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Yang TH, Xirasagar S, Cheng YF, Chen CS, Lin HC. Increased prevalence of peripheral vestibular disorder among patients with Fabry disease. Orphanet J Rare Dis 2024; 19:97. [PMID: 38431642 PMCID: PMC10909259 DOI: 10.1186/s13023-024-03088-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Although peripheral vestibular disorder is a non-fatal complication of Fabry disease, fatalities have been reported in some case reports and case series. To date, no studies have examined the relative risk of peripheral vestibular disorder in patients with Fabry disease compared to the general population without the condition. Due to the high prevalence of Fabry disease in East Asia and the potential shared pathogenic pathways between Fabry disease and vasculopathy, we conducted a study using a nationwide population-based dataset to compare the prevalence of peripheral vestibular disorder between patients with Fabry disease and matched comparison patients. METHODS Data was sourced from Taiwan's Longitudinal Health Insurance Database 2010. this study consists of 11,668 sampled patients, 2917 study patients with Fabry disease and 8751 propensity-score-matching comparison patients. We conducted multiple logistic regression analysis to study the association between peripheral vestibular disorder and Fabry disease. RESULTS The study identified notable differences in the prevalence of various vestibular disorders between the study and comparison groups. Specifically, there was a 7.2% increased prevalence of peripheral vestibular disorder in the study group (28.3%) compared to the comparison group (20.9%), Meniere's disease (5.4% vs. 3.7%), benign paroxysmal positional vertigo (5.1% vs. 3.3%), and other/ unspecified peripheral vestibular dizziness (15.6% vs. 11.8%) (all p < 0.001). The odds ratios for PVD, MD, BPPV, and other PVD were 1.44 (95% CI = 1.29-1.60), 1.50 (95% CI = 1.23-1.83), 1.59 (95% CI = 1.30-1.95), and 1.40 (95% CI = 1.24-1.58), respectively, among the Fabry disease group relative to the comparison group after adjusting for age, monthly income, geographic location, urbanization level, hyperlipidemia, diabetes, coronary heart disease, and hypertension. CONCLUSION This study found that patients with Fabry disease had increased prevalence of peripheral vestibular disorder.
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Affiliation(s)
- Tzong-Hann Yang
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan
- Department of Speech, Language and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan
- Department of Exercise and Health Sciences, University of Taipei, Taipei, Taiwan
- Research Center of Data Science on Healthcare Industry, Taipei Medical University, Taipei, Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Yen-Fu Cheng
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Otorhinolaryngology, National Yang Ming Chiao Tung University, taipei, Taiwan
- Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Chin-Shyan Chen
- Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei, Taiwan
- Department of Economics, National Taipei University, New Taipei City, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
- Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
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Storck K, Stenzl A, Regenbogen C, Hofauer B, Knopf A. [Neuro-otological manifestations in Fabry disease-a retrospective single center study]. HNO 2024; 72:16-24. [PMID: 37747492 PMCID: PMC10781801 DOI: 10.1007/s00106-023-01360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Fabry disease (FD) is one of the X‑linked lysosomal storage diseases that can affect any organ. They have a specific lysosomal dysfunction in common, which results in substrate accumulation in lysosomes instead of metabolite degradation. Due to the deficiency/absence of α‑galactosidase, globotriaosylceramides (Gb3) are deposited in lysosomes of the organs. In addition to acroparesthesia, angiokeratomas, autonomic dysfunction, vortex keratopathies, ischemic cerebral or cardiac complications and chronic renal failure, also vestibulocochlear dysfunctions with sudden or progressive asymmetric hearing loss, tinnitus and vertigo may be observed. PATIENTS AND METHODS In this retrospective study, 33 patients (men = 16 and women = 17) with FD were evaluated. All patients presented to us in interdisciplinary cooperation as part of routine examinations by the specialized center for lysosomal storage diseases of the in-house department of nephrology. This presentation is carried out as a screening examination independent of neuro-otological symptoms. RESULTS The mean age at diagnosis was 34.76 (±11.55) years. The first presentation in our ENT department was at 40.45 (±11.71) years. We were able to demonstrate a significant correlation between neurological symptoms or apoplexy and hearing loss (p = 0.001) and between cardiac manifestations and hearing loss (p = 0.024). CONCLUSION Hearing loss is a potential symptom of Fabry disease and is not limited to the classic male phenotype. Due to possible positive correlations with neurological and cardiological manifestations of the disease, routine ENT screening examinations should be carried out to be able to identify and treat neuro-otological deficits at an early stage. In addition, FD should also be considered and tested as a differential diagnosis, especially in younger patients with sudden unilateral or bilateral hearing loss and a family history.
