EIM Phase Angle as a Candidate Biomarker of Muscle Function in DM1 Patients
Edwin Conquest1, Brigham McKee1, Elizabeth Cornforth2, Alex Sizemore1, Elise Townsend2, Seward Rutkove3, Thurman Wheeler1
1Massachusetts General Hospital, 2MGH Institute for Health Professions, 3Beth Israel Deaconess Medical Center
Objective:
To evaluate electrical impedance myography as a non-invasive indicator of muscle disease status in DM1 patients.
Background:
Myotonic dystrophy type 1 (DM1) is a multisystem neurogenetic disorder characterized by delayed relaxation and progressive wasting of muscle, among other symptoms. Clinical trials currently rely on invasive measures of therapeutic response, such as repeat muscle biopsies. Electrical impedance myography (EIM) is a painless, non-invasive technique that uses low-intensity current to assess muscle fiber composition and architecture through the skin. Studies in other neuromuscular disorders and in DM1 mice indicate that EIM may provide valuable metrics of muscle disease status, progression, and response to therapy. However, the usefulness of EIM in DM1 patients is unknown.
Design/Methods:
Using the Myolex mScan, we applied alternating current at 41 frequencies (1 - 10,000 kHz) and measured the resulting voltage in 7 muscle groups of DM1 (N = 21) and unaffected (N = 8) subjects. From the resistance and reactance, we calculated the phase angle—the time shift of electric current as it passes through muscle. All subjects also underwent quantitative muscle function testing. A subset of 14 DM1 subjects were re-evaluated at 6-to-8 months.
Results:
Mean phase angle at 100 kHz is significantly reduced in the wrist flexor, wrist extensor, tibialis anterior, and gastrocnemius muscles of DM1 vs unaffected subjects. Phase angle correlates with strength in the biceps, triceps, wrist flexors, wrist extensors, gastrocnemius, and tibialis anterior (r 0.61 - 0.70; P < 0.0001). Tibialis anterior and gastrocnemius phase angles correlate with 6-minute-walk distance (r 0.68 and 0.64; P 0.0007 and 0.002) and 10-meter-walk time (r -0.60 and -0.56; P 0.008 and 0.004). Phase angle values are reproducible from side-to-side and between first and second visits.
Conclusions:
EIM phase angle is a candidate biomarker of disease status in DM1 muscle tissue.