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Bagkaki A, Parthenakis F, Chlouverakis G, Anastasakis A, Papagiannis I, Galanakis E, Germanakis I. Epidemiology of Pediatric Cardiomyopathy in a Mediterranean Population. CHILDREN (BASEL, SWITZERLAND) 2024; 11:732. [PMID: 38929311 PMCID: PMC11202073 DOI: 10.3390/children11060732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Our knowledge regarding the epidemiology of pediatric cardiomyopathy is based on large national population studies reporting an annual incidence of 1 case per 100,000 children, with a higher incidence observed in infancy and among selected populations. The aim here is to document the epidemiology of pediatric cardiomyopathy in a Mediterranean population. METHODS Children younger than 18 years of age living on the Mediterranean island of Crete, Greece, who have been evaluated since the establishment of tertiary pediatric cardiology services (2002-2022) were included in this retrospective study. RESULTS A total of 40 children were included, corresponding to an average annual incidence of pediatric cardiomyopathy of 1.59 cases (95% CI: 1.4-2.3) and a prevalence of 26 cases per 100,000 children. In decreasing order of frequency, most cases corresponded to dilated (50%), followed by hypertrophic (42.5%), arrhythmogenic (5%), and restrictive (2.5%) cardiomyopathy. An etiology was identified in 40%, including a genetic diagnosis in 22.5%. CONCLUSIONS The incidence of pediatric cardiomyopathy in the Mediterranean island of Crete is higher compared with that reported previously for other Caucasian populations. Further study is needed to investigate the exact prevalence and specific genetic factors associated with the epidemiology of pediatric cardiomyopathy in Mediterranean populations.
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Affiliation(s)
- Alena Bagkaki
- School of Medicine, University of Crete, 71 003 Heraklion, Greece; (A.B.); (F.P.); (G.C.); (E.G.)
| | - Fragiskos Parthenakis
- School of Medicine, University of Crete, 71 003 Heraklion, Greece; (A.B.); (F.P.); (G.C.); (E.G.)
| | - Gregory Chlouverakis
- School of Medicine, University of Crete, 71 003 Heraklion, Greece; (A.B.); (F.P.); (G.C.); (E.G.)
| | - Aris Anastasakis
- Onassis Cardiac Surgery Center, Syggrou Av. 356, 176 74 Athens, Greece; (A.A.); (I.P.)
| | - Ioannis Papagiannis
- Onassis Cardiac Surgery Center, Syggrou Av. 356, 176 74 Athens, Greece; (A.A.); (I.P.)
| | - Emmanouil Galanakis
- School of Medicine, University of Crete, 71 003 Heraklion, Greece; (A.B.); (F.P.); (G.C.); (E.G.)
| | - Ioannis Germanakis
- School of Medicine, University of Crete, 71 003 Heraklion, Greece; (A.B.); (F.P.); (G.C.); (E.G.)
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Kantor PF, Shi L, Colan SD, Orav EJ, Wilkinson JD, Hamza TH, Webber SA, Canter CE, Towbin JA, Everitt MD, Pahl E, Ware SM, Rusconi PG, Lamour JM, Jefferies JL, Addonizio LJ, Lipshultz SE. Progressive Left Ventricular Remodeling for Predicting Mortality in Children With Dilated Cardiomyopathy: The Pediatric Cardiomyopathy Registry. J Am Heart Assoc 2024; 13:e022557. [PMID: 38214257 PMCID: PMC10926795 DOI: 10.1161/jaha.121.022557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/08/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Pediatric dilated cardiomyopathy often leads to death or cardiac transplantation. We sought to determine whether changes in left ventricular (LV) end-diastolic dimension (LVEDD), LV end-diastolic posterior wall thickness, and LV fractional shortening (LVFS) over time may help predict adverse outcomes. METHODS AND RESULTS We studied children up to 18 years old with dilated cardiomyopathy, enrolled between 1990 and 2009 in the Pediatric Cardiomyopathy Registry. Changes in LVFS, LVEDD, LV end-diastolic posterior wall thickness, and the LV end-diastolic posterior wall thickness:LVEDD ratio between baseline and follow-up echocardiograms acquired ≈1 year after diagnosis were determined for children who, at the 1-year follow-up had died, received a heart transplant, or were alive and transplant-free. Within 1 year after diagnosis, 40 (5.0%) of the 794 eligible children had died, 117 (14.7%) had undergone cardiac transplantation, and 585 (73.7%) had survived without transplantation. At diagnosis, survivors had higher median LVFS and lower median LVEDD Z scores. Median LVFS and LVEDD Z scores improved among survivors (Z score changes of +2.6 and -1.1, respectively) but remained stable or worsened in the other 2 groups. The LV end-diastolic posterior wall thickness:LVEDD ratio increased in survivors only, suggesting beneficial reverse LV remodeling. The risk for death or cardiac transplantation up to 7 years later was lower when LVFS was improved at 1 year (hazard ratio [HR], 0.83; P=0.004) but was higher in those with progressive LV dilation (HR, 1.45; P<0.001). CONCLUSIONS Progressive deterioration in LV contractile function and increasing LV dilation are associated with both early and continuing mortality in children with dilated cardiomyopathy. Serial echocardiographic monitoring of these children is therefore indicated. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005391.
