso-Gb3). Cardiac involvement was the most prevalent (49.5%) and the main reason for treatment initiation. A total of 33 (34%) patients received disease-specific therapy, 55% of whom were diagnosed by family screening. Females carrying variants associated with a classic phenotype had higher frequencies of clinical manifestations (92.3%) and were predominant in the treated subgroup (69.7%). Despite this, there were 34 untreated females (56.7% of total untreated), with both phenotypes represented, who had major organ involvement, with 27 of cardiac, renal or cerebrovascular nature. Age or comorbidities in this subgroup were comparable to the treated subgroup (P = 0.8 and P = 0.8, respectively). CONCLUSIONS Efforts have been made in recent years to diagnose and treat timely Fabry females in Spain. A high percentage of females with pathogenic variants, regardless of their associated phenotype, will likely develop disease. A proportion of females with severe disease in this cohort received specific treatment. Still a significant number of females, even with same profile as the treated ones, who may be eligible for treatment according to European recommendations, remained untreated. Reasons for this merit further investigation.
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Left atrial strain correlates with severity of cardiac involvement in Anderson-Fabry disease. Eur Radiol 2023; 33:2039-2051. [PMID: 36322192 PMCID: PMC9935647 DOI: 10.1007/s00330-022-09183-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/08/2022] [Accepted: 09/19/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Cardiac involvement in Anderson-Fabry disease (AFD) results in myocardial lipid depositions. An early diagnosis can maximize therapeutic benefit. Thus, this study aims to investigate the potential of cardiac MRI (CMR) based parameters of left atrial (LA) function and strain to detect early stages of AFD. METHODS Patients (n = 58, age 40 (29-51) years, 31 female) with genetically proven AFD had undergone CMR including left ventricular (LV) volumetry, mass index (LVMi), T1, and late gadolinium enhancement, complemented by LA and LV strain measurements and atrial emptying fractions. Patients were stratified into three disease phases and compared to age and sex-matched healthy controls (HC, n = 58, age 41 [26-56] years, 31 female). RESULTS A total of 19 early-, 20 intermediate-, and 19 advanced-phase patients were included. LV and LA reservoir strain was significantly impaired in all AFD phases, including early disease (both p < 0.001). In contrast, LA volumetry, T1, and LVMi showed no significant differences between the early phase and HC (p > 0.05). In the intermediate phase, LVMi and T1 demonstrated significant differences. In advanced phase, all parameters except active emptying fractions differed significantly from HC. ROC curve analyses of early disease phases revealed superior diagnostic confidence for the LA reservoir strain (AUC 0.88, sensitivity 89%, specificity 75%) over the LV strain (AUC 0.82). CONCLUSIONS LA reservoir strain showed impairment in early AFD and significantly correlated with disease severity. The novel approach performed better in identifying early disease than the established approach using LVMi and T1. Further studies are needed to evaluate whether these results justify earlier initiation of therapy and help minimize cardiac complications. KEY POINTS • Parameters of left atrial function and deformation showed impairments in the early stages of Anderson-Fabry disease and correlated significantly with the severity of Anderson-Fabry disease. • Left atrial reservoir strain performed superior to ventricular strain in detecting early myocardial involvement in Anderson-Fabry disease and improved diagnostic accuracies of approaches already using ventricular strain. • Further studies are needed to evaluate whether earlier initiation of enzyme replacement therapy based on these results can help minimize cardiac complications from Anderson-Fabry disease.
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Role of cardiovascular magnetic resonance in the clinical evaluation of left ventricular hypertrophy: a 360° panorama. Int J Cardiovasc Imaging 2022; 39:793-809. [PMID: 36543912 DOI: 10.1007/s10554-022-02774-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
Left ventricular hypertrophy (LVH) is a frequent imaging finding in the general population. In order to identify the precise etiology, a comprehensive diagnostic approach should be adopted, including the prevalence of each entity that may cause LVH, family history, clinical, electrocardiographic and imaging findings. By providing a detailed evaluation of the myocardium, cardiovascular magnetic resonance (CMR) has assumed a central role in the differential diagnosis of left ventricular hypertrophy, with the technique of parametric imaging allowing more refined tissue characterization. This article aims to establish a parallel between pathophysiological features and imaging findings through the broad spectrum of LVH entities, emphasizing the role of CMR in the differential diagnosis.
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Cardiac Magnetic Resonance in Fabry Disease: Morphological, Functional, and Tissue Features. Diagnostics (Basel) 2022; 12:diagnostics12112652. [DOI: 10.3390/diagnostics12112652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 10/29/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
Fabry disease (FD) is an X-linked inheritable storage disease caused by a deficiency of alpha-galactosidase causing lysosomal overload of sphingolipids. FD cardiomyopathy is characterized by left ventricular (LV) hypertrophy and should be considered in differential diagnosis with all the other causes of LV hypertrophy. An early diagnosis of FD is very important because the enzyme replacement therapy (ERT) may change the fate of patients by blocking both cardiac and systemic involvement and improving prognosis. Diagnosis may be relatively easy in young patients with the typical signs and symptoms of FD, but in male patients with late onset of disease and in females, diagnosis may be very challenging. Morphological and functional aspects are not specific to FD, which cannot be diagnosed or excluded by echocardiography. Cardiac magnetic resonance (CMR) with tissue characterization capability is an accurate technique for the differential diagnosis of LV hypertrophy. The finding of decreased myocardial T1 value in LV hypertrophy is specific to FD. Late gadolinium enhancement (LGE) is found in the late stage of the disease, but it is useful to predict the cardiac response to ERT and to stratify the prognosis.