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Affiliation(s)
- Katharina Storck
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, TU München, München, Deutschland.
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - Anna Stenzl
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, TU München, München, Deutschland
| | - Claudia Regenbogen
- Innere Medizin II, Nephrologie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - Benedikt Hofauer
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, TU München, München, Deutschland
| | - Andreas Knopf
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universität Freiburg, Freiburg, Deutschland
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Preparation of PLGA nano inner ear drug delivery system and its transport mechanism in inner ears of rats. APPLIED NANOSCIENCE 2022. [DOI: 10.1007/s13204-022-02646-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Cochleovestibular involvement in patients with Fabry disease: data from the multicenter cohort FFABRY. Eur Arch Otorhinolaryngol 2021; 279:1639-1644. [PMID: 34825971 DOI: 10.1007/s00405-021-07173-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/03/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Fabry disease (FD) is a lysosomal storage disease responsible for cochleovestibular involvement. Exact prevalence and pathophysiological mechanisms behind ENT affections are still poorly known. Treating FD with enzyme replacement therapy (ERT) does not seem to significantly improve the ENT symptoms, while the impact of migalastat has yet to be determined. METHODS We carried out a retrospective multi-centre study on 47 patients from the FFABRY cohort who had an ENT consultation in the context of their FD. The information collected were as follows: clinical examination, videonystagmoscopy, pure-tone speech audiometry, videonystagmography or VHIT (Video Head Impulse Test). Severe hearing loss was defined as greater than 70 dB. RESULTS The median age of our cohort was 52 years with a non-negligible proportion of non-classic variants and female carriers. 72.3% of the patients complained of at least one of the following symptoms: hearing loss, tinnitus or vertigo. Pure-tone audiometry was abnormal in 61.7% of the patients (29/47), while speech audiometry was abnormal for 41.7% of the patients. The age of the patients and hypertrophic cardiomyopathy were significantly associated with the existence of an anomaly in pure-tone audiometry results. Severe hearing loss (> 70 dB) was significantly more common in male patients. DISCUSSION Hearing loss is particularly frequent in FD and is not limited to classic phenotypes. Close ENT follow-up is essential for Fabry patients to detect those who might benefit from hearing aid. Further studies are needed to define the impact of migalastat on cochleovestibular symptoms.
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Gago MF, Azevedo O, Guimarães A, Teresa Vide A, Lamas NJ, Oliveira TG, Gaspar P, Bicho E, Miltenberger-Miltenyi G, Ferreira J, Sousa N. Parkinson's Disease and Fabry Disease: Clinical, Biochemical and Neuroimaging Analysis of Three Pedigrees. JOURNAL OF PARKINSONS DISEASE 2021; 10:141-152. [PMID: 31594250 PMCID: PMC7029331 DOI: 10.3233/jpd-191704] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Sporadic Parkinson’s disease (PD) patients have lower α-galactosidase A (α-GAL A) enzymatic activity and Fabry disease (FD) patients potentially carry an increased risk of PD. Objective: Determination of PD prevalence in FD and clinical, biochemical and vascular neuroimaging description of FD pedigrees with concomitant PD. Methods: Clinical screening for PD in 229 FD patients belonging to 31 families, harbouring GLA gene mutation p.F113L, and subsequent pedigree analysis. Gender-stratified comparison of FD+/PD+ patients with their family members with FD but without PD (FD+/PD–) regarding Mainz scores, plasma & leukocytes α-GAL A enzymatic activity, urinary Gb3 and plasma Lyso-Gb3, vascular brain neuroimaging. Results: Prevalence of PD in FD was 1.3% (3/229) (3% in patients aged ≥50 years). Three FD patients, one female (73 years old) (P1) and two males (60 and 65 years old) (P2 and P3), three different pedigrees, presented akinetic-rigid PD, with weak response to levodopa (16% – 36%), and dopaminergic deficiency on 18F-DOPA PET. No pathogenic mutations were found in a PD gene panel. FD+/PD+ patients had worse clinical severity of FD (above upper 75% IQR in Mainz scores), and cortico-subcortical white matter/small vessel lesions. P3 patient was under enzyme therapy, started 1 year before PD diagnosis. P2-P3 patients had higher leucocyte α-GAL A activity (2,2-3 vs.1,0 (median)(nmol/h/mg)). Conclusion: We have shown a high prevalence of PD in a late-onset phenotype of FD, presenting high cerebrovascular burden and weak response to levodopa. Further studies will untangle how much of this PD phenotype is due to Gb3 deposition versus cerebrovascular lesions in the nigro-striatal network.