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Affiliation(s)
- Paul F. Kantor
- Children’s Hospital Los Angeles and Keck School of Medicine of USCLos AngelesCA
| | - Ling Shi
- New England Research InstitutesWatertownMA
| | | | | | | | | | | | | | | | | | - Elfriede Pahl
- Ann and Robert H. Lurie Children’s Hospital of ChicagoChicagoIL
| | | | | | | | | | | | - Steven E. Lipshultz
- University at Buffalo Jacobs School of Medicine and Biomedical SciencesBuffaloNY
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Shafqat A, Shaik A, Koritala S, Mushtaq A, Sabbah BN, Nahid Elshaer A, Baqal O. Contemporary review on pediatric hypertrophic cardiomyopathy: insights into detection and management. Front Cardiovasc Med 2024; 10:1277041. [PMID: 38250029 PMCID: PMC10798042 DOI: 10.3389/fcvm.2023.1277041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Hypertrophic cardiomyopathy is the most common genetic cardiac disorder and is defined by the presence of left ventricular (LV) hypertrophy in the absence of a condition capable of producing such a magnitude of hypertrophy. Over the past decade, guidelines on the screening, diagnostic, and management protocols of pediatric primary (i.e., sarcomeric) HCM have undergone significant revisions. Important revisions include changes to the appropriate screening age, the role of cardiac MRI (CMR) in HCM diagnosis, and the introduction of individualized pediatric SCD risk assessment models like HCM Risk-kids and PRIMaCY. This review explores open uncertainties in pediatric HCM that merit further attention, such as the divergent American and European recommendations on CMR use in HCM screening and diagnosis, the need for incorporating key genetic and imaging parameters into HCM-Risk Kids and PRIMaCY, the best method of quantifying myocardial fibrosis and its prognostic utility in SCD prediction for pediatric HCM, devising appropriate genotype- and phenotype-based exercise recommendations, and use of heart failure medications that can reverse cardiac remodeling in pediatric HCM.
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Affiliation(s)
- Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah Shaik
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
| | - Snygdha Koritala
- Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Gannavaram, India
| | - Ali Mushtaq
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | | | - Ahmed Nahid Elshaer
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, United States
| | - Omar Baqal
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, United States
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4
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Mariani MV, Pierucci N, Fanisio F, Laviola D, Silvetti G, Piro A, La Fazia VM, Chimenti C, Rebecchi M, Drago F, Miraldi F, Natale A, Vizza CD, Lavalle C. Inherited Arrhythmias in the Pediatric Population: An Updated Overview. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:94. [PMID: 38256355 PMCID: PMC10819657 DOI: 10.3390/medicina60010094] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Pediatric cardiomyopathies (CMs) and electrical diseases constitute a heterogeneous spectrum of disorders distinguished by structural and electrical abnormalities in the heart muscle, attributed to a genetic variant. They rank among the main causes of morbidity and mortality in the pediatric population, with an annual incidence of 1.1-1.5 per 100,000 in children under the age of 18. The most common conditions are dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). Despite great enthusiasm for research in this field, studies in this population are still limited, and the management and treatment often follow adult recommendations, which have significantly more data on treatment benefits. Although adult and pediatric cardiac diseases share similar morphological and clinical manifestations, their outcomes significantly differ. This review summarizes the latest evidence on genetics, clinical characteristics, management, and updated outcomes of primary pediatric CMs and electrical diseases, including DCM, HCM, arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQTS), and short QT syndrome (SQTS).
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Affiliation(s)
- Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Nicola Pierucci
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Francesca Fanisio
- Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy; (F.F.); (M.R.)
| | - Domenico Laviola
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Giacomo Silvetti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Vincenzo Mirco La Fazia
- Department of Electrophysiology, St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX 78705, USA; (V.M.L.F.); (A.N.)
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Marco Rebecchi
- Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy; (F.F.); (M.R.)
