Cardiac involvement in genotype-positive Fabry disease patients assessed by cardiovascular MR

• Published in: Heart (British Cardiac Society) Vol. 102; no. 4; pp. 298 - 302
• Main Authors: Kozor, Rebecca, Grieve, Stuart M, Tchan, Michel C, Callaghan, Fraser, Hamilton-Craig, Christian, Denaro, Charles, Moon, James C, Figtree, Gemma A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.02.2016
• Subjects: Adult; Age; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - drug therapy; Cardiomyopathies - genetics; Early Diagnosis; Enzyme Replacement Therapy; Enzymes; Fabry Disease - diagnostic imaging; Fabry Disease - drug therapy; Fabry Disease - genetics; Female; Genetic Predisposition to Disease; Genotype & phenotype; Humans; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - genetics; Magnetic Resonance Imaging, Cine; Male; Males; Middle Aged; Mortality; New South Wales; Phenotype; Predictive Value of Tests; Queensland; Risk Assessment; Risk Factors; Severity of Illness Index; Variables
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2015-308494

ObjectiveCardiac magnetic resonance (CMR) has the potential to provide early detection of cardiac involvement in Fabry disease. We aimed to gain further insight into this by assessing a cohort of Fabry patients using CMR.Methods/resultsFifty genotype-positive Fabry subjects (age 45±2 years; 50% male) referred for CMR and 39 matched controls (age 40±2 years; 59% male) were recruited. Patients had a mean Mainz severity score index of 15±2 (range 0–46), reflecting an overall mild degree of disease severity. Compared with controls, Fabry subjects had a 34% greater left ventricular mass (LVM) index (82±5 vs 61±2 g/m2, p=0.001) and had a significantly greater papillary muscle contribution to total LVM (13±1 vs 6±0.5%, p<0.001), even in the absence of left ventricular hypertrophy (LVH). Late gadolinium enhancement (LGE) was present in 15 Fabry subjects (9/21 males and 6/23 females). The most common site for LGE was the basal inferolateral wall (93%, 14/15). There was a positive association between LVM index and LGE. Despite this, there were two males and three females with no LVH that displayed LGE. Of Fabry subjects who were not on enzyme replacement therapy at enrolment (n=28), six were reclassified as having cardiac involvement (four LVH-negative/LGE-positive, one LVH-positive/LGE-positive and one LVH-positive/LGE-negative).ConclusionsCMR was able to detect cardiac involvement in 48% of this Fabry cohort, despite the overall mild disease phenotype of the cohort. Of those not on ERT, 21% were reclassified as having cardiac involvement allowing improved risk stratification and targeting of therapy.