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Spinelli L, Bianco A, Riccio E, Pisani A, Iaccarino G. Cardiac involvement in Anderson-Fabry disease. The role of advanced echocardiography. Front Cardiovasc Med 2024; 11:1440636. [PMID: 39314767 PMCID: PMC11417619 DOI: 10.3389/fcvm.2024.1440636] [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: 05/29/2024] [Accepted: 08/19/2024] [Indexed: 09/25/2024] Open
Abstract
Anderson-Fabry disease (AFD) is a lysosomal storage disorder, depending on defects in alpha galactosidase A activity, due to a mutation in the galactosidase alpha gene. Cardiovascular involvement represents the leading cause of death in AFD. Cardiac imaging plays a key role in the evaluation and management of AFD patients. Echocardiography is the first-line imaging modality for the identification of the typical features of AFD cardiomyopathy. Advanced echocardiography that allows assessment of myocardial deformation has provided insights into the cardiac functional status of AFD patients. The present review highlights the value and the perspectives of advanced ultrasound imaging in AFD.
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Affiliation(s)
- Letizia Spinelli
- Interdepartmental Research Center for Hypertension and Related Conditions, University of Naples, Naples, Italy
| | - Antonio Bianco
- Department of Public Health, Federico II University, Naples, Italy
| | - Eleonora Riccio
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Pisani
- Department of Public Health, Federico II University, Naples, Italy
| | - Guido Iaccarino
- Interdepartmental Research Center for Hypertension and Related Conditions, University of Naples, Naples, Italy
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Zhou GW, Yang F, Qiao F, Song ZG, Han L, Lu FL, Xu ZY. Transcatheter Tricuspid Valve Replacement for Anderson Fabry Disease With Severe Tricuspid Regurgitation. CASE (PHILADELPHIA, PA.) 2023; 7:39-46. [PMID: 36704486 PMCID: PMC9871382 DOI: 10.1016/j.case.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
• Two-dimensional STE is useful for AFD diagnosis. • Increased LV wall thickness and multiorgan involvement should trigger suspicion of AFD. • Severe TR is rare for AFD. • TTVR is a novel therapy for AFD with severe TR.
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Affiliation(s)
| | | | | | | | | | - Fang-Lin Lu
- Correspondence: Dr. Fang-Lin Lu, MD, PhD, Department of Cardiovascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai 200433, People’s Republic of China.
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Quinaglia T, Gongora C, Awadalla M, Hassan MZO, Zafar A, Drobni ZD, Mahmood SS, Zhang L, Coelho-Filho OR, Suero-Abreu GA, Rizvi MA, Sahni G, Mandawat A, Zatarain-Nicolás E, Mahmoudi M, Sullivan R, Ganatra S, Heinzerling LM, Thuny F, Ederhy S, Gilman HK, Sama S, Nikolaidou S, Mansilla AG, Calles A, Cabral M, Fernández-Avilés F, Gavira JJ, González NS, García de Yébenes Castro M, Barac A, Afilalo J, Zlotoff DA, Zubiri L, Reynolds KL, Devereux R, Hung J, Picard MH, Yang EH, Gupta D, Michel C, Lyon AR, Chen CL, Nohria A, Fradley MG, Thavendiranathan P, Neilan TG. Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis. JACC Cardiovasc Imaging 2022; 15:1883-1896. [PMID: 36357131 PMCID: PMC10334352 DOI: 10.1016/j.jcmg.2022.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/25/2022] [Accepted: 06/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Global circumferential strain (GCS) and global radial strain (GRS) are reduced with cytotoxic chemotherapy. There are limited data on the effect of immune checkpoint inhibitor (ICI) myocarditis on GCS and GRS. OBJECTIVES This study aimed to detail the role of GCS and GRS in ICI myocarditis. METHODS In this retrospective study, GCS and GRS from 75 cases of patients with ICI myocarditis and 50 ICI-treated patients without myocarditis (controls) were compared. Pre-ICI GCS and GRS were available for 12 cases and 50 controls. Measurements were performed in a core laboratory blinded to group and time. Major adverse cardiovascular events (MACEs) were defined as a composite of cardiogenic shock, cardiac arrest, complete heart block, and cardiac death. RESULTS Cases and controls were similar in age (66 ± 15 years vs 63 ± 12 years; P = 0.20), sex (male: 73% vs 61%; P = 0.20) and cancer type (P = 0.08). Pre-ICI GCS and GRS were also similar (GCS: 22.6% ± 3.4% vs 23.5% ± 3.8%; P = 0.14; GRS: 45.5% ± 6.2% vs 43.6% ± 8.8%; P = 0.24). Overall, 56% (n = 42) of patients with myocarditis presented with preserved left ventricular ejection fraction (LVEF). GCS and GRS were lower in myocarditis compared with on-ICI controls (GCS: 17.5% ± 4.2% vs 23.6% ± 3.0%; P < 0.001; GRS: 28.6% ± 6.7% vs 47.0% ± 7.4%; P < 0.001). Over a median follow-up of 30 days, 28 cardiovascular events occurred. A GCS (HR: 4.9 [95% CI: 1.6-15.0]; P = 0.005) and GRS (HR: 3.9 [95% CI: 1.4-10.8]; P = 0.008) below the median was associated with an increased event rate. In receiver-operating characteristic (ROC) curves, GCS (AUC: 0.80 [95% CI: 0.70-0.91]) and GRS (AUC: 0.76 [95% CI: 0.64-0.88]) showed better performance than cardiac troponin T (cTnT) (AUC: 0.70 [95% CI: 0.58-0.82]), LVEF (AUC: 0.69 [95% CI: 0.56-0.81]), and age (AUC: 0.54 [95% CI: 0.40-0.68]). Net reclassification index and integrated discrimination improvement demonstrated incremental prognostic utility of GRS over LVEF (P = 0.04) and GCS over cTnT (P = 0.002). CONCLUSIONS GCS and GRS are lower in ICI myocarditis, and the magnitude of reduction has prognostic significance.