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, 00165 Rome, Italy;
| | - Fabio Miraldi
- Cardio Thoracic-Vascular and Organ Transplantation Surgery Department, Policlinico Umberto I Hospital, 00161 Rome, Italy;
| | - Andrea Natale
- Department of Electrophysiology, St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX 78705, USA; (V.M.L.F.); (A.N.)
| | - Carmine Dario Vizza
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
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Tulbah S, Alruwaili N, Alhashem A, Aljohany A, Alhadeq F, Brotons DCA, Alwadai A, Al-Hassnan ZN. Variable phenotype of a null PPP1R13L allele in children with dilated cardiomyopathy. Am J Med Genet A 2024; 194:59-63. [PMID: 37698259 DOI: 10.1002/ajmg.a.63402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
Childhood-onset cardiomyopathy is a genetically heterogeneous group of conditions with several genes implicated. Recently, biallelic loss-of-function variants in PPP1R13L have been reported in association with a syndromic form of dilated cardiomyopathy (DCM). In addition, affected children manifest skin and hair abnormalities, cleft lip and palate (CLP), and eye findings. Here, we delineate the condition further by describing the phenotype associated with a homozygous frameshift variant (p.Arg330 ProfsTer76) in PPP1R13L detected in two sibships in a consanguineous family with six affected children. The index case had DCM and wooly hair, two of his siblings had DCM and CLP while three cousins had, in addition, glaucoma. Global developmental delay was observed in one child. All the children, except one, died during early childhood. Whole exome sequencing and whole genome sequencing did not reveal any other plausible variant. We provide further evidence that implicates PPP1R13L in a variable syndromic form of severe childhood-onset DCM and suggests expanding the spectrum of this condition to include glaucoma. Given the variability of the phenotype associated with PPP1R13-related DCM, a thorough evaluation of each case is highly recommended even in the presence of an apparently isolated DCM.
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Affiliation(s)
- Sahar Tulbah
- Cardiovascular Genetics Program, Department of Translational Genomics, Center for Genomic Medicine, Riyadh, Saudi Arabia
| | - Nadiah Alruwaili
- Heart Center, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia
| | - Amal Alhashem
- Division of Medical Genetics, Department of Pediatrics, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Arwa Aljohany
- King Khalid University Hospital and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faten Alhadeq
- Cardiovascular Genetics Program, Department of Translational Genomics, Center for Genomic Medicine, Riyadh, Saudi Arabia
| | - Dimpna C Albert Brotons
- Heart Center, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia
| | - Abdullah Alwadai
- Heart Failure and Transplant Program, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Zuhair N Al-Hassnan
- Cardiovascular Genetics Program, Department of Translational Genomics, Center for Genomic Medicine, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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6
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Kim MJ, Cha S, Baek JS, Yu JJ, Seo GH, Kang M, Do HS, Lee SE, Lee BH. Genetic heterogeneity of cardiomyopathy and its correlation with patient care. BMC Med Genomics 2023; 16:270. [PMID: 37904158 PMCID: PMC10614404 DOI: 10.1186/s12920-023-01639-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/21/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Cardiomyopathy, which is a genetically and phenotypically heterogeneous pathological condition, is associated with increased morbidity and mortality. Genetic diagnosis of cardiomyopathy enables accurate phenotypic classification and optimum patient management and counseling. This study investigated the genetic spectrum of cardiomyopathy and its correlation with the clinical course of the disease. METHODS The samples of 72 Korean patients with cardiomyopathy (43 males and 29 females) were subjected to whole-exome sequencing (WES). The familial information and clinical characteristics of the patients were reviewed and analyzed according to their genotypes. RESULTS Dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), left ventricular non-compaction cardiomyopathy, and restrictive cardiomyopathy was detected in 41 (56.9%), 25 (34.7%), 4 (5.6%), and 2 (2.8%) patients, respectively. WES analysis revealed positive results in 37 (51.4%) patients. Subsequent familial testing identified ten additional familial cases. Among DCM cases, 19 (46.3%) patients exhibited positive results, with TTN variants being the most common alteration, followed by LMNA and MYH7 variants. Meanwhile, among HCM cases, 15 (60%) patients exhibited positive results with MYH7 variants being the most common alteration. In six patients with positive results, extracardiac surveillance was warranted based on disease information. The incidence of worse outcomes, such as mortality and life-threatening arrhythmic events, in patients with DCM harboring LMNA variants, was higher than that in patients with DCM harboring TTN or MYH7 variants. CONCLUSIONS Diverse genotypes were identified in a substantial proportion of patients with cardiomyopathy. Genetic diagnosis enables personalized disease surveillance and management.
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Affiliation(s)
- Mi Jin Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seulgi Cha
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Suk Baek
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Jin Yu
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Minji Kang
- Genome Research Center for Birth Defects and Genetic Diseases, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Hyo-Sang Do
- Genome Research Center for Birth Defects and Genetic Diseases, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Sang Eun Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Beom Hee Lee
- Medical Genetics Center, Asan Medical Center Children's Hospital, University of Ulsan College of Medicines, Seoul, Korea.
