Progression of left ventricular mass is associated with clinical events in key subgroups of Fabry disease: Analyses from the Fabry Registry

Introduction

Cardiovascular complications are the primary cause of morbidity and mortality in Fabry disease. Despite disease-specific and adjuvant treatments, gaps in care exist. Cardiac imaging facilitates the understanding of disease progression, however data on the clinical relevance of imaging endpoints in Fabry disease are scant. Therefore, we evaluated the association between left ventricular mass index (LVMi) measured via echocardiography and risk of subsequent clinical events.

Methods

Adult patients from the Fabry Registry treated with enzyme replacement therapy, with echocardiography measurements and no prior kidney events were analyzed. Composite clinical events included cardiac, cerebrovascular, and kidney events, or death. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for the association between (1) baseline LVMi and (2) LVMi progression (i.e., slopes) with the risk of subsequent clinical events.

Results

Baseline LVMi analysis included 809 patients (53.1 % females) with median age at diagnosis [25^th, 75^th percentile]: 39.5 years [26.7, 52.2]) who had 248 clinical events, including 170 cardiac events, over 4752 and 5128 person-years, respectively. Higher baseline LVMi was associated with greater risk of composite clinical and cardiac events (adjusted HR per 10 % higher baseline LVMi: 1.09 [95 % CI: 1.04–1.13; p < 0.001] and 1.11 [95 % CI: 1.06–1.17; p < 0.0001], respectively). LVMi slope analysis included 377 patients with median 3-year LVMi slope [25^th, 75^th percentile] of −0.5 g/m²/year [−7.8, 7.2]; and evaluated 86 composite clinical events and 57 cardiac events, over 1899 and 2028 person-years, respectively. Increasing LVMi slope was associated with higher incidence of clinical events in key subgroups including in those with the classic Fabry phenotype, those with left ventricular hypertrophy (LVH) at baseline, those with pre-baseline clinical events and in patients with history of hypertension; adjusted HR per 10 g/m²/year increase in LVMi slope ranged from 1.16 to 1.64 (p < 0.05).

Conclusions

Our study quantifies the biologically plausible association between LVMi and its progression with composite clinical events, including in key subgroups of Fabry patients.