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Balci MC, Karaca M, Ergul Y, Omeroglu RE, Demirkol M, Gokcay GF. Cardiologic evaluation of Turkish mitochondrial fatty acid oxidation disorders. Pediatr Int 2022; 64:e15317. [PMID: 36331231 DOI: 10.1111/ped.15317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 07/03/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mitochondrial fatty acid oxidation disorders (FAODs) cause impairment in energy metabolism and can lead to a spectrum of cardiac pathologies including cardiomyopathy and arrhythmias. The frequency of underlying cardiac pathologies and the response to recommended treatment in FAODs was investigated. METHODS Sixty-eight children (35 males, 33 females) with the diagnosis of a FAOD were included in the study. Cardiac function was evaluated with 12-lead standard electrocardiography, echocardiography, and 24 h Holter monitoring. RESULTS Forty-five patients (66%) were diagnosed after disease symptoms developed and 23 patients (34%) were diagnosed in the pre-symptomatic period. Among symptomatic patients (n: 45), cardiovascular findings were detected in 18 (40%) patients, including cardiomyopathy in 14 (31.1%) and conduction abnormalities in 4 (8.8%) patients. Cardiac symptoms were more frequently detected in primary systemic carnitine deficiency (57.1%). Patients with multiple acyl-CoA dehydrogenase, long-chain 3-hydroxyacyl-CoA dehydrogenase, and mitochondrial trifunctional protein deficiencies also had an increased frequency of cardiac symptoms. Patients with medium-chain acyl-CoA dehydrogenase, very long-chain acyl-CoA dehydrogenase, and carnitine palmitoyltransferase I deficiencies had a lower prevalence of cardiac symptoms both during admission and during clinical follow up. Cardiomyopathy resolved completely in 8/14 (57%) patients and partially in 2/14 (14.3%) patients with treatment. Two patients with cardiomyopathy died in the newborn period; cardiomyopathy persisted in 1 (7.1%) patient with very long-chain acyl-CoA dehydrogenase deficiency. CONCLUSION Early diagnosis, treatment and follow up made a significant contribution to the improvement of cardiac symptoms of patients with FAODs.
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Affiliation(s)
- Mehmet Cihan Balci
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty Children's Hospital, Istanbul University, Istanbul, Turkey
| | - Meryem Karaca
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty Children's Hospital, Istanbul University, Istanbul, Turkey
| | - Yakup Ergul
- Division of Pediatric Cardiology, Istanbul Medical Faculty Children's Hospital, Istanbul University, Istanbul, Turkey
| | - Rukiye Eker Omeroglu
- Division of Pediatric Cardiology, Istanbul Medical Faculty Children's Hospital, Istanbul University, Istanbul, Turkey
| | - Mubeccel Demirkol
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty Children's Hospital, Istanbul University, Istanbul, Turkey
| | - Gulden Fatma Gokcay
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty Children's Hospital, Istanbul University, Istanbul, Turkey.,Department of Rare Diseases, Institute of Child Health, Istanbul University, Istanbul, Turkey
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Brailova M, Clerfond G, Trésorier R, Minet-Quinard R, Durif J, Massoullié G, Pereira B, Sapin V, Eschalier R, Bouvier D. Inherited Metabolic Diseases and Cardiac Pathology in Adults: Diagnosis and Prevalence in a CardioMetabo Study. J Clin Med 2020; 9:jcm9030694. [PMID: 32143453 PMCID: PMC7141305 DOI: 10.3390/jcm9030694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 01/03/2023] Open
Abstract
Many inherited metabolic diseases (IMD) have cardiac manifestations. The aim of this study was to estimate the prevalence of IMD in adult patients with hypertrophic cardiomyopathy (HCM) and cardiac rhythm abnormalities that require cardiac implantable electronic devices (CIEDs). The study included a review of the medical files of patients aged 18 to 65 years who were followed in our cardiology department during the period 2010–2017. Metabolic explorations for Fabry disease (FD), mitochondrial cytopathies, and fatty-acid metabolism disorders were carried out in patients with unexplained etiology. The prevalence of IMD in patients with HCM was 5.6% (confidence interval (CI): 2.6–11.6). Six cases of IMD were identified: 1 mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome, 1 Hurler syndrome, 2 Friedreich’s ataxia, 1 FD, and 1 short-chain acyl-CoA dehydrogenase deficiency. Three cases of IMD were identified in patients requiring CIEDs: 1 patient with Leber hereditary optic neuropathy, 1 FD, and 1 short chain acyl-CoA dehydrogenase (SCAD) deficiency. IMD prevalence in patients with CIEDs was 3.1% (CI: 1.1–8.8). IMD evaluation should be performed in unexplained HCM and cardiac rhythm abnormalities adult patients, since the prevalence of IMD is relatively important and they could benefit from specific treatment and family diagnosis.