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Beyond Sarcomeric Hypertrophic Cardiomyopathy: How to Diagnose and Manage Phenocopies. Curr Cardiol Rep 2022; 24:1567-1585. [PMID: 36053410 DOI: 10.1007/s11886-022-01778-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW We describe the most common phenocopies of hypertrophic cardiomyopathy, their pathogenesis, and clinical presentation highlighting similarities and differences. We also suggest a step-by-step diagnostic work-up that can guide in differential diagnosis and management. RECENT FINDINGS In the last years, a wider application of genetic testing and the advances in cardiac imaging have significantly changed the diagnostic approach to HCM phenocopies. Different prognosis and management, with an increasing availability of disease-specific therapies, make differential diagnosis mandatory. The HCM phenotype can be the cardiac manifestation of different inherited and acquired disorders presenting different etiology, prognosis, and treatment. Differential diagnosis requires a cardiomyopathic mindset allowing to recognize red flags throughout the diagnostic work-up starting from clinical and family history and ending with advanced imaging and genetic testing. Different prognosis and management, with an increasing availability of disease-specific therapies make differential diagnosis mandatory.
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Monda E, Limongelli G. A Roadmap to Predict Adverse Outcome in Fabry Disease. J Am Coll Cardiol 2022; 80:995-997. [PMID: 36049807 DOI: 10.1016/j.jacc.2022.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London, United Kingdom. https://twitter.com/glimongelli
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Hongo K. Cardiac involvement in Fabry disease - A non-invasive assessment and the role of specific therapies. Mol Genet Metab 2022; 137:179-186. [PMID: 36088815 DOI: 10.1016/j.ymgme.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Abstract
Fabry disease is an X-linked inherited metabolic disorder due to the pathogenic mutation of the GLA gene, which codes lysosomal enzyme alpha-galactosidase A. The resultant accumulation of glycosphingolipids causes various systemic symptoms in childhood and adolescence, and major organ damage in adulthood. Cardiac involvement is important as the most frequent cause of death in Fabry disease patients. Progressive left ventricular hypertrophy with varying degrees of contractile dysfunction as well as conduction abnormalities and arrhythmias are typical cardiac features, and these findings can be evaluated in detail via non-invasive modalities, such as an electrocardiogram, echocardiography and cardiac magnetic resonance. In addition, specific therapies of enzyme replacement therapy and pharmacological chaperone therapy are available, and their beneficial effects on cardiac involvement have been reported. This minireview highlights recent evidence concerning non-invasive modalities for assessing cardiac involvement in Fabry disease and the effects of enzyme replacement therapy and pharmacological chaperone therapy on the findings of those modalities.
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Affiliation(s)
- Kenichi Hongo
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, 105-8461 Tokyo, Japan.
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Germain DP, Altarescu G, Barriales-Villa R, Mignani R, Pawlaczyk K, Pieruzzi F, Terryn W, Vujkovac B, Ortiz A. An expert consensus on practical clinical recommendations and guidance for patients with classic Fabry disease. Mol Genet Metab 2022; 137:49-61. [PMID: 35926321 DOI: 10.1016/j.ymgme.2022.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Abstract
Fabry disease is an X-linked inherited lysosomal disorder that causes accumulation of glycosphingolipids in body fluids and tissues, leading to progressive organ damage and reduced life expectancy. It can affect both males and females and can be classified into classic or later-onset phenotypes. In classic Fabry disease, α-galactosidase A (α-Gal A) activity is absent or severely reduced and disease manifestations have an early onset that can affect multiple organs. In contrast, in later-onset Fabry disease, patients have residual α-Gal A activity and clinical features are primarily confined to the heart. Individualized therapeutic goals in Fabry disease are required due to varying phenotypes and patient characteristics, and the wide spectrum of disease severity. An international group of expert physicians convened to discuss and develop practical clinical recommendations for disease- and organ-specific therapeutic goals in Fabry disease, based on expert consensus and evidence identified through a structured literature review. Biomarkers reflecting involvement of various organs in adult patients with classic Fabry disease are discussed and consensus recommendations for disease- and organ-specific therapeutic goals are provided. These consensus recommendations should support the establishment of individualized approaches to the management of patients with classic Fabry disease by considering identification, diagnosis, and initiation of disease-specific therapies before significant organ involvement, as well as routine monitoring, to reduce morbidity, optimize patient care, and improve patient health-related quality of life.
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Affiliation(s)
- Dominique P Germain
- French Referral Center for Fabry disease and MetabERN European Reference Network for Inherited Metabolic Diseases, Division of Medical Genetics, University of Versailles, Paris-Saclay University, 2, allée de la source de la Bièvre, 78180 Montigny, France
| | - Gheona Altarescu
- Shaare Zedek Institute of Medical Genetics, Shaare Zedek Medical Center, Shmu'el Bait St 12, Jerusalem 9103102, Israel
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Hospital Universitario da Coruña, (INIBIC/CIBERCV), As Xubias, 84, 15006 A Coruña, Spain
| | - Renzo Mignani
- Department of Nephrology, Infermi Hospital, Viale Luigi Settembrini, 2, 47923 Rimini, RN, Italy
| | - Krzysztof Pawlaczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Collegium Maius, Fredry 10, 61-701 Poznań, Poland
| | - Federico Pieruzzi
- Nephrology Clinic, School of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milano, MI, Italy; Nephrology and Dialysis Department, ASST-Monza, San-Gerardo Hospital, Via Aliprandi, 23, 20900 Monza, MB, Italy
| | - Wim Terryn
- General Internal Medicine and Nephrology, Jan Yperman Hospital, Briekestraat 12, 8900 Ypres, Belgium
| | - Bojan Vujkovac
- Fabry Center, Slovenj Gradec General Hospital, Gosposvetska cesta 3, 2380 Slovenj Gradec, Slovenia
| | - Alberto Ortiz
- Jiménez Díaz Foundation University Hospital, Avda. Reyes Católicos, 2, 28040 Madrid, Spain; Department of Medicine, Universidad Autonoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain.
