title: Characteristics of cardiac and vascular structure and function in Prader-Willi syndrome.
abstract: OBJECTIVE
  Prader-Willi syndrome (PWS) is a genetic obesity syndrome characterized by hyperphagia, behavioural disturbance and intellectual disability. PWS appears to be associated with a high incidence of sudden death, suspected to be cardiopulmonary in origin. We therefore sought to provide an assessment of cardiac and vascular structure and function in patients with PWS.
  
  
  METHODS
  Nine patients with genetically confirmed PWS, mean age 28 years, body mass index (BMI) 42 kg/m2, were compared with nine age- and gender-matched lean controls.
  
  
  METHODS
  Lipid parameters, high-sensitivity C-reactive protein (hs-CRP) and fasting glucose and insulin were measured. To assess cardiac structure and function, a resting electrocardiogram (ECG), exercise stress test, 24-h continuous ECG monitoring, and echocardiogram were obtained. Patients and control subjects also underwent comprehensive noninvasive vascular assessment, including venous-occlusion forearm plethysmography, brachial artery flow-mediated dilatation (FMD), radial artery tonometry and carotid intima-media thickness (IMT) measurements.
  
  
  RESULTS
  All patients with PWS had significantly elevated hs-CRP (> 3.0 mg/l) (mean 11.5 mg/l, median 11.47, interquartile range: 4.48-15.8 mg/l), compared with controls (P < 0.001). Five of nine patients with PWS had subnormal exercise capacity (< 4 mets on exercise stress testing). Twenty-four-hour ECG monitoring revealed prolonged sinus pauses in one patient, up to 4.8 s, requiring pacemaker insertion. Microvascular function as assessed by peak hyperaemic flow response was decreased in PWS (6.1 +/- 1.0 times baseline flow vs. controls 13.5 +/- 1.6 times baseline flow, P = 0.01). Other measures were similar between PWS and controls.
  
  
  CONCLUSIONS
  This group of PWS patients had significantly raised levels of the inflammatory marker hs-CRP and evidence of microcirculatory dysfunction, both of which are associated with coronary artery disease and early sudden death. The sinus node dysfunction may in itself be a risk factor for sudden cardiac death.
authors: Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia. spatel@email.cs.nsw.gov.au
authors: Sanjay
authors: S
authors: Patel
authors: Jason A
authors: JA
authors: Harmer
authors: Georgina
authors: G
authors: Loughnan
authors: Michael R
authors: MR
authors: Skilton
authors: Katharine
authors: K
authors: Steinbeck
authors: David S
authors: DS
authors: Celermajer
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D001916:Brachial Artery / Q000503:physiopathology; D002097:C-Reactive Protein / Q000032:analysis; D002319:Cardiovascular System / Q000503:physiopathology*; D002339:Carotid Arteries / Q000503:physiopathology; D016022:Case-Control Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology; D017079:Exercise Tolerance; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D010991:Plethysmography; D011218:Prader-Willi Syndrome / Q000097:blood / Q000276:immunology / Q000503:physiopathology*; D011446:Prospective Studies; D017534:Radial Artery / Q000503:physiopathology; D012039:Regional Blood Flow; D012307:Risk Factors; D014664:Vasodilation
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin; D002097:C-Reactive Protein