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Affiliation(s)
- Miguel Fernandes Gago
- Neurology Department, Reference Center on Lysosomal Storage Disorders, Hospital da Senhora da Oliveira, EPE, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal.,European Reference Network for Hereditary Metabolic Disorders (MetabERN)
| | - Olga Azevedo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Cardiology Department, Reference Center on Lysosomal Storage Disorders, Hospital da Senhora da Oliveira, EPE, Guimarães, Portugal.,European Reference Network for Hereditary Metabolic Disorders (MetabERN)
| | - Andreia Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana Teresa Vide
- Neuroradiology Department, Reference Center on Lysosomal Storage Disorders, Hospital da Senhora da Oliveira, EPE, Guimarães, Portugal.,European Reference Network for Hereditary Metabolic Disorders (MetabERN)
| | - Nuno J Lamas
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Anatomic Pathology Service, Pathology Department, Hospital and University Center of Porto, Porto, Portugal
| | - Tiago Gil Oliveira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Paulo Gaspar
- Newborn Screening, Metabolism and Genetic Unit, Genetics Department, National Institute for Health Doutor Ricardo Jorge (INSA)
| | - Estela Bicho
- Centro Algoritmi, Campus Azurem, University of Minho, Guimarães, Braga, Portugal
| | - Gabriel Miltenberger-Miltenyi
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Genetics Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal.,European Reference Network for Hereditary Metabolic Disorders (MetabERN)
| | - Joaquim Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular, Lisbon, Portugal; CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Abstract
OBJECTIVES Fabry disease (FD) is an X-linked lysosomal storage disorder that causes multisystem involvement, including ear disease. In this study, we aimed to investigate the nature of auditory issues in FD using a wide spectrum of audiological tests. DESIGN This cross-sectional study was conducted between June 2017 and December 2018. We collected the clinical and laboratory data of 40 eligible FD patients, 45 healthy subjects, and 26 diabetic controls. All patients and controls completed audiologic evaluations that included tympanometry, acoustic reflex threshold test, reflex decay test, pure-tone audiometry, speech audiometry, transient otoacoustic emissions (TEOAEs), high-frequency audiometry, and distortion product otoacoustic emission (DPOAE). RESULTS In our study population, hearing was reduced at higher frequencies starting at 4 kHz in both the FD and diabetic groups. Regarding the acoustic reflex threshold test, FD and diabetic patients had similar results. In all frequencies, positive decay was significantly more frequent in FD patients when compared with the diabetic patients and healthy controls (p < 0.001 for each ear). The FD patients and healthy controls had similar results for DPOAE testing. CONCLUSIONS We showed that FD patients had a higher rate of reflex decay, indicating retrocochlear involvement. Thus, further investigation of factors associated with retrocochlear involvement could be investigated, such as ABR and speech in noise tests.
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Russo C, Cocozza S, Riccio E, Pontillo G, Petruzzelli LA, Lanzillo R, Spinelli L, Colomba P, Duro G, Imbriaco M, Russo CV, De Riso G, Di Risi T, Tedeschi E, Cuocolo A, Brunetti A, Morra VB, Cocozza S, Pisani A. Prevalence of GLA gene mutations and polymorphisms in patients with multiple sclerosis: A cross-sectional study. J Neurol Sci 2020; 412:116782. [DOI: 10.1016/j.jns.2020.116782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/26/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
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Yazdanfard PD, Madsen CV, Nielsen LH, Rasmussen ÅK, Petersen JH, Seth A, Sørensen SS, Køber L, Feldt-Rasmussen U. Significant hearing loss in Fabry disease: Study of the Danish nationwide cohort prior to treatment. PLoS One 2019; 14:e0225071. [PMID: 31809513 PMCID: PMC6897399 DOI: 10.1371/journal.pone.0225071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/27/2019] [Indexed: 11/21/2022] Open
Abstract
Background Fabry disease (FD) is a lysosomal storage disorder resulting in systemic accumulation of globotriaosylceramide resulting in multi-organ dysfunction e.g. cerebral, cardiac, renal and audiologic complications. The audiologic involvement in FD has often been neglected; while not a lethal aspect of the disease, hearing loss can have a significantly negative impact on quality of life. Objectives To investigate baseline hearing status of the Danish Fabry cohort prior to treatment, compared to sex- and age-expected hearing levels and correlating hearing to renal and cerebral findings. Material and methods Retrospective study of baseline hearing status of the Danish Fabry cohort (n = 83, 9–72 years). Air conduction and speech discrimination scores were assessed at 6 frequencies between 0.25–8 kHz bilaterally. Data were collected between 2001–2014 and compiled in STATA using multilinear mixed modelling for statistical evaluation. Results Hearing thresholds at all frequencies deviated from the expected thresholds of an otologically normal cohort (p<0.001) and