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Halfmann MC, Benz S, Schoepf UJ, Hennermann JB, Kreitner KF, Lollert A, Dueber C, Altmann S, Varga-Szemes A, Kampmann C, Emrich T. Biventricular strain assessment indicates progressive impairment of myocardial contractility in phenotypically negative patients with Fabry's disease. Eur J Radiol 2022; 155:110471. [PMID: 35985091 DOI: 10.1016/j.ejrad.2022.110471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/01/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The accumulation of sphingolipids in Fabry's disease (FD) leads to left ventricular (LV) hypertrophy and shortened T1 in cardiac magnetic resonance (CMR). Early detection of myocardial involvement is essential for the timely initiation and efficacy of enzyme replacement therapy. However, there is a diagnostic gap between the onset of accumulation and detectable myocardial changes. This study aimed to evaluate the diagnostic value of biventricular strain assessment in early FD. METHODS Genetically proven FD patients (n = 58) and healthy volunteers (HV, n = 62) who had undergone 3 T CMR were retrospectively identified and stratified into 3 groups according to disease severity. Biventricular volumetry, global longitudinal strains (GLS), indexed biventricular masses (RVMi/LVMi), and T1 were evaluated. Group comparisons were performed by ANOVA and diagnostic accuracy was evaluated by ROC-analysis. RESULTS The study population included 19 group I, 20 group II and 19 group III patients. LV volumetry and T1 showed no significant difference between early FD patients and HV (all p > 0.760). However, RVMi was increased, while RV-GLS and LV-GLS were significantly impaired (p = 0.024 and < 0.001, respectively). Biventricular strains accurately discriminated early FD patients and HV with RV-GLS being non-inferior to LV-GLS (AUC for both 0.83, p > 0.05). Adding strains to the established approach using T1 and LVMi further increased diagnostic accuracy (AUC 0.99, p < 0.05). CONCLUSIONS Biventricular strains may help detect altered myocardial deformation patterns in phenotypically negative FD patients. These findings may lead to an earlier initiation of therapy, which in turn may slow hypertrophy and the associated long-term risks.
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Affiliation(s)
- Moritz C Halfmann
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany; German Centre for Cardiovascular Research, DZHK, Potsdamer St. 58, 10785 Berlin, Germany.
| | - Sebastian Benz
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425, USA.
| | - Julia B Hennermann
- Center of Pediatric and Adolescent Medicine, Department of Metabolic Diseases, Villa Metabolica, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - Karl-Friedrich Kreitner
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - André Lollert
- Department for Diagnostic and Interventional Radiology, Section of Pediatric Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - Christoph Dueber
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - Sebastian Altmann
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany; German Centre for Cardiovascular Research, DZHK, Potsdamer St. 58, 10785 Berlin, Germany.
| | - Akos Varga-Szemes
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - Christoph Kampmann
- Center of Pediatric and Adolescent Medicine, Department of Paediatric Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - Tilman Emrich
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany; German Centre for Cardiovascular Research, DZHK, Potsdamer St. 58, 10785 Berlin, Germany; Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425, USA.
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Ojha V, Khalique OK, Khurana R, Lorenzatti D, Leung SW, Lawton B, Slesnick TC, Cavalcante JC, Ducci CB, Patel AR, Prieto CC, Plein S, Raman SV, Salerno M, Parwani P. Highlights of the Virtual Society for Cardiovascular Magnetic Resonance 2022 Scientific Conference: CMR: improving cardiovascular care around the world. J Cardiovasc Magn Reson 2022; 24:38. [PMID: 35725565 PMCID: PMC9207863 DOI: 10.1186/s12968-022-00870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
The 25th Society for Cardiovascular Magnetic Resonance (SCMR) Annual Scientific Sessions saw 1524 registered participants from more than 50 countries attending the meeting virtually. Supporting the theme "CMR: Improving Cardiovascular Care Around the World", the meeting included 179 invited talks, 52 sessions including 3 plenary sessions, 2 keynote talks, and a total of 93 cases and 416 posters. The sessions were designed so as to showcase the multifaceted role of cardiovascular magnetic resonance (CMR) in identifying and prognosticating various myocardial pathologies. Additionally, various social networking sessions as well as fun activities were organized. The major areas of focus for the future are likely to be rapid efficient and high value CMR exams, automated and quantitative acquisition and post-processing using artificial intelligence and machine learning, multi-contrast imaging and advanced vascular imaging including 4D flow.
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Affiliation(s)
- Vineeta Ojha
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Steve W Leung
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | | | | | | | | | - Amit R Patel
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Claudia C Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Subha V Raman
- Indiana University Cardiovascular Institute and Krannert Cardiovascular Research Center, Indianapolis, IN, USA
| | - Michael Salerno
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda University Medical Center, Loma Linda, CA, USA.