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Affiliation(s)
- Thiago Quinaglia
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Carlos Gongora
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Magid Awadalla
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Malek Z O Hassan
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amna Zafar
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zsofia D Drobni
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Syed S Mahmood
- Cardiology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, New York, USA
| | - Lili Zhang
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Otavio R Coelho-Filho
- Discipline of Cardiology, Department of Medicine, Faculty of Medical Science, State University of Campinas, Campinas, Brazil
| | | | - Muhammad A Rizvi
- Division of Oncology and Hematology, Department of Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania, USA
| | - Gagan Sahni
- Cardiology-Oncology Program, Mount Sinai Hospital, New York, New York, USA
| | - Anant Mandawat
- Cardio-Oncology Program, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eduardo Zatarain-Nicolás
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red CardioVascular (CIBER-CV), Madrid, Spain
| | - Michael Mahmoudi
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ryan Sullivan
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Lucie M Heinzerling
- Department of Dermatology and Allergy, LMU Klinikum, Munich, Germany and Department of Dermatology, University Hospital Erlangen, Germany
| | - Franck Thuny
- Mediterranean University Center of Cardio-Oncology, Aix-Marseille University, North Hospital, Marseille, France
| | - Stephane Ederhy
- Cardio-Oncology Program, Division of Cardiology, Hopitaux Universitaires Est Parisien, Paris, France
| | - Hannah K Gilman
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Supraja Sama
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sofia Nikolaidou
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ana González Mansilla
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red CardioVascular (CIBER-CV), Madrid, Spain
| | - Antonio Calles
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red CardioVascular (CIBER-CV), Madrid, Spain
| | - Marcella Cabral
- Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red CardioVascular (CIBER-CV), Madrid, Spain
| | - Juan José Gavira
- Cardio-Oncology Program, Department of Cardiology, Clínica Universidad de Navarra, Pamplona and Madrid, Spain
| | - Nahikari Salterain González
- Cardio-Oncology Program, Department of Cardiology, Clínica Universidad de Navarra, Pamplona and Madrid, Spain
| | | | - Ana Barac
- Cardio-Oncology Program, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jonathan Afilalo
- Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Daniel A Zlotoff
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leyre Zubiri
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kerry L Reynolds
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard Devereux
- Cardiology Division, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael H Picard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Dipti Gupta
- Cardiology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, New York, USA
| | - Caroline Michel
- Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital and Imperial College London, London, UK
| | - Carol L Chen
- Cardiology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, New York, USA
| | - Anju Nohria
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tomas G Neilan
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Roller FC, Brose A, Richter M, Schüssler A, Harth S, Tanislav C, Krombach GA. Value of Left Ventricular Feature Tracking Strain Analysis for Detection of Early Cardiac Involvement in Fabry Disease (FD). J Clin Med 2021; 10:jcm10163734. [PMID: 34442030 PMCID: PMC8397220 DOI: 10.3390/jcm10163734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: Detection of cardiac involvement in Fabry disease (FD) is of high importance for treatment management. Native T1 mapping especially showed great potential for detection of early cardiac manifestations. Echocardiographic studies showed strain abnormalities in FD patients, but data on MRI feature tracking strain analysis (FT-SA) is limited. Therefore, the aim of our study was to evaluate the potential of FT-SA compared to native T1 and the FD specific biomarker Globotriaosylsphingosine (LysoGb3). Methods: 28 consecutive FD patients (18 female; 47.8 years ± 17.4 standard deviation (SD)) and 28 control subjects (18 female; 46.6 years ± 18.2 SD) underwent cardiac MRI at 1.5 Tesla. Global native T1 times and left ventricular FT-SA were evaluated. Results were correlated to serum Lyso-Gb3-levels. Results: Native T1 times, global longitudinal (GLS) and global radial strain (GRS) were significantly reduced in FD patients (p < 0.0064, p = 0.0009 and p = 0.0184, respectively). Moreover, native T1 times and GLS were significantly lower in Lyso-Gb3 positive FD patients (p < 0.005 and p = 0.03). GLS, native T1 times showed significant moderate correlations to LysoGb3 (p = 0.002 and p < 0.001). Furthermore, GLS and native T1 times reduce when LysoGb3 was elevated and increasingly with presence of left ventricular hypertrophy (LVH) or late gadolinium enhancement (LGE). Conclusions: Native T1 times and strain values differ significantly between FD patients and control subjects and showed promising correlations to the FD specific biomarker LysoGb3. We therefore conclude that strain abnormalities occur early beside native T1 reductions in cardiac FD involvement. Large scale trials are needed to verify our findings.
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Affiliation(s)
- Fritz Christian Roller
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; (A.B.); (M.R.); (A.S.); (S.H.); (G.A.K.)
- Correspondence:
| | - Alexander Brose
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; (A.B.); (M.R.); (A.S.); (S.H.); (G.A.K.)
| | - Martin Richter
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; (A.B.); (M.R.); (A.S.); (S.H.); (G.A.K.)
| | - Armin Schüssler
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; (A.B.); (M.R.); (A.S.); (S.H.); (G.A.K.)
| | - Sebastian Harth
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; (A.B.); (M.R.); (A.S.); (S.H.); (G.A.K.)
| | - Christian Tanislav
- Department of Neurology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany;
| | - Gabriele Anja Krombach
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; (A.B.); (M.R.); (A.S.); (S.H.); (G.A.K.)
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Yim J, Yau O, Yeung DF, Tsang TSM. Fabry Cardiomyopathy: Current Practice and Future Directions. Cells 2021; 10:cells10061532. [PMID: 34204530 PMCID: PMC8233708 DOI: 10.3390/cells10061532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in the galactosidase A (GLA) gene that result in deficient galactosidase A enzyme and subsequent accumulation of glycosphingolipids throughout the body. The result is a multi-system disorder characterized by cutaneous, corneal, cardiac, renal, and neurological manifestations. Increased left ventricular wall thickness represents the predominant cardiac manifestation of FD. As the disease progresses, patients may develop arrhythmias, advanced conduction abnormalities, and heart failure. Cardiac biomarkers, point-of-care dried blood spot testing, and advanced imaging modalities including echocardiography with strain imaging and magnetic resonance imaging (MRI) with T1 mapping now allow us to detect Fabry cardiomyopathy much more effectively than in the past. While enzyme replacement therapy (ERT) has been the mainstay of treatment, several promising therapies are now in development, making early diagnosis of FD even more crucial. Ongoing initiatives involving artificial intelligence (AI)-empowered interpretation of echocardiographic images, point-of-care dried blood spot testing in the echocardiography laboratory, and widespread dissemination of point-of-care ultrasound devices to community practices to promote screening may lead to more timely diagnosis of FD. Fabry disease should no longer be considered a rare, untreatable disease, but one that can be effectively identified and treated at an early stage before the development of irreversible end-organ damage.
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Affiliation(s)
- Jeffrey Yim
- Department of Medicine, University of British Columbia, Vancouver, BC V6H 0A5, Canada;
| | - Olivia Yau
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 0A5, Canada;
| | - Darwin F. Yeung
- Vancouver General Hospital and University of British Columbia Echocardiography Laboratory, Division of Cardiology, University of British Columbia, Vancouver, BC V6H 0A5, Canada
- Correspondence: (D.F.Y.); (T.S.M.T.)
| | - Teresa S. M. Tsang
- Vancouver General Hospital and University of British Columbia Echocardiography Laboratory, Division of Cardiology, University of British Columbia, Vancouver, BC V6H 0A5, Canada
- Correspondence: (D.F.Y.); (T.S.M.T.)
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Cardiac Imaging in Anderson-Fabry Disease: Past, Present and Future. J Clin Med 2021; 10:jcm10091994. [PMID: 34066467 PMCID: PMC8124634 DOI: 10.3390/jcm10091994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 01/04/2023] Open
Abstract
Anderson-Fabrydisease is an X-linked lysosomal storage disorder caused by a deficiency in the lysosomal enzyme α-galactosidase A. This results in pathological accumulation of glycosphingolipids in several tissues and multi-organ progressive dysfunction. The typical clinical phenotype of Anderson-Fabry cardiomyopathy is progressive hypertrophic cardiomyopathy associated with rhythm and conduction disturbances. Cardiac imaging plays a key role in the evaluation and management of Anderson-Fabry disease patients. The present review highlights the value and perspectives of standard and advanced cardiovascular imaging in Anderson-Fabry disease.
