| Summary: | Left ventricular hypertrophy (LVH) caused by cardiac variant Fabry disease (FD) is typically late-onset and may mimic LVH caused by abnormal loading conditions. We aimed to determine the prevalence of FD in a non-selective patient population of everyday practice presenting with LVH, including those with hypertension and valve disease. We measured plasma alpha-galactosidase A activity using dried blood spot tests in 499 (age = 66 ± 13 years; 336 men) Hong Kong Chinese patients with LVH defined as maximal LV septal/posterior wall thickness ≥13 mm on echocardiography. Patients with low enzyme activity underwent mutation analysis of the GLA gene. Eight (age = 53−74 years; all men) unrelated patients (1.6%) had low plasma alpha-galactosidase A activity (0.57 ± 0.27 μmol/L wb/hr) and all were confirmed to have the GLA IVS4 + 919G > A mutation. FD patients presented with heart failure (<i>n</i> = 5), heart block (<i>n</i> = 2), ventricular tachycardia (<i>n</i> = 1), chest pain (<i>n</i> = 3), and/or murmur (<i>n</i> = 1). Uncontrolled hypertension (<i>n</i> = 4) and/or severe mitral/aortic valve pathology (<i>n</i> = 2) were frequent. Ethnic subgroups included Teochew (<i>n</i> = 5), Canton (<i>n</i> = 2), and Wenzhou (<i>n</i> = 1). Endomyocardial biopsy (<i>n</i> = 6) revealed hypertrophic myocytes with vacuolization and dense lamellar bodies. Late-onset IVS4 + 919G > A FD is prevalent among Chinese LVH patients, and should be considered as a cause of LVH in adult patients even when hypertension and/or valve pathology are present.
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