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Acampa W, D'Antonio A, Imbriaco M, Pisani A, Cuocolo A. Multimodality imaging approach to Fabry cardiomyopathy: Any role for nuclear cardiology? J Nucl Cardiol 2022; 29:1439-1445. [PMID: 32378117 DOI: 10.1007/s12350-020-02124-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Indexed: 11/29/2022]
Abstract
Anderson-Fabry disease (AFD) is a multisystem X-linked disorder of lipid metabolism frequently associated with progressive glycosphingolipid accumulation in cardiac, renal, and nervous cells. The diagnosis of AFD is usually assessed by enzyme assay and genetic tests, but advanced cardiac imaging can be useful in detecting early signs of the disease. Echocardiography and cardiac magnetic resonance are the first-line imaging modalities to investigate cardiac involvement in AFD, but the recent introduction of new molecular and hybrid imaging techniques opens to a wider range of diagnostic applications. This article aims to provide an overview of nuclear cardiology techniques in diagnosis and clinical management of AFD.
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Affiliation(s)
- Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Antonio Pisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy.
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Christidi A, Mavrogeni SI. Rare Metabolic and Endocrine Diseases with Cardiovascular Involvement: Insights from Cardiovascular Magnetic Resonance - A Review. Horm Metab Res 2022; 54:339-353. [PMID: 35526533 DOI: 10.1055/a-1846-4878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Aikaterini Christidi
- Cardiovascular Magnetic Resonance, Euromedica General Clinic, Thessaloniki, Greece
| | - Sophie I Mavrogeni
- Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece, Exercise Physiology and Sport Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, Athens, Greece
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40
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The Cardiovascular Manifestations of Anderson-Fabry Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00691-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ponsiglione A, Gambardella M, Green R, Cantoni V, Nappi C, Ascione R, De Giorgi M, Cuocolo R, Pisani A, Petretta M, Cuocolo A, Imbriaco M. Cardiovascular magnetic resonance native T1 mapping in Anderson-Fabry disease: a systematic review and meta-analysis. J Cardiovasc Magn Reson 2022; 24:31. [PMID: 35606874 PMCID: PMC9125845 DOI: 10.1186/s12968-022-00859-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND T1 mapping is an established cardiovascular magnetic resonance (CMR) technique that can characterize myocardial tissue. We aimed to determine the weighted mean native T1 values of Anderson-Fabry disease (AFD) patients and the standardized mean differences (SMD) as compared to healthy control subjects. METHODS A comprehensive literature search of the PubMed, Scopus and Web of Science databases was conducted according to the PRISMA statement to retrieve original studies reporting myocardial native T1 values in AFD patients and healthy controls. A random effects model was used to calculate SMD, and meta-regression analysis was conducted to explore heterogeneity sources. Subgroup analysis was also performed according to scanner field strength and sequence type. RESULTS From a total of 151 items, 14 articles were included in the final analysis accounting for a total population of 982 subjects. Overall, the weighted mean native T1 values was 984 ± 47 ms in AFD patients and 1016 ± 26 ms in controls (P < 0.0001) with a pooled SMD of - 2.38. In AFD patients there was an inverse correlation between native T1 values and male gender (P = 0.002) and left ventricular hypertrophy (LVH) (P < 0.001). Subgroup analyses confirmed lower T1 values in AFD patients compared to controls with a pooled SMD of - 2.54, - 2.28, - 2.46 for studies performed on 1.5T with modified Look-Locker inversion recovery (MOLLI), shortened MOLLI and saturation-recovery single-shot acquisition, respectively and of - 2.41 for studies conducted on 3T. CONCLUSIONS Our findings confirm a reduction of native T1 values in AFD patients compared to healthy controls and point out that the degree of T1 shortening in AFD is influenced by gender and LVH. Although T1 mapping is useful in proving cardiac involvement in AFD patients, there is need to standardize shreshold values according to imaging equipment and protocols.
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Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Michele Gambardella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Renato Cuocolo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Interdepartmental Research Center on Management and Innovation in Healthcare (CIRMIS), University of Naples Federico II, Naples, Italy
| | - Antonio Pisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
- Interdepartmental Research Center on Management and Innovation in Healthcare (CIRMIS), University of Naples Federico II, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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Cha MJ, Kim C, Park CH, Hong YJ, Shin JM, Kim TH, Cha YJ, Park CH. Differential Diagnosis of Thick Myocardium according to Histologic Features Revealed by Multiparametric Cardiac Magnetic Resonance Imaging. Korean J Radiol 2022; 23:581-597. [PMID: 35555885 PMCID: PMC9174501 DOI: 10.3348/kjr.2021.0815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 11/16/2022] Open
Abstract
Left ventricular (LV) wall thickening, or LV hypertrophy (LVH), is common and occurs in diverse conditions including hypertrophic cardiomyopathy (HCM), hypertensive heart disease, aortic valve stenosis, lysosomal storage disorders, cardiac amyloidosis, mitochondrial cardiomyopathy, sarcoidosis and athlete’s heart. Cardiac magnetic resonance (CMR) imaging provides various tissue contrasts and characteristics that reflect histological changes in the myocardium, such as cellular hypertrophy, cardiomyocyte disarray, interstitial fibrosis, extracellular accumulation of insoluble proteins, intracellular accumulation of fat, and intracellular vacuolar changes. Therefore, CMR imaging may be beneficial in establishing a differential diagnosis of LVH. Although various diseases share LV wall thickening as a common feature, the histologic changes that underscore each disease are distinct. This review focuses on CMR multiparametric myocardial analysis, which may provide clues for the differentiation of thickened myocardium based on the histologic features of HCM and its phenocopies.