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Fabry Disease and the Heart: A Comprehensive Review. Int J Mol Sci 2021; 22:ijms22094434. [PMID: 33922740 PMCID: PMC8123068 DOI: 10.3390/ijms22094434] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations of the GLA gene that result in a deficiency of the enzymatic activity of α-galactosidase A and consequent accumulation of glycosphingolipids in body fluids and lysosomes of the cells throughout the body. GB3 accumulation occurs in virtually all cardiac cells (cardiomyocytes, conduction system cells, fibroblasts, and endothelial and smooth muscle vascular cells), ultimately leading to ventricular hypertrophy and fibrosis, heart failure, valve disease, angina, dysrhythmias, cardiac conduction abnormalities, and sudden death. Despite available therapies and supportive treatment, cardiac involvement carries a major prognostic impact, representing the main cause of death in FD. In the last years, knowledge has substantially evolved on the pathophysiological mechanisms leading to cardiac damage, the natural history of cardiac manifestations, the late-onset phenotypes with predominant cardiac involvement, the early markers of cardiac damage, the role of multimodality cardiac imaging on the diagnosis, management and follow-up of Fabry patients, and the cardiac efficacy of available therapies. Herein, we provide a comprehensive and integrated review on the cardiac involvement of FD, at the pathophysiological, anatomopathological, laboratory, imaging, and clinical levels, as well as on the diagnosis and management of cardiac manifestations, their supportive treatment, and the cardiac efficacy of specific therapies, such as enzyme replacement therapy and migalastat.
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Spinelli L, Imbriaco M, Giugliano G, Nappi C, Gaudieri V, Riccio E, Pisani A, Trimarco B, Cuocolo A. Focal reduction in left ventricular 123I-metaiodobenzylguanidine uptake and impairment in systolic function in patients with Anderson-Fabry disease. J Nucl Cardiol 2021; 28:641-649. [PMID: 31087266 DOI: 10.1007/s12350-019-01734-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/21/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Abnormalities of cardiac sympathetic innervation have been demonstrated in Anderson-Fabry disease (AFD). We aimed to investigate the relationship between regional left ventricular (LV) denervation and regional function abnormalities. METHODS Twenty-four AFD patients (43.7 ± 12.8 years) were studied by 123I-metaiodobenzylguanidine (MIBG) cardiac imaging and speckle-tracking echocardiography. Segmental tracer uptake was estimated according to 0 to 4 score, and total defect score (TDS) was calculated for each patient. RESULTS Segmental longitudinal strain worsened as MIBG uptake score increased (P < 0.001). By ROC analysis, a segmental longitudinal strain > - 16.2% predicted a segmental MIBG uptake score ≥1, with 79.7% sensitivity and 65.3% specificity. Segmental MIBG uptake defects were found in 13 out 24 AFD patients. LV mass index (60.8 ± 10.1 vs. 41.4 ± 9.8 g/h2.7), relative wall thickness (0.51 ± 0.06 vs. 0.40 ± 0.06), systolic pulmonary artery pressure (35.2 ± 6.7 vs. 27.2 ± 4.2 mmHg), and longitudinal strain (- 14.3 ± 2.7 vs. -19.4 ± 1.8%) were significantly higher in patients with segmental defect (all P < 0.01). At multivariate linear regression analysis, global longitudinal strain was independently associated with TDS (B = 3.007, 95% confidence interval 1.384 to 4.630, P = 0.001). CONCLUSIONS Reduced cardiac MIBG uptake reflects the severity of cardiac involvement in AFD patients. LV longitudinal function impairment seems to be an earlier disease feature than regional myocardial denervation.
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Affiliation(s)
- Letizia Spinelli
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy.
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Giuseppe Giugliano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Eleonora Riccio
- Department of Public Health, Nephrology Unit, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Antonio Pisani
- Department of Public Health, Nephrology Unit, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
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9
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Zhao L, Zhang C, Tian J, Saiedi M, Ma C, Li N, Fang F, Ma X, Selvanayagam J. Quantification of myocardial deformation in patients with Fabry disease by cardiovascular magnetic resonance feature tracking imaging. Cardiovasc Diagn Ther 2021; 11:91-101. [PMID: 33708481 DOI: 10.21037/cdt-20-897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cardiac involvement is a major contributor of morbidity and mortality in Fabry disease (FD). Early detection and accurate evaluation of the disease progression is important in management. Cardiovascular magnetic resonance (CMR) derived feature fracking (FT) is a validated quantitative method of assessing myocardial deformation which may reflect early changes of myocardial function and track disease severity. We sought to evaluate the utility of CMR-FT as a measure of myocardial dysfunction in FD. Methods Twenty FD patients (12 males, 40.8±14.9 years) and 20 age and sex matched healthy controls (10 males, 40.5±7.2 years) were prospectively enrolled. Subjects underwent CMR including cine, pre-/post-contrast T1 mapping and late gadolinium enhancement (LGE). FD patients were divided into three groups; group 1: patients without left ventricular hypertrophy (LVH) and LGE negative; group 2: patients with LVH positive, LGE either positive or negative; group 3: patients with LGE positive, LV wall thinning and heart failure. FT derived strain indices were measured and its associations with other processes were investigated. Results In FD patients, 14 (70%) had LVH and 4 (20%) had LGE. Compared with normal controls, LV global longitudinal strain (GLS) were reduced significantly in all three Fabry groups (all P<0.05), global circumferential strain (GCS) were reduced only in group 2 and group 3 (P<0.05). Among three FD groups, there were significant differences of LV GLS, GCS, native T1 value and extracellular volume fraction (ECV) (all P<0.01), group 1 had mild LV strain indices impairment, group 3 had the most severe LV strain indices. When compared between FD subgroups, GLS and GCS showed significant difference between each two groups (all P<0.05). There were weak correlations between the LV functional parameters (ejection fraction, LV mass index), maximal wall thickness, T1 mapping indices (native T1, ECV) and LV strain indices. The strongest relation was between global longitudinal early diastolic strain rate and native T1 value (r=0.783, P<0.01). Conclusions CMR strain imaging identifies myocardial deformation in FD in different stages. Strain imaging can track disease severity and may be an alternative method for follow-up of FD patients.
