CARDIOMYOPATHY IN THE FRIEDREICH ATAXIA: CLINICAL PRESENTATION AND DIAGNOSTICS OF COMPLICATIONS
https://doi.org/10.15829/1560-4071-2017-10-100-106
Abstract
Friedreich’s ataxia (FA) is one of the most prevalent variants of the inherited ataxias. The disease is characterized by complicated phenotype that includes neurological signs (ataxia, sensory polyneuropathy, dysarthria, disorders of deep sensitivity, areflexia, pyramid symptoms with lower extremities involvement, vegetative disorders, sometimes — psychopathological symptoms), cardiological disorders (cardiomyopathy, heart failure, arrhythmias), and disorders of carbohydrate metabolism, and skeletal deformities. If neurological disorders lead to significant decrease of life quality and disability, cardiovascular complications are the main cause of fatal outcome in FA. It is worthy to mention that involvement of the heart into pathological process might long remain undiagnosed.
Recently, most of abroad and local publications on FA are related to neurological presentation. Cardiovascular side of the problem in the scientific society remains underestimated, regardless the risk of sudden death and of heart failure (due to symmetric myocardial hypertrophy with the areas of intramyocardial fibrosis) being high.
We present clinical and genetic observation of a 27-year old patient with FA, moderate neurological disorders and severe myocardial hypertrophy. The article is focused on the contemporary clinical and diagnostic aspects of FA associated cardiomyopathy.
About the Authors
Е. I. FomichevaRussian Federation
Moscow
R. P. Myasnikov
Russian Federation
Moscow
Yu. A. Selivyorstov
Russian Federation
Moscow
Competing Interests:
Е. L. Dadali
Russian Federation
Moscow
Yu. Yu. Kotalevskaya
Russian Federation
М. S. Kharlap
Russian Federation
Moscow
S. N. Koretsky
Russian Federation
Moscow
Е. P. Nuzhny
Russian Federation
Moscow
Е. А. Mershina
Russian Federation
Moscow
V. Е. Sinitsyn
Russian Federation
Moscow
Competing Interests:
А. N. Vernokhaeva
Russian Federation
Moscow
Е. V. Bazaeva
Russian Federation
Moscow
О. М. Drapkina
Russian Federation
Moscow
S. А. Boytsov
Moscow
References
1. Ershova MV, Illarioshkin SN. Molecular basis of Friedreich’s disease. Journal of Neurology and Psychiatry. C.C. Korsakov. 2003; 103 (2): 61-7 (In Russ.) Ершова М.В., Иллариошкин С.Н. Молекулярные основы болезни Фридрейха. Журнал неврологии и психиатрии им. C.C. Корсакова. 2003; 103 (2): 61-7.
2. Illarioshkin SN, Ershova MV, Bagyeva GKh, et al. Atypical phenotypes of Friedreich’s disease: DNA analysis and clinical-genetic comparisons. Medical genetics. 2004; 3 (1): 36-42. (In Russ.) Иллариошкин С.Н., Ершова М.В., Багыева Г.Х., и др. Атипичные фенотипы болезни Фридрейха: ДНК-анализ и клинико-генетические сопоставления. Медицинская генетика. 2004; 3 (1): 36-42.
3. Weidemann F, Stork S, Liu D, et al. Cardiomyopathy of Friedreich Ataxia. Jou of neurochemistry. 2013; 126 (Suppl. 1): 88-93.
4. Myasnikov RP, Andreenko EY, Kushunina DV, et al. Amyloidosis of the heart: modern aspects of diagnosis and treatment (clinical observation). Wedge. And experiment. hir. Jour. them. acad. B.V. Petrovsky. 2014; 4: 72-82. (In Russ.) Мясников Р. П., Андреенко Е.Ю., Кушунина Д.В., и др. Амилоидоз сердца: современные аспекты диагностики и лечения (клиническое наблюдение). Клин. И эксперимент. хир. Журн. им. акад. Б.В. Петровского. 2014; 4: 72-82.
5. Mershina EA, Myasnikov RP, Kulikova OV, et al. Non-compact cardiomyopathy of theleft ventricle: clinical features and diagnostic capabilities. Rational pharmacotherapy in cardiology 2015; 11 (6): 638-42. (In Russ.) Мершина Е. А., Мясников Р. П., Куликова О.В., и др. Некомпактная кардиомиопатия левого желудочка: особенности клинического течения и возможности диагностики. Рациональная фармакотерапия в кардиологии 2015; 11 (6): 638-42.
6. Gregory S, Macrae C, Aziz K, et al. Myocardial blood flow and oxygen consumption in patients with Friedreich’s ataxia prior to the onset of cardiomyopathy. Coron Artery Dis. 2007; 18: 15-22.
7. Dedobbeleer C, Rai M, Donal E, et al. Normal left ventricular ejection fraction and mass but subclinical myocardial dysfunction in patients with Friedreich’s ataxia. Eur.Heart J. Cardiovasc. 2012; 13: 346-52.
8. Rajagopalan B, Francis J, Cooke F, et al. Analysis of the factors influencing the cardiacphenotype in Friedreich’s ataxia. Mov. Disord. 2010; 25: 846-52.
9. Koeppen A, Ramirez R, Becker A, et al. The pathogenesis of cardiomyopathy in Friedreich ataxia, PLoS One. 2015; 105e0116396.
10. Weidemann F, Niemann M, Ertl G. and Stork S. The different faces of echocardiographic left ventricular hypertrophy: clues to the etiology. J. Am. Soc. Echocardiogr. 2010; 23: 793-801.
11. Tsou A, Paulsen E, Lagedrost SJ, et al. Mortality in Friedreich ataxia. J Neurol Sci. 2011; 307 (1-2): 46-9.
12. Weidemann F, Liu D, Hu K, et al. The cardiomyopathy in Friedreich ataxia New biomarker for staging cardiac involvement, Int. J. Cardiol. 2015; 1 (94): 50-7.
13. Bruder O, Wagner A, Jensen C, et al. Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy, J. Am. Coll. Cardiol. 2010; 56: 875-87.
Review
For citations:
Fomicheva Е.I., Myasnikov R.P., Selivyorstov Yu.A., Dadali Е.L., Kotalevskaya Yu.Yu., Kharlap М.S., Koretsky S.N., Nuzhny Е.P., Mershina Е.А., Sinitsyn V.Е., Vernokhaeva А.N., Bazaeva Е.V., Drapkina О.М., Boytsov S.А. CARDIOMYOPATHY IN THE FRIEDREICH ATAXIA: CLINICAL PRESENTATION AND DIAGNOSTICS OF COMPLICATIONS. Russian Journal of Cardiology. 2017;(10):100-106. (In Russ.) https://doi.org/10.15829/1560-4071-2017-10-100-106