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Affiliation(s)
- Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Min Shin
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Silva CAB, Andrade LGMD, Vaisbich MH, Barreto FDC. Brazilian consensus recommendations for the diagnosis, screening, and treatment of individuals with fabry disease: Committee for Rare Diseases - Brazilian Society of Nephrology/2021. J Bras Nefrol 2022; 44:249-267. [PMID: 35212703 PMCID: PMC9269181 DOI: 10.1590/2175-8239-jbn-2021-0208] [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: 08/26/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022] Open
Abstract
Fabry disease (FD) is an X-linked inherited disorder caused by mutations in the GLA gene encoding enzyme alpha-galactosidase A (α-Gal A). The purpose of this study was to produce a consensus statement to standardize the recommendations concerning kidney involvement in FD and provide advice on the diagnosis, screening, and treatment of adult and pediatric patients. This consensus document was organized from an initiative led by the Committee for Rare Diseases (Comdora) of the Brazilian Society of Nephrology (SBN). The review considered randomized clinical trials, real-world data studies, and the expertise of its authors. The purpose of this consensus statement is to help manage patient and physician expectations concerning the outcomes of treatment. Our recommendations must be interpreted within the context of available evidence. The decisions pertaining to each individual case must be made with the involvement of patients and their families and take into account not only the potential cost of treatment, but also concurrent conditions and personal preferences. The Comdora intends to update these recommendations regularly so as to reflect recent literature evidence, real-world data, and appreciate the professional experience of those involved. This consensus document establishes clear criteria for the diagnosis of FD and for when to start or stop specific therapies or adjuvant measures, to thus advise the medical community and standardize clinical practice.
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44
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Menacho KD, Ramirez S, Perez A, Dragonetti L, Perez de Arenaza D, Katekaru D, Illatopa V, Munive S, Rodriguez B, Shimabukuro A, Cupe K, Bansal R, Bhargava V, Rodriguez I, Seraphim A, Knott K, Abdel-Gadir A, Guerrero S, Lazo M, Uscamaita D, Rivero M, Amaya N, Sharma S, Peix A, Treibel T, Manisty C, Mohiddin S, Litt H, Han Y, Fernandes J, Jacob R, Westwood M, Ntusi N, Herrey A, Walker JM, Moon J. Improving cardiovascular magnetic resonance access in low- and middle-income countries for cardiomyopathy assessment: rapid cardiovascular magnetic resonance. Eur Heart J 2022; 43:2496-2507. [PMID: 35139531 PMCID: PMC9259377 DOI: 10.1093/eurheartj/ehac035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/30/2021] [Accepted: 01/18/2022] [Indexed: 02/01/2023] Open
Abstract
AIMS To evaluate the impact of a simplified, rapid cardiovascular magnetic resonance (CMR) protocol embedded in care and supported by a partner education programme on the management of cardiomyopathy (CMP) in low- and middle-income countries (LMICs). METHODS AND RESULTS Rapid CMR focused particularly on CMP was implemented in 11 centres, 7 cities, 5 countries, and 3 continents linked to training courses for local professionals. Patients were followed up for 24 months to assess impact. The rate of subsequent adoption was tracked. Five CMR conferences were delivered (920 attendees-potential referrers, radiographers, reporting cardiologists, or radiologists) and five new centres starting CMR. Six hundred and one patients were scanned. Cardiovascular magnetic resonance indications were 24% non-contrast T2* scans [myocardial iron overload (MIO)] and 72% suspected/known cardiomyopathies (including ischaemic and viability). Ninety-eighty per cent of studies were of diagnostic quality. The average scan time was 22 ± 6 min (contrast) and 12 ± 4 min (non-contrast), a potential cost/throughput reduction of between 30 and 60%. Cardiovascular magnetic resonance findings impacted management in 62%, including a new diagnosis in 22% and MIO detected in 30% of non-contrast scans. Nine centres continued using rapid CMR 2 years later (typically 1-2 days per week, 30 min slots). CONCLUSIONS Rapid CMR of diagnostic quality can be delivered using available technology in LMICs. When embedded in care and a training programme, costs are lower, care is improved, and services can be sustained over time.