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Affiliation(s)
- Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chen Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Tian
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Madiha Saiedi
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Chenyao Ma
- Department of Sleep Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ning Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fang Fang
- Department of Sleep Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaohai Ma
- Department of Interventional Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Joseph Selvanayagam
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
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10
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Zada M, Lo Q, Boyd AC, Bradley S, Devine K, Denaro CP, Sadick N, Richards DAB, Tchan MC, Thomas L. Basal Segmental Longitudinal Strain: A Marker of Subclinical Myocardial Involvement in Anderson-Fabry Disease. J Am Soc Echocardiogr 2020; 34:405-413.e2. [PMID: 33242609 DOI: 10.1016/j.echo.2020.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cardiac involvement in Anderson-Fabry disease (AFD) is associated with increased left ventricular (LV) wall thickness. The aim of this study was to evaluate if two-dimensional global and regional strain in patients with AFD can identify early myocardial involvement (when LV wall thickness and function are normal). Additionally, the association of altered strain with adverse cardiovascular events was evaluated. METHODS In a retrospective cross-sectional study, 43 patients with AFD, before enzyme replacement therapy (mean age, 44 ± 12 years; 58.1% men), were compared with age- and gender-matched healthy control subjects. The mean follow-up duration among patients with AFD for major adverse cardiovascular events (MACE) was 82 months. RESULTS LV ejection fraction was similar between groups (patients with AFD vs control subjects, 61 ± 8% vs 61 ± 6%; P = .89). However, global longitudinal strain (LS) was impaired in patients with AFD compared with control subjects (-16.5 ± 3.8% vs -20.2 ± 1.7%, P < .001), with greater impairment in patients with AFD with increased LV wall thickness (-15.4 ± 3.9% vs -18.7 ± 2.3%, P < .006). Additionally, LS was most impaired in the basal segments in patients with AFD (-14.8 ± 3.7% vs -20.3 ± 1.1%, P < .001). MACE occurred in 19 of 43 patients (four women, 15 men), and Kaplan-Meier analysis demonstrated that MACE were associated with impaired basal LS. CONCLUSIONS In patients with AFD, altered basal LS is present even in those with normal LV wall thickness and is associated with MACE. Therefore, basal LS should be considered when screening for cardiac involvement in AFD, particularly in female patients with AFD with normal LV wall thickness.
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Affiliation(s)
- Matthew Zada
- Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Queenie Lo
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Sydney, Australia
| | | | - Sue Bradley
- Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, Australia
| | - Kerry Devine
- Genetic Medicine, Westmead Hospital, Sydney, Australia
| | - Charles P Denaro
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Australia; University of Queensland Faculty of Medicine, Brisbane, Australia
| | - Norman Sadick
- Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - David A B Richards
- Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Sydney, Australia
| | | | - Liza Thomas
- Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Sydney, Australia.
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11
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Spinelli L, Giugliano G, Pisani A, Imbriaco M, Riccio E, Russo C, Cuocolo A, Trimarco B, Esposito G. Does left ventricular function predict cardiac outcome in Anderson-Fabry disease? Int J Cardiovasc Imaging 2020; 37:1225-1236. [PMID: 33211238 PMCID: PMC8026432 DOI: 10.1007/s10554-020-02105-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/08/2020] [Indexed: 11/11/2022]
Abstract
In Anderson–Fabry disease (AFD) the impact of left ventricular (LV) function on cardiac outcome is unknown. Noninvasive LV pressure–strain loop analysis is a new echocardiographic method to estimate myocardial work (MW). We aimed to evaluate whether LV function was associated with outcome and whether MW had a prognostic value in AFD. Ninety-six AFD patients (41.8 ± 14.7 years, 43.7% males) with normal LV ejection fraction were retrospectively evaluated. Inclusion criteria were sinus rhythm and ≥ 2-year follow-up. Standard echocardiography measurements, myocardial mechano-energetic efficiency (MEE) index, global longitudinal strain (GLS) and MW were evaluated. Adverse cardiac events were defined as composite of cardiac death, malignant ventricular tachycardia, atrial fibrillation and severe heart failure development. During a median follow-up of 63 months (interquartile range 37–85), 14 events occurred. Patient age, cardiac biomarkers, LV mass index, left atrium volume, E/Ea ratio, LV ejection fraction, MEE index, GLS and all MW indices were significantly related to adverse outcome at univariate analysis. After adjustment for clinical and echocardiographic parameters, which were significant at univariate analysis, GLS and MW resulted independent predictors of adverse events (p < 0.01). By ROC curve analysis, constructive MW ≤ 1513 mmHg% showed the highest sensitivity and specificity in predicting adverse outcome (92.9% and 86.6%, respectively). MW did not improve the predictive value of a model including clinical data, LV diastolic function and GLS. LV function impairment (both systolic and diastolic) is associated with adverse events in AFD. MW does not provide additive information over clinical features and systolic and diastolic function.
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Affiliation(s)
- Letizia Spinelli
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy.
| | - Giuseppe Giugliano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Antonio Pisani
- Department of Public Health, Nephrology Unit, Federico II University, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Eleonora Riccio
- Department of Public Health, Nephrology Unit, Federico II University, Naples, Italy
| | - Camilla Russo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
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12
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Linhart A, Germain DP, Olivotto I, Akhtar MM, Anastasakis A, Hughes D, Namdar M, Pieroni M, Hagège A, Cecchi F, Gimeno JR, Limongelli G, Elliott P. An expert consensus document on the management of cardiovascular manifestations of Fabry disease. Eur J Heart Fail 2020; 22:1076-1096. [PMID: 32640076 DOI: 10.1002/ejhf.1960] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/04/2020] [Accepted: 07/04/2020] [Indexed: 12/18/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by pathogenic variants in the α-galactosidase A (GLA) gene that leads to reduced or undetectable α-galactosidase A enzyme activity and progressive accumulation of globotriaosylceramide and its deacylated form globotriaosylsphingosine in cells throughout the body. FD can be multisystemic with neurological, renal, cutaneous and cardiac involvement or be limited to the heart. Cardiac involvement is characterized by progressive cardiac hypertrophy, fibrosis, arrhythmias, heart failure and sudden cardiac death. The cardiac management of FD requires specific measures including enzyme replacement therapy or small pharmacological chaperones in patients carrying amenable pathogenic GLA gene variants and more general management of cardiac symptoms and complications. In this paper, we summarize current knowledge of FD-related heart disease and expert consensus recommendations for its management.
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Affiliation(s)
- Aleš Linhart
- Second Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Dominique P Germain
- Division of Medical Genetics, University of Versailles and AP-HP Paris-Saclay, Paris, France
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Mohammed M Akhtar
- Institute of Cardiovascular Science, University College London and Barts Heart Centre, London, UK
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Derralynn Hughes
- Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Mehdi Namdar
- Department of Internal Medicine Specialties, Cardiology, Electrophysiology, University Hospital of Geneva, Geneva, Switzerland
| | - Maurizio Pieroni
- Cardiomyopathy Clinic, Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | - Albert Hagège
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM CMR970, Paris Cardiovascular Research Center PARCC, Paris, France
| | - Franco Cecchi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Juan R Gimeno
- Hospital C. Universitario Virgen Arrixaca, Murcia, Spain
| | - Giuseppe Limongelli
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli", AORN Colli, Ospedale Monaldi, Naples, Italy
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London and Barts Heart Centre, London, UK
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13
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Left ventricular radial strain impairment precedes hypertrophy in Anderson-Fabry disease. Int J Cardiovasc Imaging 2020; 36:1465-1476. [PMID: 32306159 DOI: 10.1007/s10554-020-01847-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/09/2020] [Indexed: 01/22/2023]
Abstract
In Anderson-Fabry disease (AFD), left ventricular (LV) radial function has been scarcely investigated. We hypothesized that LV function may be affected by disease specific mechanisms and sought to comprehensively evaluate LV radial, circumferential and longitudinal function in a large population of AFD patients looking at the influence of LV geometry and fibrosis. We prospectively studied 94 consecutive AFD patients (41.5 ± 14.5 years; 41 men) with preserved LV ejection fraction (EF) utilizing speckle-tracking echocardiography. A subset of patients underwent gadolinium-enhanced cardiac magnetic resonance. Cases were compared to 48 healthy subjects matched for age and sex. LV concentric hypertrophy was found in 33 AFD patients while LV concentric remodeling (relative wall thickness ≥ 0.43) in 16 out 61 patients with normal LV mass. AFD patients had lower radial, longitudinal and circumferential strains than controls, independently by LV geometry pattern. Patients with LV hypertrophy showed reduced global longitudinal strain (p < 0.001) and early diastolic untwisting rate (p = 0.002) as compared to patients with normal geometry. In the whole AFD population, neither radial strain nor circumferential strain correlated with LV mass, while global longitudinal strain and early diastolic untwisting rate did (both p < 0.001). Late gadolinium enhancement was significantly associated with longitudinal strain, twisting rate and early diastolic untwisting rate, with twisting rate being the most powerful independent predictor (β = - 0.461; p = 0.002). Findings demonstrate impairment of LV radial strain in AFD patients with preserved EF, even in a pre-hypertrophic stage. Development of LV hypertrophy and fibrosis make worse mostly longitudinal dysfunction.
