Clinical study of left ventricular structure and function in patients with Anderson–Fabry disease before and after enzyme replacement therapy

Abstract

AimsCardiac left ventricular hypertrophy (LVH) is the most common manifestation of heart involvement in Anderson–Fabry disease (AFD). Conventional cardiac imaging is not sensitive enough to detect early signs of LVH in AFD. It remains uncertain whether enzyme replacement therapy (ERT) can prevent LVH progression and improve myocardial function. This study aimed to assess the effectiveness of two‐dimensional speckle tracking echocardiography (2D‐STE) in early detection of cardiac involvement in AFD and monitoring the efficacy of agalsidase alfa and agalsidase beta therapy.Methods and ResultsThirteen consecutive AFD patients and 12 healthy controls underwent standard transthoracic 2D, color Doppler, tissue Doppler echocardiography, and 2D strain analysis. Global longitudinal strain (GLS) and global circumferential strain (GCS) were measured. Diastolic strain rate (SR) was extracted. Compared to healthy subjects, AFD patients without LVH showed lower levels of GLS (p < 0.001) and SR (p = 0.01), while there was no difference in GCS (p = 0.82). Following treatment, apical circumferential strain (ACS) showed improvement (p = 0.01).ConclusionIn AFD patients without LVH, there was a decrease in global and segmental LS. Higher plasma Lyso‐GL‐3 concentrations were associated with elevated ACS values after ERT, indicating that ACS in AFD patients without LVH, albeit normal, is involved in early LV dysfunction.

The role of two dimensional speckle tracking echocardiography in determining cardiac prognosis and monitoring enzyme replacement therapy efficacy in patients with Anderson–Fabry disease

“…Higher plasma Lyso-GL-3 concentrations were associated with elevated apical CS values after ERT, representing apical CS in AFD patients without LVH was involved in early LV dysfunction. 12 In this study, 2D-STE was utilized for the first time to determine the efficacy of ERT in patients with AFD according to 12-month follow-up data. However, this study was performed only on a small number of clinically stable patients with AFD who did not have LVH.…”