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Affiliation(s)
- Marina Brailova
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (M.B.); (J.D.)
| | - Guillaume Clerfond
- Cardiology Department, CHU Clermont-Ferrand, Faculty of Medicine, Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France; (G.C.); (R.T.); (G.M.); (R.E.)
- INI-CRCT F-CRIN, 54500 Nancy, France
| | - Romain Trésorier
- Cardiology Department, CHU Clermont-Ferrand, Faculty of Medicine, Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France; (G.C.); (R.T.); (G.M.); (R.E.)
| | - Régine Minet-Quinard
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Faculty of Medicine, Université Clermont-Auvergne, CNRS 6293, INSERM 1103, GReD, 63000 Clermont-Ferrand, France; (R.M.-Q.); (V.S.)
| | - Julie Durif
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (M.B.); (J.D.)
| | - Grégoire Massoullié
- Cardiology Department, CHU Clermont-Ferrand, Faculty of Medicine, Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France; (G.C.); (R.T.); (G.M.); (R.E.)
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Faculty of Medicine, Université Clermont-Auvergne, CNRS 6293, INSERM 1103, GReD, 63000 Clermont-Ferrand, France; (R.M.-Q.); (V.S.)
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Faculty of Medicine, Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France; (G.C.); (R.T.); (G.M.); (R.E.)
- INI-CRCT F-CRIN, 54500 Nancy, France
| | - Damien Bouvier
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Faculty of Medicine, Université Clermont-Auvergne, CNRS 6293, INSERM 1103, GReD, 63000 Clermont-Ferrand, France; (R.M.-Q.); (V.S.)
- Correspondence: ; Tel.: +33-4-7375-4882
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Labarthe F, Tardieu M, de Parscau L, Lamireau D. [Clinical presentation of inborn metabolic diseases in the neonatal period]. Arch Pediatr 2012; 19:953-8. [PMID: 22877859 DOI: 10.1016/j.arcped.2012.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 06/21/2012] [Indexed: 11/18/2022]
Abstract
Inborn metabolic diseases (IMDs) that can start in the neonatal period include various defects in numerous metabolic pathways. Such diseases are due to the genetic deficiency of an enzyme or a transporter. From a physiopathological point of view, the metabolic disorders can be divided into 3 diagnostically useful groups of diseases. The first group is due to the accumulation of endogenous toxic metabolites and includes inborn errors of amino acid metabolism, organic acidemias, urea cycle disorders, and sugar intolerances. The second one includes IMDs of intermediary metabolism causing a disturbance in energy production or utilization resulting from a defect in the liver, the muscles, the myocardium, or the brain (fatty acid oxidation defects, congenital lactic acidosis, etc.). The third group includes diseases that disturb the synthesis or the catabolism of complex molecules (lysosomal or peroxisomal disorders, etc.). IMDs are individually rare, but collectively numerous. Therefore, it is difficult to acquire extensive experience in the management of these diseases. However, the neonate has a limited repertoire of responses to severe illness and, at first, presents with nonspecific symptoms that could be easily attributed to infection or some other common cause. An IMD must be suspected in all situations of neonatal distress for which there is no apparent reason and that does not respond to symptomatic therapy. The priority is given to IMDs that are amenable to treatment, and emergency management has to be scheduled as soon as the diagnosis is suspected, even if the precise diagnosis is still unknown. In fact, emergency treatment must be undertaken in parallel with metabolic investigations, to prevent any delay in the management of the disease. The neonatologist must be able to recognize the neonatal distresses that suggest the possibility of an IMD. In such situations, an adequate diagnostic approach can be based on the proper use of only a few screening tests, which will also be useful to schedule adequate emergency treatment.
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Affiliation(s)
- F Labarthe
- Inserm U921, service de médecine pédiatrique, hôpital Clocheville, CHRU de Tours, université François-Rabelais, 49, boulevard Béranger, 37044 Tours cedex 1, France.
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