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14
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Yenerçağ M, Arslan U. Tp-e interval and Tp-e/QT ratio and their association with left ventricular diastolic dysfunction in Fabry disease without left ventricular hypertrophy. J Electrocardiol 2019; 59:20-24. [PMID: 31945689 DOI: 10.1016/j.jelectrocard.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In the early stage of the Fabry disease, diastolic dysfunction can occur before left ventricular hypertrophy (LVH). Cardiovascular complications, most of which are seen as malignant arrhythmias and heart failure, are the leading causes of death in these patients. The aim of the present study was to assess repolarization parameters of Fabry patients in early stage (without LVH) and to show the relationship between these parameters and left ventricular diastolic dysfunction. METHODS This cross-sectional single center study was carried out with newly diagnosed 23 Fabry patients and 20 healthy individuals, between April 2016 and September 2019. Diagnosis of Fabry disease was based on a measurement of enzyme activity in leukocytes and was confirmed by genetic analysis. Basic, demographic and clinical features were reviewed. The risk of ventricular arrhythmia was evaluated by calculating the electrocardiographic, the Tp-e and QT interval, corrected QT (QTc), Tp-e/QT and Tp-e/QTc ratios. Left ventricular systolic and diastolic dysfunctions were evaluated using echocardiography. RESULTS Tp-e interval (86.9 ± 6.2 vs. 73.8 ± 6.3 ms; p < 0.001), Tp-e/QT ratio (0.23 ± 0.008 vs. 0.21 ± 0.01; p < 0.001) and Tp-e/QTc ratio (0.21 ± 0.007vs. 0.18 ± 0.017; p < 0.001) were significantly higher in Fabry patients than the control group. There was a significant positive correlation between Tp-e interval and E/e' ratio (r = 0.626, p = 0.003) and Tp-e/QTc ratio and E/e' ratio (r = 0.578, p = 0.008) in Fabry patients. CONCLUSION Our study showed that the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which are evaluated electrocardiographically in patients with pre-hypertrophic Fabry patients, are prolonged compared to normal healthy individuals. The most significant finding was the positive correlation found between repolarization parameters and LV diastolic dysfunction. These results may be indicative of an early subclinical cardiac involvement in Fabry patients, considering the diastolic dysfunction severity.
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Affiliation(s)
- Mustafa Yenerçağ
- Department of Cardiology, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey
| | - Uğur Arslan
- Department of Cardiology, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey.
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15
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Militaru S, Jurcuț R, Adam R, Roşca M, Ginghina C, Popescu BA. Echocardiographic features of Fabry cardiomyopathy—Comparison with hypertrophy‐matched sarcomeric hypertrophic cardiomyopathy. Echocardiography 2019; 36:2041-2049. [DOI: 10.1111/echo.14508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/10/2019] [Accepted: 09/23/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Sebastian Militaru
- Department of Cardiology Expert Center for Rare Genetic Cardiovascular Diseases Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” Bucharest Romania
- University of Medicine and Pharmacy “Carol Davila” – Euroecolab Bucharest Romania
- University of Medicine and Pharmacy Craiova Romania
| | - Ruxandra Jurcuț
- Department of Cardiology Expert Center for Rare Genetic Cardiovascular Diseases Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” Bucharest Romania
- University of Medicine and Pharmacy “Carol Davila” – Euroecolab Bucharest Romania
| | - Robert Adam
- Department of Cardiology Expert Center for Rare Genetic Cardiovascular Diseases Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” Bucharest Romania
- University of Medicine and Pharmacy “Carol Davila” – Euroecolab Bucharest Romania
| | - Monica Roşca
- Department of Cardiology Expert Center for Rare Genetic Cardiovascular Diseases Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” Bucharest Romania
- University of Medicine and Pharmacy “Carol Davila” – Euroecolab Bucharest Romania
| | - Carmen Ginghina
- Department of Cardiology Expert Center for Rare Genetic Cardiovascular Diseases Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” Bucharest Romania
- University of Medicine and Pharmacy “Carol Davila” – Euroecolab Bucharest Romania
| | - Bogdan A. Popescu
- Department of Cardiology Expert Center for Rare Genetic Cardiovascular Diseases Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” Bucharest Romania
- University of Medicine and Pharmacy “Carol Davila” – Euroecolab Bucharest Romania
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16
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Esposito R, Galderisi M, Santoro C, Imbriaco M, Riccio E, Maria Pellegrino A, Sorrentino R, Lembo M, Citro R, Angela Losi M, Spinelli L, Trimarco B, Pisani A. Prominent longitudinal strain reduction of left ventricular basal segments in treatment-naïve Anderson-Fabry disease patients. Eur Heart J Cardiovasc Imaging 2019; 20:438-445. [PMID: 30085001 DOI: 10.1093/ehjci/jey108] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 06/20/2018] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS Little is known about regional longitudinal strain (LS) distribution in early stages of Anderson-Fabry disease (AFD) cardiomyopathy. We investigated regional left ventricular (LV) patterns of LS strain and base-to-apex behaviour of LS in treatment-naïve AFD patients. METHODS AND RESULTS Twenty-three consecutive AFD patients at diagnosis and 23 healthy controls without cardiovascular risk factors and matched for age and sex to the patients, underwent a comprehensive evaluation of target organs. An echo-Doppler exam, including determination of regional and global LS strain (GLS) was obtained. The average LS of 6 basal (BLS), 6 middle (MLS), and 5 apical (ALS) segments and relative regional strain ratio [ALS/(BLS + MLS)] were also calculated. Ejection fraction and diastolic indices did not differ between the two groups. LV mass index was greater in AFD (P < 0.01). GLS (P = 0.006), BLS (P < 0.0001), and MLS (P = 0.003), but not ALS, were lower in AFD patients and relative regional strain ratio was higher in AFD (P < 0.01) than in controls. These analyses were confirmed separately in the two genders and even after excluding patients with wall hypertrophy. By subdividing AFD patients according to lysoGB3 levels, 9 patients with lysoGB3 ≥ 1.8 ng/L had lower ALS compared to 11 patients with lysoGB3 < 1.8 ng/L (P < 0.01). CONCLUSION In naïve AFD patients, we observed an early reduction of LV LS, involving mainly LV basal myocardial segments. Nevertheless, the association found between the higher lysoGB3 levels and the lower apical cap LS demonstrates that apical segments LS, despite still normal, is not spared at diagnosis.