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Affiliation(s)
- Katia Devorha Menacho
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | | | - Aylen Perez
- Cardiology and Cardiovascular Surgery National Institute, La Havana, Cuba
| | | | | | - Diana Katekaru
- Military National Hospital, Cardiac Imaging Department, Lima, Peru
| | | | - Sara Munive
- National Cardiovascular Institute—INCOR, Lima, Peru
| | | | - Ana Shimabukuro
- Guillermo Almenara Irigoyen Hospital, National Hospital, Lima, Peru
| | - Kelly Cupe
- Guillermo Almenara Irigoyen Hospital, National Hospital, Lima, Peru
| | - Rajiv Bansal
- Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, Jaipur, India
| | | | | | - Andreas Seraphim
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - Kris Knott
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - Amna Abdel-Gadir
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Marco Lazo
- Ramiro Priale National Hospital, Huancayo, Peru
| | - David Uscamaita
- Edgardo Rebagliati Hospital, MRI and CT Department, Lima, Peru
| | | | - Neil Amaya
- Edgardo Rebagliati Hospital, MRI and CT Department, Lima, Peru
| | - Sanjiv Sharma
- AlI India Institute of Medical Sciences, New Delhi, India
| | - Amelia Peix
- Cardiology and Cardiovascular Surgery National Institute, La Havana, Cuba
| | - Thomas Treibel
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - Sam Mohiddin
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - Harold Litt
- Department of Medicine (Cardiovascular Division), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuchi Han
- Department of Medicine (Cardiovascular Division), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ron Jacob
- Lancaster General Health Hospital, Lancaster, USA
| | - Mark Westwood
- St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - Ntobeko Ntusi
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Anna Herrey
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - John Malcolm Walker
- Institute of Cardiovascular Science, University College London, London, UK,The Hatter Cardiovascular Institute, University College London Hospital, London, UK
| | - James Moon
- Corresponding author. Tel: +44 203 8870566,
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Monda E, Palmiero G, Lioncino M, Rubino M, Cirillo A, Fusco A, Caiazza M, Verrillo F, Diana G, Mauriello A, Iavarone M, Losi MA, De Rimini ML, Dellegrottaglie S, D’Andrea A, Bossone E, Pacileo G, Limongelli G. Multimodality Imaging in Cardiomyopathies with Hypertrophic Phenotypes. J Clin Med 2022; 11:jcm11030868. [PMID: 35160323 PMCID: PMC8836956 DOI: 10.3390/jcm11030868] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/29/2022] [Accepted: 02/04/2022] [Indexed: 12/16/2022] Open
Abstract
Multimodality imaging is a comprehensive strategy to investigate left ventricular hypertrophy (LVH), providing morphologic, functional, and often clinical information to clinicians. Hypertrophic cardiomyopathy (HCM) is defined by an increased LV wall thickness not only explainable by abnormal loading conditions. In the context of HCM, multimodality imaging, by different imaging techniques, such as echocardiography, cardiac magnetic resonance, cardiac computer tomography, and cardiac nuclear imaging, provides essential information for diagnosis, sudden cardiac death stratification, and management. Furthermore, it is essential to uncover the specific cause of HCM, such as Fabry disease and cardiac amyloidosis, which can benefit of specific treatments. This review aims to elucidate the current role of multimodality imaging in adult patients with HCM.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Gaetano Diana
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Alfredo Mauriello
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Michele Iavarone
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Maria Angela Losi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Maria Luisa De Rimini
- Department of Nuclear Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy;
| | - Santo Dellegrottaglie
- Cardiovascular MRI Laboratory, Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80011 Acerra, Italy;
| | - Antonello D’Andrea
- Unit of Cardiology and Intensive Coronary Care, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy;
| | - Eduardo Bossone
- Department of Cardiology, Cardarelli Hospital, 80131 Naples, Italy;
| | - Giuseppe Pacileo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
- Correspondence:
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van der Veen SJ, Körver S, Hirsch A, Hollak CEM, Wijburg FA, Brands MM, Tøndel C, van Kuilenburg ABP, Langeveld M. Early start of enzyme replacement therapy in pediatric male patients with classical Fabry disease is associated with attenuated disease progression. Mol Genet Metab 2022; 135:163-169. [PMID: 35033446 DOI: 10.1016/j.ymgme.2021.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/12/2021] [Accepted: 12/13/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Enzyme replacement therapy (ERT) slows disease progression of Fabry disease (FD), especially when initiated before the onset of irreversible organ damage. However, with the clinically asymptomatic progression of renal, cardiac and cerebral disease manifestations spanning decades, optimal timing of ERT initiation remains unclear. METHODS In this cross-sectional retrospective study, seven male FD patients with a classical disease phenotype (cFD) who started treatment with agalsidase-beta in childhood were evaluated after 10 years of treatment (median age at evaluation 24 years, range 14-26). Cardiac imaging (echocardiography and MRI), electrophysiological and biochemical data of these patients were compared to those of untreated male cFD patients (n = 23, median age 22 years, range 13-27). RESULTS Albuminuria was less common and less severe in treated patients (albumin to creatinine ratio, ACR 0-8.8 mg/mmol, median 0.4) compared to untreated patients (ACR 0-248 mg/mmol, median 3.7, p = 0.02). The treated group had a lower left ventricular mass, measured using echocardiography (median 80 g/m2 versus 94 g/m2, p = 0.02) and MRI (median 53 g/m2 versus 68 g/m2, p = 0.02). Myocardial fibrosis was absent in all included patients. eGFR was normal in all treated patients whereas 7/23 (30%) of untreated patients had abnormal eGFR. Cerebral manifestations did not differ. CONCLUSIONS Start of treatment with ERT before age 16, in male cFD patients is associated with reduced occurrence of renal and cardiac manifestations of FD, as assessed by intermediate endpoints. Confirmation that this approach delays or even prevents renal failure and cardiac events requires another decade of follow-up.
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Affiliation(s)
- S J van der Veen
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Lysosome Center "Sphinx", Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - S Körver
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Lysosome Center "Sphinx", Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - A Hirsch
- Department of Cardiology and Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - C E M Hollak
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Lysosome Center "Sphinx", Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - F A Wijburg
- Amsterdam UMC, University of Amsterdam, Department of Pediatric Metabolic Diseases, Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Lysosome Center "Sphinx", Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - M M Brands
- Amsterdam UMC, University of Amsterdam, Department of Pediatric Metabolic Diseases, Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Lysosome Center "Sphinx", Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - C Tøndel
- Haukeland University Hospital, Department of Paediatrics and University of Bergen, Department of Clinical Medicine, Bergen, Norway
| | - A B P van Kuilenburg
- Amsterdam UMC, University of Amsterdam, Department of Clinical Chemistry, Gastroenterology & Metabolism, Laboratory Genetic Metabolic Diseases, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - M Langeveld
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Lysosome Center "Sphinx", Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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47
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Rubino M, Monda E, Lioncino M, Caiazza M, Palmiero G, Dongiglio F, Fusco A, Cirillo A, Cesaro A, Capodicasa L, Mazzella M, Chiosi F, Orabona P, Bossone E, Calabrò P, Pisani A, Germain DP, Biagini E, Pieroni M, Limongelli G. Diagnosis and Management of Cardiovascular Involvement in Fabry Disease. Heart Fail Clin 2021; 18:39-49. [PMID: 34776082 DOI: 10.1016/j.hfc.2021.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Fabry disease (FD, OMIM 301500) is an X-linked lysosomal storage disease caused by pathogenic variants in the GLA gene. Cardiac involvement is common in FD and is responsible for impaired quality of life and premature death. The classic cardiac involvement is a nonobstructive form of hypertrophic cardiomyopathy, usually manifesting as concentric left ventricular hypertrophy, with subsequent arrhythmogenic intramural fibrosis. Treatment of patients with FD should be directed to prevent the disease progression to irreversible organ damage and organ failure. The aim of this review is to describe the current state of knowledge regarding cardiovascular involvement in FD, focusing on clinical and instrumental features, cardiovascular management, and targeted therapy.
