1
|
Abstract
Friedreich Ataxia (FRDA) is an autosomal recessive disease in which a mitochondrial protein, frataxin, is severely decreased in its expression. In addition to progressive ataxia, patients with FRDA often develop a cardiomyopathy that can be hypertrophic. This cardiomyopathy is unlike the sarcomeric hypertrophic cardiomyopathies in that the hypertrophy is associated with massive mitochondrial proliferation within the cardiomyocyte rather than contractile protein overexpression. This is associated with atrial arrhythmias, apoptosis, and fibrosis over time, and patients often develop heart failure leading to premature death. The differences between this mitochondrial cardiomyopathy and the more common contractile protein hypertrophic cardiomyopathies can be a source of misunderstanding in the management of these patients. Although imaging studies have revealed much about the structure and function of the heart in this disease, we still lack an understanding of many important clinical and fundamental molecular events that determine outcome of the heart in FRDA. This review will describe the current basic and clinical understanding of the FRDA heart, and most importantly, identify major gaps in our knowledge that represent new directions and opportunities for research.
Collapse
Affiliation(s)
- R. Mark Payne
- Address for correspondence: Dr R. Mark Payne, Division of Pediatric Cardiology, Wells Center for Pediatric Research, Indiana University School of Medicine, 1044 West Walnut, R4 302b, Indianapolis, Indiana 46202, USA.
| |
Collapse
|
2
|
Egbe AC, Miranda WR, Connolly HM. Increased prevalence of left ventricular diastolic dysfunction in adults with repaired coarctation of aorta. Int J Cardiol Heart Vasc 2020; 28:100530. [PMID: 32462075 PMCID: PMC7240224 DOI: 10.1016/j.ijcha.2020.100530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 01/28/2023]
Abstract
Background Left ventricular (LV) pressure overload and coronary artery disease are common in patients with coarctation of aorta (COA), and they are risk factors for LV diastolic dysfunction. Patients with COA may have aortic vasculopathy that can result in LV pressure overload even in the absence of hemodynamically significant COA. We therefore hypothesized that patients with mild COA (without hemodynamically significant COA) will have more LV diastolic dysfunction compared to controls. Methods Adult patients with mild COA (Doppler peak velocity < 2.5 m/s) were matched 1:1 to patients without structural heart disease using propensity score method based on age, sex, body mass index, hypertension and blood pressure. The objective was to compare LV diastolic dysfunction (defined as E/e′ > 2 standard deviations above age-specific normative values) between adults with repaired COA and controls. Results Of 204 COA and 204 control patients (age 35 ± 12 years), patients with COA had higher septal and lateral E/e′ ratio (12 ± 4 vs 9 ± 4, p = 0.009) and (10 ± 3 vs 7 ± 3, p < 0.001), respectively. Compared to controls, the prevalence of LV diastolic dysfunction was higher in patients with COA for every age group: <40 years (63% vs 13%, p < 0.001); 41–60 years (87% vs 33%, p < 0.001); age > 60 years (82% vs 56%, p = 0.076). Left ventricular mass index (LVMI) was the strongest determinant of E/e′ (β = 2.71 per 10 g/m2, standard error = 1.25, p < 0.001). Conclusion LV diastolic dysfunction was common in patients with COA, and the association with LVMI suggests that patients with COA may have ongoing LV pressure overload in the absence of hemodynamically significant re-coarctation.
Collapse
Affiliation(s)
- Alexander C Egbe
- The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - William R Miranda
- The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Heidi M Connolly
- The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States
| |
Collapse
|
3
|
Almahmoud MF, Gonzalez HM, Swett K, Tarraf W, Schneiderman N, Kansal MM, Lamar M, Talavera GA, Rodriguez CJ. Association of Cardiac Structure and Function With Neurocognition in Hispanics/Latinos: The Echocardiographic Study of Latinos. Mayo Clin Proc Innov Qual Outcomes 2018; 2:165-75. [PMID: 30225446 DOI: 10.1016/j.mayocpiqo.2018.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective To study the associations of comprehensive measures of cardiac structure and function with multidimensional neurocognitive measures. Patients and Methods The Echocardiographic Study of Latinos is a population-based cohort of Hispanic/Latino adults older than 45 years enrolled from October 1, 2011, through June 30, 2014. Neurocognitive measures included Word Fluency (WF), Brief-Spanish English Verbal Learning Test (B-SEVLT), and Digit Symbol Substitution Test. The B-SEVLT included B-SEVLT-recall and B-SEVLT-sum. Echocardiographic measures included cardiac structure, systolic and diastolic function, and myocardial strain. Multivariable regression models were fit using survey statistics and sampling probabilities. Results A total of 1794 participants (mean age, 56±0.5 years; 56% women) were included in the analysis. In the adjusted model, higher left ventricular mass index was associated with lower B-SEVLT-sum and Digit Symbol Substitution Test scores. Left ventricular systolic dysfunction was associated with lower WF scores. Abnormal left ventricular geometry was associated with lower B-SEVLT-sum scores. Higher relative wall thickness was associated with B-SEVLT-recall and B-SEVLT-sum scores. Mitral annular relaxation velocities were associated with lower B-SEVLT-recall, B-SEVLT-sum, and WF scores. Higher mitral inflow to annular early diastolic velocity ratio was associated with lower B-SEVLT-recall and B-SEVLT-sum scores. Diastolic dysfunction was associated with lower B-SEVLT-sum scores. Finally, lower global longitudinal strain was associated with lower WF scores. Conclusion Alterations in cardiac structure, systolic and diastolic function, and myocardial strain were associated with worse neurocognitive function. Further study is needed to determine the mechanisms (ie, impairment of cerebral flow and silent brain infarctions) mediating these heart-brain associations.