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Affiliation(s)
- Roberta Esposito
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Eleonora Riccio
- Department of Public Medicine, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | | | - Regina Sorrentino
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Rodolfo Citro
- Division of Cardiology, San Giovanni e Ruggi D'Aragona Hospital, Via San Leonardo, 1, Salerno, Italy
| | - Maria Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Letizia Spinelli
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Antonio Pisani
- Department of Public Medicine, University Federico II, Via Sergio Pansini, 5, Naples, Italy
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17
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Mathur S, Dreisbach JG, Karur GR, Iwanochko RM, Morel CF, Wasim S, Nguyen ET, Wintersperger BJ, Hanneman K. Loss of base-to-apex circumferential strain gradient assessed by cardiovascular magnetic resonance in Fabry disease: relationship to T1 mapping, late gadolinium enhancement and hypertrophy. J Cardiovasc Magn Reson 2019; 21:45. [PMID: 31366357 PMCID: PMC6670217 DOI: 10.1186/s12968-019-0557-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiac involvement is common and is the leading cause of mortality in Fabry disease (FD). We explored the association between cardiovascular magnetic resonance (CMR) myocardial strain, T1 mapping, late gadolinium enhancement (LGE) and left ventricular hypertrophy (LVH) in patients with FD. METHODS In this prospective study, 38 FD patients (45.0 ± 14.5 years, 37% male) and 8 healthy controls (40.1 ± 13.7 years, 63% male) underwent 3 T CMR including cine balanced steady-state free precession (bSSFP), LGE and modified Look-Locker Inversion recovery (MOLLI) T1 mapping. Global longitudinal (GLS) and circumferential (GCS) strain and base-to-apex longitudinal strain (LS) and circumferential strain (CS) gradients were derived from cine bSSFP images using feature tracking analysis. RESULTS Among FD patients, 8 had LVH (FD LVH+, 21%) and 17 had LGE (FD LGE+, 45%). Nineteen FD patients (50%) had neither LVH nor LGE (FD LVH- LGE-). None of the healthy controls had LVH or LGE. FD patients and healthy controls did not differ significantly with respect to GLS (- 15.3 ± 3.5% vs. - 16.3 ± 1.5%, p = 0.45), GCS (- 19.4 ± 3.0% vs. -19.5 ± 2.9%, p = 0.84) or base-to-apex LS gradient (7.5 ± 3.8% vs. 9.3 ± 3.5%, p = 0.24). FD patients had significantly lower base-to-apex CS gradient (2.1 ± 3.7% vs. 6.5 ± 2.2%, p = 0.002) and native T1 (1170.2 ± 37.5 ms vs. 1239.0 ± 18.0 ms, p < 0.001). Base-to-apex CS gradient differentiated FD LVH- LGE- patients from healthy controls (OR 0.42, 95% CI: 0.20 to 0.86, p = 0.019), even after controlling for native T1 (OR 0.24, 95% CI: 0.06 to 0.99, p = 0.049). In a nested logistic regression model with native T1, model fit was significantly improved by the addition of base-to-apex CS gradient (χ2(df = 1) = 11.04, p < 0.001). Intra- and inter-observer agreement were moderate to good for myocardial strain parameters: GLS (ICC 0.849 and 0.774, respectively), GCS (ICC 0.831 and 0.833, respectively), and base-to-apex CS gradient (ICC 0.737 and 0.613, respectively). CONCLUSIONS CMR reproducibly identifies myocardial strain abnormalities in FD. Loss of base-to-apex CS gradient may be an early marker of cardiac involvement in FD, with independent and incremental value beyond native T1.
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Affiliation(s)
- Shobhit Mathur
- Toronto Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - John G. Dreisbach
- Toronto Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Gauri R. Karur
- Toronto Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Robert M. Iwanochko
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Ave, Toronto, ON M5G 2N2 Canada
| | - Chantal F. Morel
- Fred A. Litwin Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON M5T 3L9 Canada
| | - Syed Wasim
- Fred A. Litwin Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON M5T 3L9 Canada
| | - Elsie T. Nguyen
- Toronto Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Bernd J. Wintersperger
- Toronto Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Kate Hanneman
- Toronto Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2 Canada
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18
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Esposito R, Santoro C, Sorrentino R, Riccio E, Citro R, Buonauro A, Di Risi T, Imbriaco M, Trimarco B, Pisani A, Galderisi M. Layer-specific longitudinal strain in Anderson-Fabry disease at diagnosis: A speckle tracking echocardiography analysis. Echocardiography 2019; 36:1273-1281. [PMID: 31246327 DOI: 10.1111/echo.14399] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Speckle tracking advancements make now available the analysis of layer-specific myocardial deformation. This study investigated multilayer longitudinal strain in Anderson-Fabry disease (AFD) patients at diagnosis. METHODS In a case-control study, 33 newly diagnosed, untreated AFD patients and 33 healthy age- and sex-matched healthy controls underwent a complete echocardiogram, including assessment of left ventricular (LV) transmural global longitudinal strain (GLS), subendocardial longitudinal strain (LSsubendo), subepicardial longitudinal strain (LSsubepi), and strain gradient (LSsubendo-LSsubpepi). RESULTS Anderson-Fabry disease patients had similar blood pressure, heart rate, and ejection fraction but higher body mass index in comparison with controls. LV mass index, maximal, and relative wall thickness were significantly greater in AFD patients. LSsubendo was significantly higher than LSsubepi in both groups, but GLS (P < 0.0001), LSsubendo (P = 0.003), and particularly LSsubepi (21.4 ± 1.7 vs 18.8 ± 1.4%, P < 0.0001) were lower in AFD patients than in controls. Accordingly, LS gradient was higher in AFD patients (P = 0.003). Three patients symptomatic for dyspnoea presented a combination of LV hypertrophy and reduced LSsubepi. After adjusting for confounders by multivariate analyses, LV mass index or maximal wall thickness were independently and inversely associated with transmural GLS and LSsubepi, but not with LSsubendo in the AFD group. At receiver operating curve curves, LSsubepi best discriminated AFD and normals. CONCLUSIONS In newly diagnosed, untreated AFD patients, layer-specific strain imaging highlights an impairment of LV longitudinal deformation, mainly involving subepicardial strain and causing increase in longitudinal strain myocardial gradient. These findings could be useful for identifying the mechanisms underlying early LV dysfunction in AFD patients.