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Affiliation(s)
- Marta Rubino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Emanuele Monda
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Michele Lioncino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Giuseppe Palmiero
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Francesca Dongiglio
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Adelaide Fusco
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Annapaola Cirillo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Laura Capodicasa
- Department of Nephrology, Monaldi Hospital, Via L. Bianchi, Naples 80131, Italy
| | - Marialuisa Mazzella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Flavia Chiosi
- Department of Ophthalmology, Monaldi Hospital, Via L. Bianchi, Naples 80131, Italy
| | - Paolo Orabona
- Department of Ophthalmology, Monaldi Hospital, Via L. Bianchi, Naples 80131, Italy
| | - Eduardo Bossone
- Division of Cardiology, Antonio Cardarelli Hospital, Via A. Cardarelli, Naples 80131, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Antonio Pisani
- Department of Public Health, University Federico II of Naples, Via Pansini, Naples 80131, Italy
| | - Dominique P Germain
- French Referral Centre for Fabry Disease, Division of Medical Genetics, Hôpital Raymond-Poincare, AP-HP, Garches 92380, France
| | - Elena Biagini
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, Grower Street, London WC1E 6DD, UK.
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48
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Nappi C, Ponsiglione A, Pisani A, Riccio E, Di Risi T, Pieroni M, Klain M, Assante R, Acampa W, Nicolai E, Spinelli L, Cuocolo A, Imbriaco M. Role of serial cardiac 18F-FDG PET-MRI in Anderson-Fabry disease: a pilot study. Insights Imaging 2021; 12:124. [PMID: 34487259 PMCID: PMC8421465 DOI: 10.1186/s13244-021-01067-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/07/2021] [Indexed: 11/10/2022] Open
Abstract
Aim We investigated the value of serial cardiac 18F-FDG PET-MRI in Anderson–Fabry disease (AFD) and the potential relationship of imaging results with FASTEX score. Methods and results Thirteen AFD patients underwent cardiac 18F-FDG PET-MRI at baseline and follow-up. Coefficient of variation (COV) of FDG uptake and FASTEX score were assessed. At baseline, 9 patients were enzyme replacement therapy (ERT) naïve and 4 patients were under treatment. Two patients presented a FASTEX score of 0 indicating stable disease and did not show any imaging abnormality at baseline and follow-up PET-MRI. Eleven patients had a FASTEX score > 20% indicating disease worsening. Four of these patients without late gadolinium enhancement (LGE) and with normal COV at baseline and follow-up had a FASTEX score of 35%. Three patients without LGE and with abnormal COV at baseline and follow-up had a FASTEX score ranging from 30 to 70%. Three patients with LGE and abnormal COV at baseline and follow-up had a FASTEX score between 35 and 75%. Finally, one patient with LGE and normal COV had a FASTEX score of 100%. Of the 12 patients on ERT at follow-up, FASTEX score was significantly higher in those 4 showing irreversible cardiac injury at baseline compared to 8 with negative LGE (66 ± 24 vs. 32 ± 21, p = 0.03). Conclusion 18F-FDG PET-MRI may be effective to monitor cardiac involvement in AFD.
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Affiliation(s)
- Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Antonio Pisani
- Department of Public Health, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Eleonora Riccio
- Department of Public Health, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Teodolinda Di Risi
- Department of Public Health, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Maurizio Pieroni
- Cardiovascular Department, San Donato Hospital, Via Pietro Nenni 22, 52100, Arezzo, Italy
| | - Michele Klain
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | | | - Letizia Spinelli
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
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49
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Schuster A, Thiele H, Katus H, Werdan K, Eitel I, Zeiher AM, Baldus S, Rolf A, Kelle S. Kompetenz und Innovation in der kardiovaskulären MRT: Stellungnahme der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung. DER KARDIOLOGE 2021. [PMCID: PMC8361824 DOI: 10.1007/s12181-021-00494-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diese Stellungnahme der Deutschen Gesellschaft für Kardiologie (DGK) beschäftigt sich mit der Bedeutung kardiologischer Kompetenz im Gebiet der kardiovaskulären Magnetresonanztomographie (CMR) und deren Aus- und Wechselwirkungen auf klinisches Management im Bereich der Diagnostik, Therapieplanung und Therapie von kardiologischen Patienten. Zahlreiche Innovationen sowohl im technischen als auch klinischen Bereich der CMR basieren auf Publikationen deutscher und europäischer Kardiologen und haben Einzug in die nationalen, europäischen und auch US-amerikanischen Leitlinien gefunden. Hier sollen Empfehlungen zur sicheren, qualitativ hochwertigen und kompetenten Durchführung von CMR-Untersuchungen gegeben werden, im Sinne einer optimalen Nutzung dieser Technik mit unmittelbarer klinischer Einordnung des Untersuchungsergebnisses für die Planung einer Therapiestrategie des kardiovaskulär erkrankten Patienten.