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7
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 300] [Impact Index Per Article: 300.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Xin XX, Se YY. Caution in the use of sedation and endomyocardial biopsy for the management of pediatric acute heart failure caused by endocardial fibroelastosis. World J Clin Cases 2023; 11:5412-5415. [PMID: 37621580 PMCID: PMC10445076 DOI: 10.12998/wjcc.v11.i22.5412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/04/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
Endocardial fibroelastosis (EFE) is commonly considered to be an inflammatory reactive lesion of hyperplasia and deposition of tissue fibers and collagen in the endocardium and/or subendocardium, which is strongly associated with endocardial sclerosis, ventricular remodeling and acute and chronic heart failure, and is one of the important causes for pediatric heart transplantation. Early diagnosis and treatment are the key factors in determining the prognosis of the children. In this paper, we would like to highlight the potential unintended consequences of the use of sedation and biopsy for pediatric acute heart failure caused by EFE and the comprehensive considerations prior to clinical diagnosis.
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Affiliation(s)
- Xiao-Xuan Xin
- School of Hulunbuir Clinical Medicine, Inner Mongolia Minzu University, Hulunbuir 021000, Inner Mongolia Autonomous Region, China
| | - Yo-Yeng Se
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong 999077, China
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9
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Xin XX, Se YY. Caution in the use of sedation and endomyocardial biopsy for the management of pediatric acute heart failure caused by endocardial fibroelastosis. World J Clin Cases 2023; 11:5406-5409. [DOI: 10.12998/wjcc.v11.i22.5406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/04/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
Endocardial fibroelastosis (EFE) is commonly considered to be an inflammatory reactive lesion of hyperplasia and deposition of tissue fibers and collagen in the endocardium and/or subendocardium, which is strongly associated with endocardial sclerosis, ventricular remodeling and acute and chronic heart failure, and is one of the important causes for pediatric heart transplantation. Early diagnosis and treatment are the key factors in determining the prognosis of the children. In this paper, we would like to highlight the potential unintended consequences of the use of sedation and biopsy for pediatric acute heart failure caused by EFE and the comprehensive considerations prior to clinical diagnosis.
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Affiliation(s)
- Xiao-Xuan Xin
- School of Hulunbuir Clinical Medicine, Inner Mongolia Minzu University, Hulunbuir 021000, Inner Mongolia Autonomous Region, China
| | - Yo-Yeng Se
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong 999077, China
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10
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Bogle C, Colan SD, Miyamoto SD, Choudhry S, Baez-Hernandez N, Brickler MM, Feingold B, Lal AK, Lee TM, Canter CE, Lipshultz SE. Treatment Strategies for Cardiomyopathy in Children: A Scientific Statement From the American Heart Association. Circulation 2023; 148:174-195. [PMID: 37288568 DOI: 10.1161/cir.0000000000001151] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This scientific statement from the American Heart Association focuses on treatment strategies and modalities for cardiomyopathy (heart muscle disease) in children and serves as a companion scientific statement for the recent statement on the classification and diagnosis of cardiomyopathy in children. We propose that the foundation of treatment of pediatric cardiomyopathies is based on these principles applied as personalized therapy for children with cardiomyopathy: (1) identification of the specific cardiac pathophysiology; (2) determination of the root cause of the cardiomyopathy so that, if applicable, cause-specific treatment can occur (precision medicine); and (3) application of therapies based on the associated clinical milieu of the patient. These clinical milieus include patients at risk for developing cardiomyopathy (cardiomyopathy phenotype negative), asymptomatic patients with cardiomyopathy (phenotype positive), patients with symptomatic cardiomyopathy, and patients with end-stage cardiomyopathy. This scientific statement focuses primarily on the most frequent phenotypes, dilated and hypertrophic, that occur in children. Other less frequent cardiomyopathies, including left ventricular noncompaction, restrictive cardiomyopathy, and arrhythmogenic cardiomyopathy, are discussed in less detail. Suggestions are based on previous clinical and investigational experience, extrapolating therapies for cardiomyopathies in adults to children and noting the problems and challenges that have arisen in this experience. These likely underscore the increasingly apparent differences in pathogenesis and even pathophysiology in childhood cardiomyopathies compared with adult disease. These differences will likely affect the utility of some adult therapy strategies. Therefore, special emphasis has been placed on cause-specific therapies in children for prevention and attenuation of their cardiomyopathy in addition to symptomatic treatments. Current investigational strategies and treatments not in wide clinical practice, including future direction for investigational management strategies, trial designs, and collaborative networks, are also discussed because they have the potential to further refine and improve the health and outcomes of children with cardiomyopathy in the future.
