Mueller P, Attenhofer Jost C H, Rohrbach M, Valsangiacomo Buechel E R, Seifert B, Balmer C, Kretschmar O, Baumgartner M R, Weber R
Department of Cardiology, University Children's Hospital, Switzerland.
Cardiovascular Clinic Zürich, Klinik Im Park, Switzerland.
Int J Cardiol Heart Vessel. 2013 Nov 13;2:1-7. doi: 10.1016/j.ijchv.2013.10.002. eCollection 2013 Mar.
Lysosomal storage disease (LSD) is a rare inherited disease group. Consecutively there are few data on cardiac changes in mucopolysaccharidosis (MPS), Anderson Fabry disease (AFD), and other LSD (oLSD) including Pompe disease (PD) and Danon disease (DD), I-cell disease ICD and mucolipidosis III (ML III).
Between 1994 and 2011, we identified 39 patients with LSD: 25 with MPS, 8 with AFD, and 6 with oLSD including PD (1), ML III (2), DD (1), and ICD (2) at our institution fulfilling the inclusion criteria of at least one echocardiogram and ECG.
Median age was 11.4 years (range: 2-27), 22 were females (56%). Normal echocardiograms were present in 12 patients (31%): 4 with MPS (16%), 7 AFD (88%), and 1 oLSD (17%). Valvular heart disease was present in 23 patients (59%) occurring more often in MPS (76%) and oLSD (67%) than in AFD (0%) (p < 0.001). The most common ECG abnormality was a short PR interval in 10 of 35 patients (29%) occurring in all LSD groups. Median follow-up was 5.8 (0.2-22.2) years showing diminished 5-year survival compared to an age-matched group. However, no patient died due to a cardiac cause and no cardiovascular intervention was necessary.
Echocardiographically detectable cardiovascular involvement in children with LSD is mostly confined to MPS and oLSD. Valve thickening in echo and a short PR interval in the ECG are the most frequent abnormalities. Routine repeat assessment is recommended in LSD. However, significant cardiac disease necessitating cardiac intervention is rare during a short follow-up.
溶酶体贮积症(LSD)是一组罕见的遗传性疾病。关于黏多糖贮积症(MPS)、安德森法布里病(AFD)以及包括庞贝病(PD)、达农病(DD)、I型细胞病(ICD)和黏脂贮积症III型(ML III)在内的其他溶酶体贮积症(oLSD)中心脏变化的数据相继较少。
1994年至2011年期间,我们在本机构确定了39例溶酶体贮积症患者:25例黏多糖贮积症患者、8例安德森法布里病患者以及6例其他溶酶体贮积症患者,包括1例庞贝病、2例黏脂贮积症III型、1例达农病和2例I型细胞病,这些患者符合至少有一次超声心动图和心电图检查的纳入标准...
中位年龄为11.4岁(范围:2至27岁),22例为女性(56%)。12例患者(31%)超声心动图正常:4例黏多糖贮积症患者(16%)、7例安德森法布里病患者(88%)和1例其他溶酶体贮积症患者(17%)。23例患者(59%)存在瓣膜性心脏病,在黏多糖贮积症(76%)和其他溶酶体贮积症(67%)中比在安德森法布里病(0%)中更常见(p<0.001)。35例患者中有10例(29%)最常见的心电图异常是PR间期缩短,在所有溶酶体贮积症组中均有发生。中位随访时间为5.8(0.2至22.2)年,与年龄匹配组相比,5年生存率降低。然而,没有患者因心脏原因死亡,也无需进行心血管干预。
超声心动图可检测到的溶酶体贮积症患儿心血管受累主要局限于黏多糖贮积症和其他溶酶体贮积症。超声心动图显示的瓣膜增厚和心电图中的PR间期缩短是最常见的异常。建议对溶酶体贮积症患者进行常规重复评估。然而,在短期随访期间,需要心脏干预的严重心脏疾病很少见。