ranged 0.5 to 1.5 standard deviations below expected values. In total 29 males and 54 females were included. Hearing loss was more pronounced in the higher frequencies. There was a trend of association between hearing loss and measured glomerular filtration rate (mGFR) (p = 0.084). No association was present between hearing loss and albuminuria (p = 0.90), Fabry related cerebral abnormalities (p = 0.84) and cardiac left ventricular mass index, (LVMi) (p = 0.67) independent of sex. Hearing thresholds were poorer for men compared to women (p = 0.001). Sex differences were present at 0.25, 4 and 8 kHz. Conclusion Our findings demonstrated significant hearing loss in Danish FD patients before treatment initiation, being more profound than in otologically healthy individuals at all frequencies. Additionally, we observed no association between hearing loss and LVMi, albuminuria or FD cerebral abnormalities, with a trend of association to mGFR. Synopsis Patients with Fabrys disease have hearing loss of all frequencies and most prominently at high frequencies (4–8 kHz), with no association between the hearing loss and cerebral abnormalities, and cardiac mass but with a trend of association to measured glomerular filtration rate.
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Affiliation(s)
- Puriya Daniel Yazdanfard
- Department of Medical Endocrinology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Christoffer Valdorff Madsen
- Department of Medical Endocrinology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Lars Holme Nielsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Jørgen Holm Petersen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Alka Seth
- Department of Radiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
- * E-mail:
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Oliveira JP, Ferreira S. Multiple phenotypic domains of Fabry disease and their relevance for establishing genotype- phenotype correlations. APPLICATION OF CLINICAL GENETICS 2019; 12:35-50. [PMID: 30881085 PMCID: PMC6407513 DOI: 10.2147/tacg.s146022] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fabry disease (FD) is a rare X-linked glycosphingolipidosis resulting from deficient α-galactosidase A (AGAL) activity, caused by pathogenic mutations in the GLA gene. In males, the multisystemic involvement and the severity of tissue injury are critically dependent on the level of AGAL residual enzyme activity (REA) and on the metabolic load of the disease, but organ susceptibility to damage varies widely, with heart appearing as the most vulnerable to storage pathology, even with relatively high REA. The expression of FD can be conceived as a multidomain phenotype, where each of the component domains is the laboratory or clinical expression of the causative GLA mutation along a complex pathophysiologic cascade pathway. The AGAL enzyme activity is the most clinically useful marker of the protein phenotype. The metabolic phenotype and the pathologic phenotype are diverse expressions of the storage pathology, respectively, assessed by biochemical and histological/ultrastructural methods. The storage phenotypes are the direct consequences of enzyme deficiency and hence, together with the enzymatic phenotype, constitute the more specific diagnostic markers of FD. In the pathophysiology cascade, the clinical phenotypes are most distantly linked to the underlying genetic causation, being critically influenced by the patients’ gender and age, and modulated by the effects of variation in other genetic loci, of polygenic inheritance and of environmental risk factors. A major challenge in the clinical phenotyping of patients with FD is the differential diagnosis between its nonspecific, later-onset complications, particularly the cerebrovascular, cardiac and renal, and similar chronic illnesses that are common in the general population. Comprehensive phenotyping, whenever possible performed in hemizygous males, is therefore crucial for grading the severity of pathogenic GLA variants, to clarify the phenotypic correlations of hypomorphic alleles, to define benign polymorphisms, as well as to establish the pathogenicity of variants of uncertain significance.
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Affiliation(s)
- João Paulo Oliveira
- Department of Genetics, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal, .,Service of Medical Genetics, São João University Hospital Centre, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal.,i3S - Institute for Research and Innovation in Health / [Instituto de Investigação e Inovação em Saúde], University of Porto, 4200-135 Porto, Portugal,
| | - Susana Ferreira
- Department of Genetics, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal, .,i3S - Institute for Research and Innovation in Health / [Instituto de Investigação e Inovação em Saúde], University of Porto, 4200-135 Porto, Portugal,
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Fabry disease: Something cardiologists must always bear in mind. Rev Port Cardiol 2018; 37:467-468. [DOI: 10.1016/j.repc.2018.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Bettencourt N. Fabry disease: Something cardiologists must always bear in mind. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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