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Wanert C, El Louali F, Al Dybiat S, Nguyen K, Zaffran S, Ovaert C. Genetic profile and genotype-phenotype correlations in childhood cardiomyopathy. Arch Cardiovasc Dis 2023; 116:309-315. [PMID: 37246080 DOI: 10.1016/j.acvd.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Genetic cardiomyopathy is a rare disease in childhood. AIMS To analyse clinical and genetic aspects of a paediatric cardiomyopathy population, and to establish genotype-phenotype correlations. METHODS We performed a retrospective study of all patients with idiopathic cardiomyopathy aged<18years in Southeast France. Secondary causes of cardiomyopathy were excluded. All data (clinical, echocardiography, genetic testing) were collected retrospectively. Patients were classified into six groups: hypertrophic cardiomyopathy; dilated cardiomyopathy; restrictive cardiomyopathy; left ventricular non-compaction; arrhythmogenic right ventricular dysplasia; and mixed cardiomyopathy. Patients who did not have a complete genetic test according to current scientific developments had another deoxyribonucleic acid blood sample during the study time. Genetic tests were considered positive if the variant found was classified as pathogenic, likely pathogenic or a variant of uncertain significance. RESULTS Eighty-three patients were included between 2005 and 2019. Most patients had hypertrophic cardiomyopathy (39.8%) or dilated cardiomyopathy (27.7%). The median age at diagnosis was 1.28years (interquartile range: 0.27-10.48years). Heart transplantation was performed in 30.1% of patients, and 10.8% died during follow-up. Among 64 patients with a complete genetic analysis, 64.1% had genetic anomalies, mostly in MYH7 (34.2%) and MYBPC3 (12.2%) genes. There were no differences in the whole cohort between genotype-positive and genotype-negative patients. In the hypertrophic cardiomyopathy group, 63.6% had a positive genetic test. Patients with a positive genetic test more often had extracardiac impact (38.1% vs. 8.3%; P=0.009), and more often required an implantable cardiac defibrillator (23.8% vs. 0%; P=0.025) or a heart transplant (19.1% vs. 0%; P=0.047). CONCLUSIONS In our population, children with cardiomyopathy had a high positive genetic test rate. Hypertrophic cardiomyopathy with a positive genetic test is associated with a worse outcome.
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Affiliation(s)
- Chloé Wanert
- Department of Paediatric Cardiology, Timone Infant Hospital, AP-HM, 13005 Marseille, France; Marseille Medical Genetics, Inserm UMR 1251, Aix-Marseille University, 13385 Marseille, France.
| | - Fedoua El Louali
- Department of Paediatric Cardiology, Timone Infant Hospital, AP-HM, 13005 Marseille, France
| | - Sarab Al Dybiat
- Department of Paediatric Cardiology, Timone Infant Hospital, AP-HM, 13005 Marseille, France
| | - Karine Nguyen
- Marseille Medical Genetics, Inserm UMR 1251, Aix-Marseille University, 13385 Marseille, France; Department of Specialized Cardiogenetics, Timone Infant Hospital, AP-HM, 13005 Marseille, France
| | - Stéphane Zaffran
- Marseille Medical Genetics, Inserm UMR 1251, Aix-Marseille University, 13385 Marseille, France
| | - Caroline Ovaert
- Department of Paediatric Cardiology, Timone Infant Hospital, AP-HM, 13005 Marseille, France; Department of Specialized Cardiogenetics, Timone Infant Hospital, AP-HM, 13005 Marseille, France
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12
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Thakkar K, Karajgi AR, Kallamvalappil AM, Avanthika C, Jhaveri S, Shandilya A, Anusheel, Al-Masri R. Sudden cardiac death in childhood hypertrophic cardiomyopathy. Dis Mon 2023; 69:101548. [PMID: 36931945 DOI: 10.1016/j.disamonth.2023.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
The most prevalent cause of mortality in children with hypertrophic cardiomyopathy (HCM) is sudden cardiac death (SCD), which happens more frequently than in adult patients. Risk stratification tactics have generally been drawn from adult practice, however emerging data has revealed significant disparities between children and adult cohorts, implying the need for pediatric-specific risk stratification methodologies. We conducted an all-language literature search on Medline, Cochrane, Embase, and Google Scholar until October 2021. The following search strings and Medical Subject Heading (MeSH) terms were used: "HCM," "SCD," "Sudden Cardiac Death," and "Childhood Onset HCM." We explored the literature on the risk of SCD in HCM for its epidemiology, pathophysiology, the role of various genes and their influence, associated complications leading to SCD and preventive and treatment modalities. Childhood-onset HCM is linked to significant life-long morbidity and mortality, including a higher SCD rate in children than in adults. The present focus is on symptom relief and avoiding illness-related consequences, but the prospect of future disease-modifying medicines offers an intriguing opportunity to alter disease expression and outcomes in these young individuals. Current preventive recommendations promote implantable cardioverter defibrillator placement based on cumulative risk factor thresholds, although they have been demonstrated to have weak discriminating capacity. This article addresses questions and discusses the etiology, risk factors, and method to risk stratification for SCD in children with HCM.