Collapse
Key Words
- B-SEVLT, Brief-Spanish English Verbal Learning Test
- BMI, body mass index
- CVH, cardiovascular health
- DSST, Digit Symbol Substitution Test
- E/e′ ratio, ratio of the early mitral inflow velocity to the mitral annular early diastolic velocity
- ECHO-SOL, Echocardiographic Study of Latinos
- EF, ejection fraction
- GLS, global longitudinal strain
- HCHS/SOL, Hispanic Community Health Study/Study of Latinos
- LA, left atrial
- LAVI, left atrial volume index
- LV, left ventricular
- LVESV, left ventricular end-systolic volume
- LVMI, left ventricular mass index
- RWT, relative wall thickness
- SIS, Six-Item Screener
- S′, peak systolic annular velocity
- WF, Word Fluency
- e′, mitral annular early diastolic velocity
Collapse
|
4
|
Lin HY, Chuang CK, Wang CH, Chien YH, Wang YM, Tsai FJ, Chou YY, Lin SJ, Pan HP, Niu DM, Hwu WL, Ke YY, Lin SP. Long-term galsulfase enzyme replacement therapy in Taiwanese mucopolysaccharidosis VI patients: A case series. Mol Genet Metab Rep 2016; 7:63-9. [PMID: 27134829 PMCID: PMC4834679 DOI: 10.1016/j.ymgmr.2016.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 02/07/2016] [Accepted: 04/06/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Information regarding the long-term outcome of enzyme replacement therapy (ERT) with recombinant human N-acetylgalactosamine 4-sulfatase (rhASB, galsulfase, Naglazyme®, BioMarin Pharmaceutical Inc.) for Taiwanese patients with mucopolysaccharidosis (MPS) VI is limited. METHODS Nine Taiwanese patients with MPS VI (4 males and 5 females; age range, 1.4 to 21.1 years) treated with weekly intravenous infusions of galsulfase (1.0 mg/kg) in 5 medical centers in Taiwan were reviewed. A set of biochemical and clinical assessments were evaluated annually. RESULTS After 6.2 to 11.2 years of galsulfase treatment, 6 patients experienced improvement over baseline in the 6-minute walk test by a mean of 150 m (59% change over time), and 3 patients also increased the 3-minute stair climb test by a mean of 60 steps (46%). In a manual dexterity test, 3 patients decreased the time required to pick up 10 coins and put the coins into a cup by 15 s (33%). Shoulder range of motion in all 9 patients improved, and Joint Pain and Stiffness Questionnaire scores improved by 0.42 points (21%). Four patients showed improved pulmonary function. Five patients had positive effects on cardiac-wall diameters. Four patients had improved cardiac diastolic function. Liver and spleen sizes as measured by abdominal ultrasonography remained the same or decreased in all 9 patients. However, the severity degree of valvular stenosis or regurgitation did not show improvement despite ERT. A mean overall 69% decrease in urinary glycosaminoglycan (GAG) excretion indicated a satisfactory biomarker response. CONCLUSIONS Long-term ERT was beneficial and safe for Taiwanese patients with MPS VI. This treatment reduced urinary GAG and had positive effects on a wide range of clinical functional assessments including endurance, mobility, joint function, pulmonary function, liver and spleen size, cardiac hypertrophy and diastolic dysfunction.