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Affiliation(s)
- Roberta Esposito
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Regina Sorrentino
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Eleonora Riccio
- Department of Public Medicine, University Federico II, Naples, Italy
| | - Rodolfo Citro
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Agostino Buonauro
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Teodolinda Di Risi
- Department of Molecular Medicine and Medical Biology, University Federico II, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Antonio Pisani
- Department of Public Medicine, University Federico II, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
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19
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Spinelli L, Imbriaco M, Nappi C, Nicolai E, Giugliano G, Ponsiglione A, Diomiaiuti TC, Riccio E, Duro G, Pisani A, Trimarco B, Cuocolo A. Early Cardiac Involvement Affects Left Ventricular Longitudinal Function in Females Carrying α-Galactosidase A Mutation: Role of Hybrid Positron Emission Tomography and Magnetic Resonance Imaging and Speckle-Tracking Echocardiography. Circ Cardiovasc Imaging 2019; 11:e007019. [PMID: 29626078 DOI: 10.1161/circimaging.117.007019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/06/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hybrid 18F-fluorodeoxyglucose (FDG) positron emission tomography and magnetic resonance imaging may differentiate mature fibrosis or scar from fibrosis associated to active inflammation in patients with Anderson-Fabry disease, even in nonhypertrophic stage. This study was designed to compare the results of positron emission tomography and magnetic resonance cardiac imaging with those of speckle-tracking echocardiography in heterozygous Anderson-Fabry disease females. METHODS AND RESULTS Twenty-four heterozygous females carrying α-galactosidase A mutation and without left ventricular hypertrophy underwent cardiac positron emission tomography and magnetic resonance using 18F-FDG for glucose uptake and 2-dimensional strain echocardiography. 18F-FDG myocardial uptake was quantified by measuring the coefficient of variation (COV) of the standardized uptake value using a 17-segment model. Focal 18F-FDG uptake with COV >0.17 was detected in 13 patients, including 2 patients with late gadolinium enhancement at magnetic resonance. COV was 0.30±0.14 in patients with focal 18F-FDG uptake and 0.12±0.03 in those without (P<0.001). Strain echocardiography revealed worse global longitudinal systolic strain in patients with COV >0.17 compared with those with COV ≤0.17 (-18.5±2.7% versus -22.2±1.8%; P=0.024). For predicting COV >0.17, a global longitudinal strain >-19.8% had 77% sensitivity and 91% specificity and a value >2 dysfunctional segments 92% sensitivity and 100% specificity. CONCLUSIONS In females carrying α-galactosidase A mutation, focal 18F-FDG uptake represents an early sign of disease-related myocardial damage and is associated with impaired left ventricular longitudinal function. These findings support the hypothesis that inflammation plays an important role in glycosphingolipids storage disorders.
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Affiliation(s)
- Letizia Spinelli
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.).
| | - Massimo Imbriaco
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Carmela Nappi
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Emanuele Nicolai
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Giuseppe Giugliano
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Andrea Ponsiglione
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Tommaso Claudio Diomiaiuti
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Eleonora Riccio
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Giovanni Duro
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Antonio Pisani
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Bruno Trimarco
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
| | - Alberto Cuocolo
- Departments of Advanced Biomedical Sciences (L.S., M.I., C.N., G.G., A. Ponsiglione, B.T., A.C.) and Public Health (E.R., A. Pisani), University of Naples Federico II, Italy; SDN IRCCS, Naples, Italy (E.N., T.C.D.); and Institute of Biomedicine and Molecular Immunology, National Council of Research, Palermo, Italy (G.D.)
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20
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Perry R, Selvanayagam JB. Echocardiography in Infiltrative Cardiomyopathy. Heart Lung Circ 2019; 28:1365-1375. [PMID: 31109889 DOI: 10.1016/j.hlc.2019.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/14/2019] [Accepted: 04/11/2019] [Indexed: 01/18/2023]
Abstract
Left ventricular (LV) wall thickening can occur due to both physiological and pathological processes. Some LV wall thickening is caused by infiltrative cardiac deposition diseases - rare disorders from both inherited and acquired conditions, with varying systemic manifestations. They portend a poor prognosis and are generally not reversible except in rare circumstances when early diagnosis and treatment may alter the outcome (e.g., Fabry disease). Cardiac involvement is variable and depends on the degree of infiltration and type of infiltrate. These changes often lead to the development of abnormalities in both the relaxation and contractile function of the heart ultimately resulting in heart failure. Echocardiography is generally the first investigation of choice as it is easily available and gives valuable information about the thickness of the ventricular walls as well as systolic and diastolic function. It is also able to identify unique, characteristic features of the disease as well as detecting any haemodynamic sequelae. This review looks at the role of echocardiography in the diagnosis and prognosis of infiltrative cardiac deposition diseases.
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Affiliation(s)
- Rebecca Perry
- College of Medicine, Flinders University, Adelaide, SA, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia; Cardiac Imaging Research, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Joseph B Selvanayagam
- College of Medicine, Flinders University, Adelaide, SA, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia; Cardiac Imaging Research, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
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21
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Loncaric F, Bijnens B, Sitges M. Added value of cardiac deformation imaging in differential diagnosis of left ventricular hypertrophy. Glob Cardiol Sci Pract 2018; 2018:21. [PMID: 30393633 PMCID: PMC6209440 DOI: 10.21542/gcsp.2018.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Filip Loncaric
- Cardiovascular Institute, Hospital Clínic, University of Barcelona & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
| | - Bart Bijnens
- Universitat Pompeu Fabra, Barcelona, Spain.,ICREA, Barcelona, Spain
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, University of Barcelona & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
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22
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Abstract
Anderson-Fabry disease is an X-linked lysosomal storage disorder caused by mutations in the GLA gene that result in deficiency of the enzyme alpha-galactosidase A. The worldwide incidence of Fabry's disease is reported to be in the range of 1 in 40,000-117,000, although this value may be a significant underestimate given under recognition of symptoms and delayed or missed diagnosis. Deficiency in alpha-galactosidase A causes an accumulation of neutral glycosphingolipids such as globotriaosylceramide (Gb3) in lysosomes within various tissues including the vascular endothelium, kidneys, heart, eyes, skin and nervous system. Gb3 accumulation induces pathology via the release of pro-inflammatory cytokines, growth-promoting factors and by oxidative stress, resulting in myocardial extracellular matrix remodelling, left ventricular hypertrophy (LVH), vascular dysfunction and interstitial fibrosis. Cardiac involvement manifesting as ventricular hypertrophy, systolic and diastolic dysfunction, valvular abnormalities and conduction tissue disease is common in AFD and is associated with considerable cardiovascular morbidity and mortality from heart failure, sudden cardiac death and stroke-related death.