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Affiliation(s)
- Keval Thakkar
- G.M.E.R.S. Medical College and General Hospital, Gandhinagar, India
| | | | | | - Chaithanya Avanthika
- Karnataka Institute of Medical /Sciences, PB Rd, Vidya Nagar, Hubli, Karnataka, India.
| | | | | | - Anusheel
- Ryazan State I P Pavlov Medical Institute, Ryazan, Russia
| | - Rayan Al-Masri
- Jordan University of Science and technology, Irbid, Jordan
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13
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Pagano M, Fumagalli C, Girolami F, Passantino S, Gozzini A, Brambilla A, Spinelli V, Morrone A, Procopio E, Pochiero F, Donati MA, Olivotto I, Favilli S. Clinical profile and outcome of cardiomyopathies in infants and children seen at a tertiary centre. Int J Cardiol 2023; 371:516-522. [PMID: 36130621 DOI: 10.1016/j.ijcard.2022.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/12/2022] [Accepted: 09/15/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Due to their rare prevalence and marked heterogeneity, pediatric cardiomyopathies (CMPs) are little known and scarcely reported. We report the etiology, clinical profile and outcome of a consecutive cohort of children diagnosed with CMP and followed at Meyer Children's Hospital over a decade. PATIENTS AND METHODS We retrospectively reviewed patients consecutively referred from May 2008 to May 2019 for pediatric onset CMP (<18 years). Heart disease caused by arrhythmic disorders, toxic agents, rheumatic conditions and maternal disease were excluded. RESULTS We enrolled 110 patients (65 males), diagnosed at a median age of 27 [4-134] months; 35% had an infant onset (<1 year of age). A positive family history was more often associated with childhood-onset (38.8%). Hypertrophic cardiomyopathy (HCM; 48 patients) was the most frequent phenotype, followed by dilated cardiomyopathy (DCM; 35 patients). While metabolic and idiopathic etiologies were preponderant in infants, metabolic and sarcomeric diseases were most frequent in the childhood-onset group. Major adverse cardiac events (MACE) occurred in 31.8% of patients, including hospitalization for acute heart failure in 25.5% of patients, most commonly due to DCM. Overall, the most severe outcomes were documented in patients with metabolic diseases. CONCLUSIONS In a consecutive cohort of pediatric patients with CMP, those with infantile onset and with a metabolic etiology had the worst prognosis. Overall, MACE occurred in 41% of the entire population, most commonly associated with DCM, inborn errors of metabolism and genetic syndromes. Systematic NGS genetic testing was critical for etiological diagnosis and management.
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Affiliation(s)
- M Pagano
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy.
| | - C Fumagalli
- Cardiomyopathies Unit, Careggi University Hospital (AOUC), Florence, Italy
| | - F Girolami
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - S Passantino
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - A Gozzini
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - A Brambilla
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - V Spinelli
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - A Morrone
- Molecular and Cell Biology Laboratory of Neurometabolic Diseases, Meyer Children's Hospital, Neuroscience Department, Florence, Italy; Department of NEUROFARBA, University of Florence, Florence, Italy
| | - E Procopio
- Metabolic and Muscular Unit, Meyer Children's Hospital, Neuroscience Department, Florence, Italy
| | - F Pochiero
- Metabolic and Muscular Unit, Meyer Children's Hospital, Neuroscience Department, Florence, Italy
| | - M A Donati
- Metabolic and Muscular Unit, Meyer Children's Hospital, Neuroscience Department, Florence, Italy
| | - I Olivotto
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy; Cardiomyopathies Unit, Careggi University Hospital (AOUC), Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - S Favilli
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
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14
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Ware SM. Cardiac Disease in Patients With Mitochondrial Defects. J Am Coll Cardiol 2022; 80:1444-1446. [DOI: 10.1016/j.jacc.2022.08.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 01/07/2023]
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15
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Voges I, Latus H. Family screening of hypertrophic cardiomyopathy in children: a case report. Eur Heart J Case Rep 2022; 6:ytac360. [PMID: 36128439 PMCID: PMC9477208 DOI: 10.1093/ehjcr/ytac360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/17/2021] [Accepted: 08/30/2022] [Indexed: 11/28/2022]
Abstract
Background Paediatric hypertrophic cardiomyopathy (HCM) caused by sarcomere protein gene mutations is more common than previously thought. We present the case of a 9-year-old boy that was diagnosed with HCM during family screening. Case summary We present a case of a 9-year-old boy with a family history of sarcomeric HCM who was diagnosed with hypertrophic obstructive cardiomyopathy (HOCM) during clinical screening. Echocardiography and cardiovascular magnetic resonance imaging revealed asymmetric left ventricular hypertrophy with a maximum wall thickness of 18–19 mm. Cardiovascular magnetic resonance late gadolinium enhancement imaging showed patchy fibrosis within the area of maximum wall thickness. Genetic testing confirmed the presence of the familial mutation in the MYL2 gene. The patient was started on bisoprolol. Furthermore, risk stratification was performed and a recommendation for implantable cardioverter-defibrillator implantation was made. Discussion This case demonstrates that significant HCM can already start in childhood and discusses the recommendations for family screening on the basis of recently published studies and the present European Society of Cardiology guideline.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein , Arnold-Heller-Str. 3, Haus 9, Campus Kiel, Kiel 24105 , Germany
| | - Heiner Latus
- Department of Pediatric Cardiology, Olgahospital , Stuttgart 70174 , Germany
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16
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Torpoco Rivera DM, Hafzalah M, Pomerantz DJ, Garcia RU. Dilated cardiomyopathy associated with a mutation in the dispatched RND transporter family member 1 gene. Cardiol Young 2022; 32:1166-1168. [PMID: 34852870 DOI: 10.1017/s1047951121004625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dilated cardiomyopathy is the most common presentation of cardiomyopathy in children with 20-35% of patients having an identified genetic component. There are more than 30 genes implicated in the pathogenesis of dilated cardiomyopathy. We present the first report of a female infant with dilated cardiomyopathy with a genetic variant in the dispatched RND transporter family member 1 gene.
