European Journal of Echocardiography Advance Access originally published online on April 14, 2008
European Journal of Echocardiography 2008 9(6):729-735; doi:10.1093/ejechocard/jen129
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Anderson-Fabry disease: long-term echocardiographic follow-up under enzyme replacement therapy
1 Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
2 Department of Cardiology, Cardiovascular Center, Klinik Im Park, Seestr. 220, 8027 Zurich, Switzerland
3 Department of Internal Medicine, University of Zurich, Zurich, Switzerland
4 Division of Biostatistics, University of Zurich, Zurich, Switzerland
Received 16 October 2007; accepted after revision 2 March 2008; online publish-ahead-of-print 14 April 2008.
* Corresponding author. Tel: +41 44 209 2020; fax: +41 44 209 2029. E-mail address: ch.attenhofer{at}attglobal.net
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Abstract |
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Aims: Anderson-Fabry disease affects various organ systems due to glycosphingolipid accumulation. Enzyme replacement therapy (ERT) has been reported to decrease left ventricular wall thickening (LVWT) and to improve diastolic dysfunction.
Methods and results: This prospective study included 29 patients (patients; mean age 37 ± 13 years) with genetically, enzymatically and/or biopsy-proven Anderson-Fabry disease and long-time ERT. Data on symptoms, cardiac medications and history of hypertension were collected and all patients had comprehensive echocardiographic examination prior to ERT and at follow-up.
Disease was at an early stage with a total mean Mainz severity score index of only 18.6 ± 13.0. Prior to ERT, 79% of patients reported acroparesthesia. The median creatinine level was 121 ± 108 mcmol/L and LVWT was present in nine patients (31%). Binary appearance of the interventricular septum was found in 20% and posterobasal fibrosis in 83%. At median follow-up of 37 months, acroparesthesia decreased to 55% (P = 0.016). There was no change in creatinine levels. The incidence of LVWT was unchanged, only an increase in interventricular septal wall thickness from 11.7 ± 0.4 to 12.5 ± 0.5 was observed (P = 0.009). Left atrial size and the percentage of patients with binary appearance and posterobasal fibrosis were unchanged. There was a small improvement in diastolic function (29% decrease of E/Ea; P < 0.002).
Conclusion: Our Anderson-Fabry cohort had successful long-time ERT with impressive amelioration of subjective symptoms. Although there was not much improvement in cardiac changes apart from a slight improvement of diastolic function, at least, there was no progression of cardiac disease. For complete reversibility of cardiac changes in Anderson-Fabry disease, ERT might have to be started earlier in life and/or prescribed for a longer time.
Keywords: Anderson-Fabry disease; Enzyme replacement therapy; Cardiac function; Long-term follow-up; Left ventricular hypertrophy
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  M Imbriaco, A Pisani, L Spinelli, A Cuocolo, G Messalli, E Capuano, M Marmo, R Liuzzi, B Visciano, B Cianciaruso, et al. Effects of enzyme-replacement therapy in patients with Anderson-Fabry disease: a prospective long-term cardiac magnetic resonance imaging study Heart, July 1, 2009; 95(13): 1103 - 1107. [Abstract] [Full Text] [PDF]
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