title: Analysis of echocardiograms in a large heterogeneous cohort of patients with friedreich ataxia.
abstract: Although Friedreich ataxia (FA) is associated with cardiomyopathy, the severity and evolution of cardiac disease is poorly understood. To identify factors predicting cardiomyopathy in FA, we assessed echocardiograms from a large heterogenous cohort and their relation to disease traits. The most recent echocardiograms from 173 subjects with FA were analyzed in a core laboratory to determine their relation to disease duration, subject age, age of onset, functional disability score, and GAA repeat length. Mean age of the cohort was 19.7 years, mean age of disease onset was 10.6 years, and mean shorter GAA length was 681 repeats. Echocardiograms collectively illustrated systolic dysfunction, diastolic dysfunction, and hypertrophy. Measurements of hypertrophy correlated moderately with each other (r = 0.39 to 0.79) but not with measurements of diastolic dysfunction (r <0.35). Diastolic measurements correlated poorly with each other, although 26% of the cohort had multiple diastolic abnormalities. The most common diastolic dysfunction classification was pseudonormalization. Classification of diastolic dysfunction was predicted by GAA repeat length but not by age or gender. Ejection fraction was below normal in 20% of the cohort. In linear regression analysis, increasing age predicted decreasing ejection fraction. Functional disability score, a measurement of neurologic ability, did not predict any echocardiographic measurements. In conclusion, hypertrophy and diastolic and systolic dysfunctions occur in FA and are substantially independent; diastolic dysfunction is the most common abnormality with most patients having an assigned diastolic dysfunction class of pseudonormalization.
authors.affiliation: Department of Neurology, University of Pennsylvania, Medical School, Philadelphia, Pennsylvania, USA.
authors.forename: Sean R
authors.initials: SR
authors.lastname: Regner
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Lagedrost
authors.forename: Ted
authors.initials: T
authors.lastname: Plappert
authors.forename: Erin K
authors.initials: EK
authors.lastname: Paulsen
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Friedman
authors.forename: Madeline L
authors.initials: ML
authors.lastname: Snyder
authors.forename: Susan L
authors.initials: SL
authors.lastname: Perlman
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Mathews
authors.forename: George R
authors.initials: GR
authors.lastname: Wilmot
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Schadt
authors.forename: Martin St John
authors.initials: MS
authors.lastname: Sutton
authors.forename: David R
authors.initials: DR
authors.lastname: Lynch
mesh_terms: D000293:Adolescent; D002648:Child; D003971:Diastole; D018450:Disease Progression; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005621:Friedreich Ataxia / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D011379:Prognosis; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult