Prevalence of Fabry disease in a predominantly hypertensive population with left ventricular hypertrophy.
BACKGROUND
Patients with Fabry disease (FD) develop progressive left ventricular hypertrophy (LVH). In screening studies in patients with LVH, the prevalence of FD ranges from 0 to 12%. This variability is attributable to different factors like diverging inclusion and exclusion criteria, the evaluation of selected populations and suboptimal screening methods. In this study, we aimed to determine the prevalence of FD in an unselected population of everyday clinical practice presenting LVH, defined as a maximal end-diastolic septal or posterior wall thickness ≥ 13 mm, without exclusion of patients with arterial hypertension or valvular pathology, and using optimal screening methods.


METHODS
In adult males, a two-tier approach was used; α-Galactosidase A (aGAL A) activity was measured using a dried bloodspot test (DBS) and diagnosis was confirmed by mutation analysis of the GLA gene. In females, mutation analysis was the primary screening tool.


RESULTS
362 men and 178 women were screened. Six patients were diagnosed with a genetic sequence alteration of the GLA gene. One man had a novel mutation, GLA p.Ala5Glu (c.44C>A), presenting as classical FD. Another man and three women had the previously described GLA p.Ala143Thr (c.427G>A) mutation, which generally presents as an attenuated phenotype. One woman had a novel sequence alteration c.639+6A>C, which appeared to be a polymorphism. All true Fabry patients had arterial hypertension (AHT), and one had hypertrophic obstructive cardiomyopathy (HOCM).


CONCLUSIONS
In a group of unselected patients with LVH, we found a prevalence of Fabry disease of 0.9%. AHT or type of hypertrophy should not be an exclusion criterion for screening for FD.
Department of Internal Medicine, Division of Nephrology, Regionaal Ziekenhuis Jan Yperman, Ieper, Belgium. wim.terryn@gmail.com
Wim
W
Terryn
Gert
G
Deschoenmakere
Jan
J
De Keyser
Wouter
W
Meersseman
Wim
W
Van Biesen
Brigitte
B
Wuyts
Dimitri
D
Hemelsoet
Hilbert
H
Pascale
Julie
J
De Backer
An
A
De Paepe
Bruce
B
Poppe
Raymond
R
Vanholder
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004252:DNA Mutational Analysis / Q000379:methods; D059788:Dried Blood Spot Testing / Q000379:methods; D000795:Fabry Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D010375:Pedigree; D015995:Prevalence; D055815:Young Adult; D000519:alpha-Galactosidase / Q000235:genetics
C576330:GLA protein, human; D000519:alpha-Galactosidase