Diffuse left ventricular interstitial fibrosis is associated with sub-clinical myocardial dysfunction in Alström Syndrome: an observational study

Orphanet Journal of Rare Diseases

Richard P. Steeds¹  Tarekegn Geberhiwot⁶  Richard B. Paisey³  Robert Cramb⁴  Adrian T. Warfield⁵  Mengshi Yuan²  William E. Moody¹  Nicola C. Edwards¹ 

[1] Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK;School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK;Department of Diabetes, Torbay Hospital, Torbay, UK;Department of Biochemistry, Queen Elizabeth Hospital, Birmingham, UK;Department of Pathology, Queen Elizabeth Hospital, Birmingham, England;Department of Endocrinology, Queen Elizabeth Hospital, Birmingham, UK

关键词: Left ventricular function;    T1 mapping;    Cardiac MRI;    Myocardial fibrosis;    Alström syndrome;   

Others  :  1219115
DOI  :  10.1186/s13023-015-0292-z

 received in 2015-03-21, accepted in 2015-06-04,  发布年份 2015

【 摘 要 】

Background

Alström syndrome is a rare inherited ciliopathy with progressive multisystem involvement. Dilated cardiomyopathy is common in infancy and recurs or presents de novo in adults with high rates of premature cardiovascular death. Although Alström syndrome is characterised by fibrosis in solid organs such as the liver, the pathogenesis of related cardiomyopathy are not clear. To date it is not known whether diffuse interstitial myocardial fibrosis is present before the onset of heart failure symptoms or changes in conventional parameters of left ventricular function.

Methods

In this observational study, 26 patients with Alström syndrome (mean age 27 ± 9 years, 65 % male, 24 h ABPM 130 ± 14 / 77 ± 9 mmHg) without symptomatic cardiovascular disease were recruited from a single centre and compared to matched healthy controls. All subjects underwent cardiac MRI (1.5 T) to assess ventricular function, diffuse interstitial myocardial fibrosis by measurement of extracellular volume on T1-mapping (MOLLI) and coarse replacement fibrosis using standard late gadolinium enhancement imaging.

Results

Global extracellular volume was increased in Alström syndrome with wider variation compared to controls (0.30 ± 0.05 vs. 0.25 ± 0.01, p < 0.05). Left ventricular long axis function and global longitudinal strain were impaired in Alström syndrome without change in ejection fraction, ventricular size or atrial stress (NT-proBNP) (p < 0.05). Global extracellular volume was associated with reduced peak systolic longitudinal strain (r = −0.73, p < 0.01) and strain rate (r = −0.57, p < 0.01), increased QTc interval (r = 0.49, p < 0.05) and serum triglycerides (r = 0.66, p < 0.01). Nine (35 %) patients had diffuse mid-wall late gadolinium enhancement in a non-coronary artery distribution.

Conclusion

Diffuse interstitial myocardial fibrosis is common in Alström syndrome and is associated with impaired left ventricular systolic function. Serial studies are required to determine whether global extracellular volume may be an independent imaging biomarker of vulnerability to dilated cardiomyopathy and heart failure.

【 授权许可】

   
2015 Edwards et al.

【 图 表 】

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