title: Cardiac and skeletal myopathy in Fabry disease: a clinicopathologic correlative study.
abstract: Skeletal muscle disturbances are commonly reported in patients with Fabry disease. Whether they derive from cardiac dysfunction or direct muscle involvement is still unclear. Clinical, noninvasive, and invasive cardiac and muscle studies, including an endomyocardial and muscle biopsy, were obtained in 12 patients (mean age, 42.1 ± 12.6 years; range, 24-58 years) with Fabry disease. In the youngest patients (group A, 4 men aged <35 years), results of cardiac and skeletal noninvasive studies were normal, except for reduced velocities in tissue Doppler imaging. Histologic examination indicated that muscle myocytes were unaffected, whereas muscle vessels showed the presence of mild glycosphingolipid accumulation in endothelial and smooth muscle cells. In the heart, cardiomyocytes and endothelial and smooth muscle cells of intramural cardiac vessels were involved by the disease. The oldest patients (group B, 6 men and 2 women aged >35 years) showed ultrasound muscle disarray and electromyography signs of myopathy, increased left ventricular mass, and normal cardiac function. Histologic examination showed that muscle myocytes contained mild glycosphingolipid accumulation compared with severe engulfment of cardiomyocytes. Moreover, similar infiltration of myocardial and muscle intramural vessels, causing lumen narrowing and fibrofatty tissue replacement, was observed. Direct muscle involvement occurs in patients with Fabry disease. It is milder and delayed compared with that in the heart. The difference in organ function and the need of residual α-galactosidase A activity are the likely causes.
authors.affiliation: Cardiovascular, Respiratory, Nefrologic and Geriatric Sciences Department, La Sapienza University, 00100 Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Chimenti
authors.forename: Luca
authors.initials: L
authors.lastname: Padua
authors.forename: Costanza
authors.initials: C
authors.lastname: Pazzaglia
authors.forename: Emanuela
authors.initials: E
authors.lastname: Morgante
authors.forename: Carlos
authors.initials: C
authors.lastname: Centurion
authors.forename: Daniela
authors.initials: D
authors.lastname: Antuzzi
authors.forename: Matteo A
authors.initials: MA
authors.lastname: Russo
authors.forename: Andrea
authors.initials: A
authors.lastname: Frustaci
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D000795:Fabry Disease / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D032383:Myocytes, Cardiac / Q000473:pathology