Collapse
Key Words
- 3MSCT, 3-minute stair climb test
- 6MWT, 6-minute walk test
- AC, air conduction
- ASB, N-acetylgalactosamine 4-sulfatase
- BC, bone conduction
- BMD, bone mineral density
- CHAQ, Childhood Health Assessment Questionnaire
- Cardiac hypertrophy
- DXA, dual energy x-ray absorptiometry
- Diastolic dysfunction
- E/A, ratio between early and late (atrial) ventricular filling velocity
- ERT, enzyme replacement therapy
- Enzyme replacement therapy
- FEV1, forced expiratory volume in 1 s
- FVC, Forced vital capacity
- GAG, glycosaminoglycan
- Galsulfase, recombinant human N-acetylgalactosamine 4-sulfatase
- Glycosaminoglycans
- HAQ, Health Assessment Questionnaire
- HAZ, height-for-age
- IVSd, interventricular septum thickness in diastole
- LVM, left ventricular mass
- LVMI, left ventricular mass index
- LVPWd, left ventricular posterior wall thickness in diastole
- MPS, mucopolysaccharidosis
- Mucopolysaccharidosis VI
- PTA, pure-tone audiometry
- Pulmonary function
- Z score, standard deviation score
Collapse
Affiliation(s)
- Hsiang-Yu Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Kuang Chuang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Medical College, Fu-Jen Catholic University, Taipei, Taiwan
- Institute of Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Chung-Hsing Wang
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Yin-Hsiu Chien
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Mei Wang
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
| | - Fuu-Jen Tsai
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Yin Chou
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shio Jean Lin
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Hui-Ping Pan
- Genetic Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Dau-Ming Niu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wuh-Liang Hwu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Yuan Ke
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shuan-Pei Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Infant and Child Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| |
Collapse
|
5
|
Bruder O, Jensen CJ, Bell M, Rummel R, Boehm G, Klebs S, Sieder C, Senges J. Effects of the combinations of amlodipine/valsartan versus losartan/hydrochlorothiazide on left ventricular hypertrophy as determined with magnetic resonance imaging in patients with hypertension. J Drug Assess 2012; 1:1-10. [PMID: 27536421 PMCID: PMC4980731 DOI: 10.3109/21556660.2011.639418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Accepted: 11/02/2011] [Indexed: 01/13/2023] Open
Abstract
Background Left ventricular hypertrophy (LVH), a marker of cardiac end-organ damage, is frequently found in patients with arterial hypertension and is associated with cardiovascular and cerebrovascular morbidity and mortality. Therefore, LVH regression is an important treatment goal. For amlodipine plus valsartan (A/V) no specific study on LVH has been reported to date. Methods Prospective, open-label, randomized parallel-group study. Patients with essential hypertension and LVH were randomized to 52-week treatment with A/V 10/160 mg (n = 43) or the active comparator losartan/HCT 100/25 mg (L/H, n = 47). Add-on medication was allowed in case of inadequate blood pressure control. LV parameters were measured by cardiovascular magnetic resonance imaging (MRI), and adjudicated in a blinded manner. Study identifiers were NCT00446563 and EudraCT 2006-001977-17. Results In addition to the study treatment, 35% of patients in the A/V group and 49% in the L/H group received additional antihypertensive medication. Compared to baseline, both treatments reduced measures of LVH significantly after 52 weeks (e.g. LV mass index in the A/V group from 64.7 g/m2 by −3.5 g/m2, in the L/H group from 69.1 g/m2 by −4.4 g/m2, p < 0.01 for both). LV ejection fraction and LV volumes were not significantly changed by any regimen. A/V and L/H treatments were well tolerated. Conclusions Both regimen were effective in reducing LV mass compared to baseline and were well tolerated.
Collapse
Key Words
- A/V, amlodipine plus valsartan
- Arterial hypertension
- Asc. aorta, ascending aorta
- BP, diastolic blood pressure
- CCB, calcium channel blockers
- IVS, interventricular septum thickness
- L/H, losartan/hydrochlorothiazide
- LA, left atrium
- LVEDV, left ventricular enddiastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, left ventricular endsystolic volume
- LVH, left ventricular hypertrophy
- LVM, left ventricular mass
- LVMI, left ventricular mass index
- MRI, magnetic resonance imaging
- RAAS
- SBP, systolic blood pressure
- combination therapy
- end-organ damage
- left ventricular hypertrophy
- magnetic resonance imaging
- norm BSA, adjusted for body surface area
- treatment
Collapse
Affiliation(s)
- Oliver Bruder
- Department of Cardiology and Angiology, Elisabeth Hospital, Essen, Germany
| | - Christoph J Jensen
- Department of Cardiology and Angiology, Elisabeth Hospital, Essen, Germany
| | - Michael Bell
- Department of Cardiology and Angiology, Elisabeth Hospital, Essen, Germany
| | | | | | - Sven Klebs
- Novartis Pharma GmbH, Clinical and Regulatory Affairs, Nürnberg, Germany
| | - Christian Sieder
- Novartis Pharma GmbH, Clinical and Regulatory Affairs, Nürnberg, Germany
| | - Jochen Senges
- Institute for Myocardial Infarction Research, Ludwigshafen, Germany
| |
Collapse
|