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Affiliation(s)
- Diana M Torpoco Rivera
- Division of Cardiology, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
| | - Mina Hafzalah
- Division of Critical Care, Children's Hospital of Michigan, Detroit, MI, USA
| | | | - Richard U Garcia
- Division of Cardiology, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
- Division of Critical Care, Children's Hospital of Michigan, Detroit, MI, USA
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17
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Wasserstrum Y, Larrañaga-Moreira JM, Martinez-Veira C, Itelman E, Lotan D, Sabbag A, Kuperstein R, Peled Y, Freimark D, Barriales-Villa R, Arad M. Hypokinetic hypertrophic cardiomyopathy: clinical phenotype, genetics, and prognosis. ESC Heart Fail 2022; 9:2301-2312. [PMID: 35488723 PMCID: PMC9288812 DOI: 10.1002/ehf2.13914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/13/2022] [Accepted: 03/14/2022] [Indexed: 11/12/2022] Open
Abstract
Aims To describe the phenotype, genetics, and events associated with the development of hypertrophic cardiomyopathy (HCM) with reduced ventricular function (HCMr). Heart failure in HCM is usually associated with preserved ejection fraction, yet some HCM patients develop impaired systolic function that is associated with worse outcomes. Methods and results Our registry included 1328 HCM patients from two centres in Spain and Israel. Patients with normal baseline ventricular function were matched, and a competing‐risk analysis was performed to find factors associated with HCMr development. Patient records were reviewed to recognize clinically significant events that occurred closely before the development of HCMr. Genetic data were collected in patients with HCMr. A composite of all‐cause mortality or ventricular assist device (VAD)/heart transplantation was assessed according to ventricular function. Median age was 56, and 34% were female patients. HCMr at evaluation was seen in 37 (2.8%) patients, and 46 (3.5%) developed HCMr during median follow up of 9 years. HCMr was associated with younger age of diagnosis, poor functional class, and ventricular arrhythmia. Atrial fibrillation, pacemaker implantation, and baseline left ventricular ejection fraction (LVEF) of ≤55% were significant predictors of future HCMr development, while LV obstruction predicted a lower risk. Genetic testing performed in 53 HCMr patients, identifying one or more pathogenic variant in 38 (72%): most commonly in myosin binding protein C (n = 20). Six of these patients had an additional pathogenic variant in one of the sarcomere genes. Patients with baseline HCMr had a higher risk (hazard ratio 6.4, 4.1–10.1) for the composite outcome and for the individual components. Patients who developed HCMr in the course of the study had similar mortality but a higher rate of VAD/heart transplantation compared with HCM with normal LVEF. Conclusions Hypertrophic cardiomyopathy with reduced ejection fraction is associated with heart failure and poor outcome. Arrhythmia, cardiac surgery, and device implantation were commonly documented prior to HCMr development, suggesting they may be either a trigger or the result of adverse remodelling. Future studies should focus on prediction and prevention of HCMr.
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Affiliation(s)
- Yishay Wasserstrum
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - José M Larrañaga-Moreira
- Unidad de Cardiopatías Familiares, Cardiology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Cristina Martinez-Veira
- Unidad de Cardiopatías Familiares, Cardiology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Edward Itelman
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Dor Lotan
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Avi Sabbag
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Rafael Kuperstein
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Yael Peled
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Dov Freimark
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Cardiology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain.,Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Michael Arad
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
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18
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Cai K, Wang F, Lu JQ, Shen AN, Zhao SM, Zang WD, Gui YH, Zhao JY. Nicotinamide Mononucleotide Alleviates Cardiomyopathy Phenotypes Caused by Short-Chain Enoyl-Coa Hydratase 1 Deficiency. JACC Basic Transl Sci 2022; 7:348-362. [PMID: 35540099 PMCID: PMC9079797 DOI: 10.1016/j.jacbts.2021.12.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023]
Abstract
ECHS1 hydrates medium- and short-chain enoyl CoAs and catalyzes the oxidation of fatty acids and branched-chain amino acids. The mechanism driving ECHS1 deficiency–associated cardiomyopathy was investigated using conventional biochemistry and molecular biology methods, including immunoprecipitation and polymerase chain reaction. Echs1 heterogeneous knockout mice displayed cardiac dysfunction as evaluated by echocardiography. ECHS1 deficiency causes cardiomyopathy by enhancing p300-mediated H3K9ac. ECHS1 deficiency–induced cardiomyopathy can be prevented using an intervention approach targeting H3K9ac.