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23
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Yeung DF, Sirrs S, Tsang MY, Gin K, Luong C, Jue J, Nair P, Lee PK, Tsang TS. Echocardiographic Assessment of Patients with Fabry Disease. J Am Soc Echocardiogr 2018; 31:639-649.e2. [DOI: 10.1016/j.echo.2018.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Indexed: 12/26/2022]
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24
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Inciardi RM, Galderisi M, Nistri S, Santoro C, Cicoira M, Rossi A. Echocardiographic advances in hypertrophic cardiomyopathy: Three-dimensional and strain imaging echocardiography. Echocardiography 2018; 35:716-726. [DOI: 10.1111/echo.13878] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Riccardo M. Inciardi
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
| | - Maurizio Galderisi
- Departement of Advanced Biomedical Science; Federico II University; Naples Italy
| | - Stefano Nistri
- Cardiology Service; CMSR-Veneto Medica; Altavilla Vicentina Italy
| | - Ciro Santoro
- Departement of Advanced Biomedical Science; Federico II University; Naples Italy
| | | | - Andrea Rossi
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
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25
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Labombarda F, Saloux E, Milesi G, Bienvenu B. Loss of base-to-apex circumferential strain gradient: A specific pattern of Fabry cardiomyopathy? Echocardiography 2017; 34:504-510. [DOI: 10.1111/echo.13496] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Eric Saloux
- Department of Cardiology; Caen CHU; Caen France
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26
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Silbiger JJ. Abnormalities of the Mitral Apparatus in Hypertrophic Cardiomyopathy: Echocardiographic, Pathophysiologic, and Surgical Insights. J Am Soc Echocardiogr 2016; 29:622-39. [DOI: 10.1016/j.echo.2016.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Indexed: 12/30/2022]
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27
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Spinelli L, Pellegrino T, Pisani A, Giudice CA, Riccio E, Imbriaco M, Salvatore M, Trimarco B, Cuocolo A. Relationship between left ventricular diastolic function and myocardial sympathetic denervation measured by 123I-meta-iodobenzylguanidine imaging in Anderson-Fabry disease. Eur J Nucl Med Mol Imaging 2015; 43:729-39. [DOI: 10.1007/s00259-015-3273-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/27/2015] [Indexed: 12/31/2022]
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28
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Weissler-Snir A, Crean A, Rakowski H. The role of imaging in the diagnosis and management of hypertrophic cardiomyopathy. Expert Rev Cardiovasc Ther 2015; 14:51-74. [PMID: 26567960 DOI: 10.1586/14779072.2016.1113130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy, affecting approximately 1:500 people. As the yield of genetic testing is only about 35-60%, the diagnosis of HCM is still clinical and based on the demonstration of unexplained and usually asymmetric left ventricular (LV) hypertrophy by imaging modalities. In the past, echocardiography was the sole imaging modality used for the diagnosis and management of HCM. However, in recent years other imaging modalities such as cardiac magnetic resonance have played a major role in the diagnosis, management and risk stratification of HCM, particularly when the location of left ventricular hypertrophy is atypical (apex, lateral wall) and when the echocardiographic imaging is sub-optimal. However, the most unique contribution of cardiac magnetic resonance is the quantification of myocardial fibrosis. Exercise stress echocardiography is the preferred provocative test for the assessment of LV outflow tract obstruction, which is detected only on provocation in one-third of the patients.
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Affiliation(s)
| | - Andrew Crean
- a Department of Cardiology , Toronto General Hospital , Toronto , Canada
| | - Harry Rakowski
- a Department of Cardiology , Toronto General Hospital , Toronto , Canada
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29
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Cianciulli TF, Saccheri MC, Fernández SP, Fernández CC, Rozenfeld PA, Kisinovsky I. Apical left ventricular hypertrophy and mid-ventricular obstruction in fabry disease. Echocardiography 2015; 32:860-3. [PMID: 25684266 DOI: 10.1111/echo.12900] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report the case of a rare cardiac presentation of Fabry disease. Although concentric left ventricular hypertrophy is a major cardiac finding in Fabry disease, there is no case report of dynamic obstruction at mid-left ventricular level. We describe a 59-year-old-woman suffering from a severe form of Fabry disease, mimicking an apical hypertrophic cardiomyopathy with mid-ventricular obstruction. Differentiation of Fabry disease from hypertrophic cardiomyopathy is crucial given the therapeutic and prognostic differences. Fabry disease should always be suspected in an adult, independently of the pattern of left ventricular hypertrophy.
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Affiliation(s)
- Tomás F Cianciulli
- Department of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, Argentina
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30
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Smid B, van der Tol L, Cecchi F, Elliott P, Hughes D, Linthorst G, Timmermans J, Weidemann F, West M, Biegstraaten M, Lekanne Deprez R, Florquin S, Postema P, Tomberli B, van der Wal A, van den Bergh Weerman M, Hollak C. Uncertain diagnosis of Fabry disease: Consensus recommendation on diagnosis in adults with left ventricular hypertrophy and genetic variants of unknown significance. Int J Cardiol 2014; 177:400-8. [DOI: 10.1016/j.ijcard.2014.09.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/14/2014] [Indexed: 02/05/2023]
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31
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Abstract
Pathologic left ventricular hypertrophy due to hypertrophic cardiomyopathy is typically diagnosed based on compatible clinical and imaging findings. In a subset of patients however, the diagnosis is unclear, either due to the finding of concentric hypertrophy raising the possibility of physiologic hypertrophy due to athlete's heart or due to the potential of so-called hypertrophic cardiomyopathy 'phenocopies', which include Anderson-Fabry disease and cardiac amyloidosis. We review each of these diseases, highlighting important distinguishing features, the knowledge of which should permit the resolution of such diagnostic dilemmas.
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Affiliation(s)
- Emily J Lai
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, Ontario M5G2N2, Canada
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32
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Saccheri MC, Cianciulli TF, Lax JA, Gagliardi JA, Cáceres GL, Quarin AE, Kisinovsky I, Rozenfeld PA, Reisin RC. Two-dimensional speckle tracking echocardiography for early detection of myocardial damage in young patients with Fabry disease. Echocardiography 2013; 30:1069-77. [PMID: 23600802 DOI: 10.1111/echo.12216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Fabry disease (FD) is characterized by left ventricular hypertrophy (LVH). Conventional echocardiography is not sensitive enough to perform the preclinical diagnosis To assess whether longitudinal myocardial strain of the left ventricle (LV), using speckle tracking, is useful to detect early myocardial involvement in FD. Forty-four patients with FD who were diagnosed with genetic testing were prospectively included and were compared to a sex-matched control group. They were divided into three groups: 22 with LVH (Group I), 22 without LVH (Group II), and 22 healthy volunteers (Group III). LV longitudinal strain was measured from the apical views. An ANOVA test was used for multiple comparisons for variables with a normal distribution, and a Kruskal-Wallis test was used for variables with non-Gaussian distribution. Longitudinal LV strain was different in the three groups: it was ≥-15% in at least one segment in all Group I patients, in 50% of patients of Group II and in no patient of Group III. Seventy percent of the segments with abnormal strain in Group II were located in the basal regions (32/46). These findings show that the presence of at least one strain value ≥-15% demonstrates subclinical myocardial dysfunction in patients with preclinical FD. Longitudinal myocardial LV strain measured with speckle tracking is a useful tool to detect early myocardial involvement in young patients with FD. This information allows the detection and treatment of myocardial dysfunction at an early stage, which is of high clinical importance.
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Affiliation(s)
- María C Saccheri
- Cardiology Department, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, Argentina
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33
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Affiliation(s)
- Luis Rocha Lopes
- UCL Institute of Cardiovascular Science, The Heart Hospital, London, UK
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