title: Endomyocardial biopsies in patients with left ventricular hypertrophy and a common Chinese later-onset Fabry mutation (IVS4 + 919G > A).
abstract: BACKGROUND
  In Taiwan, DNA-based newborn screening showed a surprisingly high incidence of a cardiac Fabry mutation (IVS4 + 919G > A). The prevalence of this mutation is too high to be believed that it is a real pathogenic mutation. The purpose of this study is to identify the cardiac pathologic characteristics in patients with left ventricular hypertrophy and this mutation
  
  
  RESULTS
  Endomyocardial biopsies were obtained in 22 patients (Median age: 61, males: 17; females: 5) with left ventricular hypertrophy and the IVS4 + 919G > A mutation; five patients had not received enzyme replacement therapy (ERT) before biopsy, while the other 17 patients had received ERT from 8 months to 51 months. Except for three patients who had received ERT for more than 3 years, all other patients showed significant pathological change and globotriaosylceramide (Gb3) accumulation in their cardiomyocytes. In contrast to classical Fabry patients, no Gb3 accumulation was found in the capillary endothelial cells of any of our patients. Fourteen patients (63.6%) were found to have myofibrillolysis.
  
  
  CONCLUSIONS
  All of the untreated and most of the treated IVS4 + 919G > A patients showed typical pathological changes of Fabry disease in their cardiomyocytes. No endothelial accumulation of Gb3 was found, which is similar to the findings of several previous reports regarding later-onset Fabry disease. This result highly suggests that the IVS4 + 919G > A is a real pathogenic later-onset Fabry mutation.
authors: Ting-Rong
authors: TR
authors: Hsu
authors: Shih-Hsien
authors: SH
authors: Sung
authors: Fu-Pang
authors: FP
authors: Chang
authors: Chia-Feng
authors: CF
authors: Yang
authors: Hao-Chuan
authors: HC
authors: Liu
authors: Hsiang-Yu
authors: HY
authors: Lin
authors: Chun-Kai
authors: CK
authors: Huang
authors: He-Jin
authors: HJ
authors: Gao
authors: Yu-Hsiu
authors: YH
authors: Huang
authors: Hsuan-Chieh
authors: HC
authors: Liao
authors: Pi-Chang
authors: PC
authors: Lee
authors: An-Hang
authors: AH
authors: Yang
authors: Chuan-Chi
authors: CC
authors: Chiang
authors: Ching-Yuang
authors: CY
authors: Lin
authors: Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. wcyu@vghtpe.gov.tw.
authors: Wen-Chung
authors: WC
authors: Yu
authors: Dau-Ming
authors: DM
authors: Niu
mesh_terms: D001706:Biopsy; D002681:China; D000795:Fabry Disease / Q000235:genetics*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009206:Myocardium / Q000473:pathology*