Characterizing the Role of Cardiac Biomarkers in Friedreich’s Ataxia and Establishing Demographic and Echocardiographic Correlations– A Meta-analytic Review
Mohamed I. Mohamed1, Abu Omayer2, Dina Tarek Bekhit1, Moussa Nassar3, Alaa Alqadi1, Yasmeen Essam Yaqout1, Roaa Taha4, Nasser A Abdelall5
1Alexandria University, Faculty of Medicine, Alexandria, Egypt, 2Dr. Sulaiman Al Habib Hospital, Dubai, 3Lebanese American University, School of medicine, Byblos, Lebanon, 4Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia, 5Department of Neurology, Louisiana State University School of Medicine, New Orleans, LA
Objective:
Assess the cardiac serum biomarker changes in Friedreich’s Ataxia (FA) and correlate those changes to socio-demographic, disease-specific, and echocardiographic factors.
Background:
FA has been associated with cardiac dysfunction, particularly through biomarkers such as cardiac troponin T (cTnT), cardiac troponin I (cTnI), B-type natriuretic peptide (BNP), and Galectin-3. This study aimed to pool biomarker levels in FA patients and explore their relationships with clinical and demographic factors through a systematic review and meta-analysis.
Design/Methods:
On August 2, 2024, we conducted a literature search on PubMed, Scopus, and Medline. We used R software 4.4.1 for the single-armed and double-armed meta-analyses. The PRISMA guidelines were followed throughout the review.
Results:
Eleven studies were qualified for the systematic review, while eight studies were pooled for the meta-analysis. FA patients exhibited elevated cTnT levels, with a pooled estimate of 15.57 ng/L (95% CI [13.52, 17.62], I²: 18%), indicating a link to hypertrophic cardiomyopathy severity. There was no consistent association between cTnT and ejection fraction. Compared to healthy controls, FA patients had significantly higher BNP levels (p = 0.03), yet these levels remained non-pathological (pooled estimate: 57.36 ng/L, 95% CI [32.90, 81.82]). No correlation between BNP levels and sociodemographic or phenotypic factors was noted. CTnI levels were elevated in FA patients and estimated at 0.12 ng/ml (95% CI [0.03, 0.21], I²: 79.6%). Interestingly, cTnI serum levels were elevated despite the absence of acute cardiac symptomatology. Similarly, Galectin-3 levels were significantly elevated in FA patients compared to healthy controls (mean difference: 3.19, 95% CI [0.65, 5.73], I²: 80%), but there was no significant correlation with echocardiographic measures. No associations were established between GAA repeat length and cardiac biomarker levels.
Conclusions:
FA patients exhibit elevated cardiac biomarkers. However, their associations with some demographic and echocardiographic factors remain inconsistent; thus warranting further investigation into their clinical significance.
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