Cardiac and autonomic function in patients with Wilson’s disease View Full Text


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Article Info

DATE

2019-12

AUTHORS

Silvio Quick, Ulrike Reuner, Marie Weidauer, Charlotte Hempel, Felix Martin Heidrich, Christoph Mues, Krunoslav Michael Sveric, Karim Ibrahim, Heinz Reichmann, Axel Linke, Uwe Speiser

ABSTRACT

BACKGROUND: The clinical effect of copper accumulation on the heart of patients suffering from Wilson's disease (WD) is not completely understood. We aimed to determine if patients with WD show signs of cardiac involvement, structural heart disease or autonomic dysfunction. In this prospective trial, we studied 61 patients (mean age 44.3 ± 15.2 years, 51% males) with WD and compared them to 61 age- and gender-matched healthy controls. All subjects underwent clinical examination, blood tests, echocardiography and 24 h electrocardiographic (ECG) recording. RESULTS: Left- and right ventricular systolic function did not differ significantly between WD patients and controls. However, 5 of the 61 patients had a reduced left ventricular ejection fraction (LVEF). Furthermore, diastolic dysfunction was more prevalent in WD patients (9 of 61 vs. 0 of 61, p = 0.001). The severity of WD based on the Unified Wilson's Disease Rating Scale was significantly correlated to NT-pro BNP (r = 0.34, P = 0.013). Patients with an exacerbation of WD in medical history had higher troponin levels compared to those without (11.3 ± 4.7 vs 4.6 ± 1.2). The autonomic function assessed by triangular index (TI) and SDNN-index was significantly reduced in WD patients compared to controls in most in almost every age category (p-value TI and SDNN: age 20-29, p < 0.001 and 0.05; age 30-39, p < 0.01 and not significant (ns); age 40-49, p < 0,01 and 0.001; age 50-59, p = ns and < 0.001, age 60-70, p < 0.05 and ns). CONCLUSION: Our data demonstrate that cardiac involvement and autonomic dysfunction in WD is possible, however the underlying cause is still not known. We suggest that patients with signs and symptoms of structural heart disease should be examined by a cardiologist in addition to the interdisciplinary treatment team of WD. More... »

PAGES

22

References to SciGraph publications

  • 2011-06. Systems biology approach to Wilson’s disease in BIOMETALS
  • 2002-06. Cardiac involvement in Wilson disease in JOURNAL OF INHERITED METABOLIC DISEASE
  • 2013-11. The homozygosity index (HI) approach reveals high allele frequency for Wilson disease in the Sardinian population in EUROPEAN JOURNAL OF HUMAN GENETICS
  • 1982-01. The cardiomyopathy of Wilson's disease in VIRCHOWS ARCHIV A PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY
  • 1980-05. Secondary athrocytotic cardiomyopathy — Heart damage due to Wilson's disease in VIRCHOWS ARCHIV A PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY
  • Journal

    TITLE

    Orphanet Journal of Rare Diseases

    ISSUE

    1

    VOLUME

    14

    Author Affiliations

    Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1186/s13023-019-1007-7

    DOI

    http://dx.doi.org/10.1186/s13023-019-1007-7

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1111748461

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30691535


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    36 schema:description BACKGROUND: The clinical effect of copper accumulation on the heart of patients suffering from Wilson's disease (WD) is not completely understood. We aimed to determine if patients with WD show signs of cardiac involvement, structural heart disease or autonomic dysfunction. In this prospective trial, we studied 61 patients (mean age 44.3 ± 15.2 years, 51% males) with WD and compared them to 61 age- and gender-matched healthy controls. All subjects underwent clinical examination, blood tests, echocardiography and 24 h electrocardiographic (ECG) recording. RESULTS: Left- and right ventricular systolic function did not differ significantly between WD patients and controls. However, 5 of the 61 patients had a reduced left ventricular ejection fraction (LVEF). Furthermore, diastolic dysfunction was more prevalent in WD patients (9 of 61 vs. 0 of 61, p = 0.001). The severity of WD based on the Unified Wilson's Disease Rating Scale was significantly correlated to NT-pro BNP (r = 0.34, P = 0.013). Patients with an exacerbation of WD in medical history had higher troponin levels compared to those without (11.3 ± 4.7 vs 4.6 ± 1.2). The autonomic function assessed by triangular index (TI) and SDNN-index was significantly reduced in WD patients compared to controls in most in almost every age category (p-value TI and SDNN: age 20-29, p < 0.001 and 0.05; age 30-39, p < 0.01 and not significant (ns); age 40-49, p < 0,01 and 0.001; age 50-59, p = ns and < 0.001, age 60-70, p < 0.05 and ns). CONCLUSION: Our data demonstrate that cardiac involvement and autonomic dysfunction in WD is possible, however the underlying cause is still not known. We suggest that patients with signs and symptoms of structural heart disease should be examined by a cardiologist in addition to the interdisciplinary treatment team of WD.
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