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Left ventricular structural and functional changes in Friedreich ataxia - Relationship with body size, sex, age and
Roger E Peverill1, Giovanni Romanelli1, Lesley Donelan1
1Monash Cardiovascular Research Centre and Department of Medicine (School of Clinical Sciences at Monash Medical Centre), Monash University and Monash Health, Clayton, Victoria, Australia.
Insights
Friedreich ataxia (FRDA) commonly causes left ventricular (LV) abnormalities. This study found increased relative wall thickness (RWT) is most common, with sex and body size influencing LV geometry, and genetic severity linked to LV changes in adults.
Area of Science:
- Cardiology
- Genetics
- Neurology
Background:
- Friedreich ataxia (FRDA) is associated with left ventricular (LV) concentric remodeling, but diagnostic criteria are lacking.
- Previous studies have not consistently accounted for sex, body size, or age in assessing LV abnormalities in FRDA.
- The relationship between genetic severity and LV changes in FRDA remains unclear.
Purpose of the Study:
- To define LV geometric changes in FRDA considering sex, body size, and age.
- To investigate the association between LV abnormalities and genetic severity (GAA repeat length) in FRDA.
- To establish clearer diagnostic criteria for LV abnormalities in FRDA.
Main Methods:
- Echocardiography was performed on 216 subjects (68 children, 148 adults) with FRDA.
- Key LV parameters including internal diameter, wall thickness, volume, mass, and ejection fraction were measured.
- Relative wall thickness (RWT) and age-normalized RWT were calculated.
Main Results:
- Increased RWT and age-normalized RWT were the most frequent LV abnormalities in both children and adults with FRDA.
- In adults, LV variables were influenced by sex and body surface area (BSA), and genetic severity (GAA1) correlated with increased wall thickness (SWT, RWT) and smaller LV dimensions.
- In children, sex and BSA influenced LV variables, but genetic severity did not correlate with LV size or thickness.
Conclusions:
- Increased RWT is the primary LV structural abnormality in FRDA.
- Sex and body size are significant determinants of LV geometry in FRDA patients across age groups.
- Genetic severity is associated with specific LV changes (increased wall thickness, smaller dimensions) in adults with FRDA, but not in children.
Introduction:
Although a concentric pattern of left ventricular (LV) geometry appears to be common in Friedreich ataxia (FRDA), there is no accepted method for diagnosing LV abnormalities in FRDA, sex and body size have often not been taken into consideration, and it has not been clear whether children and adults should be classified using the same criteria. The aim of this study was to better define the LV geometric changes in FRDA with respect to sex, body size and subject age, and to investigate the relationship of LV changes with genetic severity, as assessed by GAA repeat length within the shorter allele of the FXN gene (GAA1).
Methods:
Echocardiography was performed in 216 subjects (68 children, 148 adults), measurements were made at end-diastole of LV internal diameter (LVEDID), septal wall thickness (SWT), LV length (LVEDL) and LV volume (LVEDV), and calculations were made of relative wall thickness (RWT), LV mass and LV ejection fraction (LVEF).
Results:
The most common LV abnormalities in both adults and children with FRDA were increases in RWT and age-normalized RWT. In adults with a normal LVEF, all LV variables other than RWT were larger in males independent of body surface area (BSA), and all LV variables other than SWT and RWT were positively correlated with BSA. After adjustment for sex and BSA, GAA1 was a positive correlate of SWT and RWT (but not of LV mass), and was an inverse correlate of LVEDID, LVEDL and LVEDV. In children with a normal LVEF, SWT, LV mass and LVEDL were larger in males than females after adjusting for BSA, and in combination with sex, BSA was a positive correlate of all the LV variables except SWT and RWT. In children there were no correlations of GAA1 with any of the LV variables.
Conclusion:
In FRDA, increases in RWT and age-normalized RWT are the most frequent LV structural abnormalities, sex and body size are important determinants of most other LV structural variables in both children and adults, and increased genetic severity is associated with a smaller left ventricle and increased LV wall thickness in adults, but not associated with LV size or wall thickness in children.
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