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Electrocardiographic changes in early recognition of Fabry disease
  1. Mehdi Namdar1,2,
  2. Jan Steffel1,
  3. Mile Vidovic1,
  4. Corinna B Brunckhorst1,
  5. Johannes Holzmeister1,
  6. Thomas F Lüscher1,3,
  7. Rolf Jenni1,3,
  8. Firat Duru1,3
  1. 1Cardiovascular Centre, Cardiology, University Hospital Zurich, Zurich, Switzerland
  2. 2Heart Rhythm Management Centre, University Hospital of Brussels, Brussels, Belgium
  3. 3Center for Integrative Human Physiology, University of Zurich, Switzerland
  1. Correspondence to Dr Mehdi Namdar, Heart Rhythm Management Centre, University Hospital Brussels – UZB, Laarbeeklaan 101, BE-1090 Brussels, Belgium; m.namdar{at}gmx.ch

Abstract

Background Fabry disease (FD) is an inherited X-chromosomal lysosomal storage disease resulting in intracellular storage of globotriaosylceramide. Cardiac involvement is most frequently manifested as left ventricular hypertrophy (LVH). However, patients with FD may also have various conduction abnormalities before LVH develops. The present study was designed to analyse early conduction abnormalities on baseline ECG of patients with FD and to investigate their diagnostic value.

Methods and results Baseline electrocardiographic (ECG) and echocardiographic measurements of patients with FD (n=30) were compared with those of heart rate and age-matched healthy individuals (n=50). The PQ-interval (131±18 vs 155±20 ms, p<0.000001) and the QRS width (83±11 vs 90±9 ms, p<0.05) were significantly shorter and repolarisation dispersion was more pronounced in patients with FD (QTc dispersion: 66±32 vs 40±24 ms, p<0.001, Tpeak−Tend dispersion: 56±20 vs 37±16 ms, p<0.0005). Moreover, P-wave duration was significantly shorter (74±16 vs 105±14 ms, p<0.000001) in FD and accounted predominantly for the shortening of the PQ-interval. P-wave duration showed a 92% sensitivity and 80% specificity for the diagnosis of FD.

Conclusions P-wave duration, PQ-interval and QRS width are shorter and repolarisation dispersion more pronounced in patients with FD compared with heart rate and age-matched controls. The significant shortening of the PQ-interval in FD occurs because of a marked shortening of the P-wave duration, which in itself demonstrated a high sensitivity and specificity for early detection and treatment of this disease.

  • Cardiomyopathy
  • electrocardiography
  • Fabry disease
  • left ventricular hypertrophy
  • lysosomal storage
  • QT dispersion

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Footnotes

  • Funding This study was supported by research grants from the Genzyme and the Shire Corporations.

  • Competing interests None to declare.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the local ethics committee of the University Hospital of Zurich, Switzerland.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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