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Norrish G, Rance T, Montanes E, Field E, Brown E, Bhole V, Stuart G, Uzun O, McLeod KA, Ilina M, Adwani S, Daubeney P, Delle Donne G, Linter K, Jones CB, Bharucha T, Cervi E, Kaski JP. Friedreich's ataxia-associated childhood hypertrophic cardiomyopathy: a national cohort study. Arch Dis Child 2022; 107:450-455. [PMID: 34610949 PMCID: PMC9046745 DOI: 10.1136/archdischild-2021-322455] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/17/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Hypertrophic cardiomyopathy (HCM) is an important predictor of long-term outcomes in Friedreich's ataxia (FA), but the clinical spectrum and survival in childhood is poorly described. This study aimed to describe the clinical characteristics of children with FA-HCM. DESIGN AND SETTING Retrospective, longitudinal cohort study of children with FA-HCM from the UK. PATIENTS 78 children (<18 years) with FA-HCM diagnosed over four decades. INTERVENTION Anonymised retrospective demographic and clinical data were collected from baseline evaluation and follow-up. MAIN OUTCOME MEASURES The primary study end-point was all-cause mortality (sudden cardiac death, atrial arrhythmia-related death, heart failure-related death, non-cardiac death) or cardiac transplantation. RESULTS The mean age at diagnosis of FA-HCM was 10.9 (±3.1) years. Diagnosis was within 1 year of cardiac referral in 34 (65.0%) patients, but preceded the diagnosis of FA in 4 (5.3%). At baseline, 65 (90.3%) had concentric left ventricular hypertrophy and 6 (12.5%) had systolic impairment. Over a median follow-up of 5.1 years (IQR 2.4-7.3), 8 (10.5%) had documented supraventricular arrhythmias and 8 (10.5%) died (atrial arrhythmia-related n=2; heart failure-related n=1; non-cardiac n=2; or unknown cause n=3), but there were no sudden cardiac deaths. Freedom from death or transplantation at 10 years was 80.8% (95% CI 62.5 to 90.8). CONCLUSIONS This is the largest cohort of childhood FA-HCM reported to date and describes a high prevalence of atrial arrhythmias and impaired systolic function in childhood, suggesting early progression to end-stage disease. Overall mortality is similar to that reported in non-syndromic childhood HCM, but no patients died suddenly.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK,Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas Rance
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Elena Montanes
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Ella Field
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Elspeth Brown
- Paediatric Cardiology, Leeds General Infirmary, Leeds, UK
| | - Vinay Bhole
- Paediatric Cardiology, Birmingham Women and Children’s NHS Foundation Trust, Birmingham, UK
| | - Graham Stuart
- Bristol Congenital Heart Centre, Bristol Heart Institute, Bristol, UK
| | - Orhan Uzun
- Paediatric cardiology, University Hospital of Wales, Cardiff, UK
| | - Karen A McLeod
- Paediatric cardiology, Royal Hospital for Sick Children, Glasgow, UK
| | - Maria Ilina
- Paediatric cardiology, Royal Hospital for Children, Glasgow, UK
| | - Satish Adwani
- Paediatric Cardiology, John Radcliffe Hospital, Oxford, UK
| | - Piers Daubeney
- Paediatric cardiology, Royal Brompton and Harefield NHS Trust and National Heart and Lung Institute, London, UK
| | - Grazia Delle Donne
- Paediatric cardiology, Royal Brompton and Harefield NHS Trust and National Heart and Lung Institute, London, UK
| | - Katie Linter
- Paediatric cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Caroline B Jones
- Paediatric cardiology, Alder Hey Children’s Hospital, Liverpool, UK
| | - Tara Bharucha
- Department of Congenital Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elena Cervi
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK .,Institute of Cardiovascular Science, University College London, London, UK
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Abstract
Introduction To The Series Genetic disorders have characteristic cardiovascular manifestations. These cardiovascular abnormalities often are a major determinant of the morbidity and mortality in this patient population. Some characteristics are unique and can be detected with echocardiography. Drs Alizad and Seward have compiled in this series a review of genetic disorders that have recognizable morphologic and/or functional cardiovascular abnormalities. The following topics will be explored, with examples from the database of the Mayo Clinic Echocardiography Laboratory:Cardiomyopathy Storage disease Shunts Connective tissue Tumors Complex cardiovascular defects Complex genetic disorders Organ system
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Affiliation(s)
- A Alizad
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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Günal N, Saraçlar M, Ozkutlu S, Senocak F, Topaloğlu H, Karaaslan S. Heart disease in Friedreich's ataxia: a clinical and echocardiographic study. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1996; 38:308-11. [PMID: 8840535 DOI: 10.1111/j.1442-200x.1996.tb03496.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Twelve patients with Friedreich's ataxia (FA) were evaluated clinically and echocardiographically for evidence of heart disease. Electrocardiographic and echocardiographic abnormal findings were discovered in eight (67%) and seven (58%) children, respectively. A high incidence of cardiac involvement is well known in FA cases. Although the patient number in the present study is small, the findings are consistent with those in the literature. The most common pathology was asymmetric septal hypertrophy (ASH), followed by concentric left ventricular hypertrophy (CLVH) and dilated cardiomyopathy (DC).
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Affiliation(s)
- N Günal
- Department of Pediatric Cardiology, Hacettepe University, Ankara, Turkey
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