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Affiliation(s)
- Andreas Schuster
- Herzzentrum, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37099 Göttingen, Deutschland
- Partner Site Göttingen, Deutsches Zentrum für Herz-Kreislauf-Forschung, Göttingen, Deutschland
| | - Holger Thiele
- Herzzentrum Leipzig, Klinik für Innere Medizin und Kardiologie, Universität Leipzig, Leipzig, Deutschland
- Leipzig Heart Science gGmbH, Leipzig, Deutschland
| | - Hugo Katus
- Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Karl Werdan
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Ingo Eitel
- Medizinische Klinik II – Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Andreas M. Zeiher
- Klinik für Kardiologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Stephan Baldus
- Medizinische Klinik III – Abteilung für Kardiologie, Pneumologie, Angiologie und Intensivmedizin, Universität Köln, Köln, Deutschland
| | - Andreas Rolf
- Klinik für Kardiologie, Herz‑, Lungen‑, Gefäß- und Rheumazentrum, Kerckhoff-Klinik, Bad Nauheim, Deutschland
| | - Sebastian Kelle
- Deutsches Herzzentrum Berlin, Berlin, Deutschland
- Klinik für Innere Medizin und Kardiologie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Deutschland
- Partner Site Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung, Berlin, Deutschland
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50
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Augusto JB, Johner N, Shah D, Nordin S, Knott KD, Rosmini S, Lau C, Alfarih M, Hughes R, Seraphim A, Vijapurapu R, Bhuva A, Lin L, Ojrzyńska N, Geberhiwot T, Captur G, Ramaswami U, Steeds RP, Kozor R, Hughes D, Moon JC, Namdar M. The myocardial phenotype of Fabry disease pre-hypertrophy and pre-detectable storage. Eur Heart J Cardiovasc Imaging 2021; 22:790-799. [PMID: 32514567 PMCID: PMC8219366 DOI: 10.1093/ehjci/jeaa101] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022] Open
Abstract
Aims Cardiac involvement in Fabry disease (FD) occurs prior to left ventricular hypertrophy (LVH) and is characterized by low myocardial native T1 with sphingolipid storage reflected by cardiovascular magnetic resonance (CMR) and electrocardiogram (ECG) changes. We hypothesize that a pre-storage myocardial phenotype might occur even earlier, prior to T1 lowering. Methods and results FD patients and age-, sex-, and heart rate-matched healthy controls underwent same-day ECG with advanced analysis and multiparametric CMR [cines, global longitudinal strain (GLS), T1 and T2 mapping, stress perfusion (myocardial blood flow, MBF), and late gadolinium enhancement (LGE)]. One hundred and fourteen Fabry patients (46 ± 13 years, 61% female) and 76 controls (49 ± 15 years, 50% female) were included. In pre-LVH FD (n = 72, 63%), a low T1 (n = 32/72, 44%) was associated with a constellation of ECG and functional abnormalities compared to normal T1 FD patients and controls. However, pre-LVH FD with normal T1 (n = 40/72, 56%) also had abnormalities compared to controls: reduced GLS (−18 ± 2 vs. −20 ± 2%, P < 0.001), microvascular changes (lower MBF 2.5 ± 0.7 vs. 3.0 ± 0.8 mL/g/min, P = 0.028), subtle T2 elevation (50 ± 4 vs. 48 ± 2 ms, P = 0.027), and limited LGE (%LGE 0.3 ± 1.1 vs. 0%, P = 0.004). ECG abnormalities included shorter P-wave duration (88 ± 12 vs. 94 ± 15 ms, P = 0.010) and T-wave peak time (Tonset – Tpeak; 104 ± 28 vs. 115 ± 20 ms, P = 0.015), resulting in a more symmetric T wave with lower T-wave time ratio (Tonset – Tpeak)/(Tpeak – Tend) (1.5 ± 0.4 vs. 1.8 ± 0.4, P < 0.001) compared to controls. Conclusion FD has a measurable myocardial phenotype pre-LVH and pre-detectable myocyte storage with microvascular dysfunction, subtly impaired GLS and altered atrial depolarization and ventricular repolarization intervals.
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Affiliation(s)
- João B Augusto
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Nicolas Johner
- Cardiology Division, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Dipen Shah
- Cardiology Division, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Sabrina Nordin
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Kristopher D Knott
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Stefania Rosmini
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Clement Lau
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Mashael Alfarih
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Rebecca Hughes
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Andreas Seraphim
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Ravi Vijapurapu
- Cardiology Department, University Hospitals Birmingham, Birmingham, UK
| | - Anish Bhuva
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Linda Lin
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Natalia Ojrzyńska
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Institute of Cardiology, Warsaw, Poland
| | - Tarekegn Geberhiwot
- Inherited Metabolic Disorders Unit, University Hospitals Birmingham, Birmingham, UK
| | - Gabriella Captur
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Uma Ramaswami
- Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Richard P Steeds
- Cardiology Department, University Hospitals Birmingham, Birmingham, UK
| | - Rebecca Kozor
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Derralynn Hughes
- Royal Free London NHS Foundation Trust and University College London, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Mehdi Namdar
- Cardiology Division, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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