Short-chain enoyl-CoA hydratase 1 (ECHS1) deficiency plays a role in cardiomyopathy. Whether ECHS1 deficiency causes or is only associated with cardiomyopathy remains unclear. By using Echs1 heterogeneous knockout (Echs1+/-) mice, we found that ECHS1 deficiency caused cardiac dysfunction, as evidenced by diffuse myocardial fibrosis and upregulated fibrosis-related genes. Mechanistically, ECHS1 interacts with the p300 nuclear localization sequence, preventing its nuclear translocation in fibroblasts. ECHS1 deficiency promotes p300 nuclear translocation, leading to increased H3K9 acetylation, a known risk factor for cardiomyopathy. Nicotinamide mononucleotide–mediated acetylation targeting suppressed ECHS1 deficiency–induced cardiomyopathy phenotypes in Echs1+/- mice. Thus, enhancing p300-mediated H3K9ac is a potential interventional approach for preventing ECHS1 deficiency–induced cardiomyopathy.
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Key Words
- ANP, atrial natriuretic peptide
- BCAA, branched-chain amino acid
- BNP, brain natriuretic peptide
- DCM, dilated cardiomyopathy
- ECHS1, short-chain enoyl-CoA hydratase 1
- FA, fatty acid
- HCM, hypertrophic cardiomyopathy
- HFF, human foreskin fibroblast
- IVSd, interventricular septum in end-diastole
- IVSs, interventricular septum in end-systole
- LVEF, left ventricular ejection fraction
- LVFS, left ventricular fractional shortening
- LVIDd, left ventricular internal dimension in end-diastole
- LVIDs, left ventricular internal dimension in end-systole
- LVPWd, left ventricular posterior wall in end-diastole
- LVPWs, left ventricular posterior wall in end-systole
- NMN, nicotinamide mononucleotide
- acetylation of H3K9
- cardiomyopathy
- enoyl-CoA hydratase 1
- nicotinamide mononucleotide
- p300
- α-SMA, smooth muscle actin-α
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Affiliation(s)
- Ke Cai
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China
| | - Feng Wang
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China
| | - Jia-Quan Lu
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China
| | - An-Na Shen
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China
| | - Shi-Min Zhao
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China.,Key Laboratory of Reproduction Regulation of NPFPC, Fudan University, Shanghai, China
| | - Wei-Dong Zang
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Yong-Hao Gui
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China
| | - Jian-Yuan Zhao
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China.,School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
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19
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Rosu RO, Lupsor A, Necula A, Cismaru G, Cainap SS, Iacob D, Lazea C, Cismaru A, Negru AG, Pop D, Gusetu G. Anatomical-MRI Correlations in Adults and Children with Hypertrophic Cardiomyopathy. Diagnostics (Basel) 2022; 12:diagnostics12020489. [PMID: 35204578 PMCID: PMC8870875 DOI: 10.3390/diagnostics12020489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022] Open
Abstract
Hypertrophic Cardiomyopathy (HCM) is the most frequent hereditary cardiovascular disease and the leading cause of sudden cardiac death in young individuals. Advancements in CMR imaging have allowed for earlier identification and more accurate prognosis of HCM. Interventions aimed at slowing or stopping the disease’s natural course may be developed in the future. CMR has been validated as a technique with high sensitivity and specificity, very few contraindications, a low risk of side effects, and is overall a good tool to be employed in the management of HCM patients. The goal of this review is to evaluate the magnetic resonance features of HCM, starting with distinct phenotypic variants of the disease and progressing to differential diagnoses of athlete’s heart, hypertension, and infiltrative cardiomyopathies. HCM in children has its own section in this review, with possible risk factors that are distinct from those in adults; delayed enhancement in children may play a role in risk stratification in HCM. Finally, a number of teaching points for general cardiologists who recommend CMR for patients with HCM will be presented.
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Affiliation(s)
- Radu Ovidiu Rosu
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, 400347 Cluj-Napoca, Romania; (R.O.R.); (D.P.); (G.G.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
| | - Ana Lupsor
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- Correspondence: (A.L.); (G.C.); Tel.: +40-004-072-192-6230 (G.C.)
| | - Alexandru Necula
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
| | - Gabriel Cismaru
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, 400347 Cluj-Napoca, Romania; (R.O.R.); (D.P.); (G.G.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- Correspondence: (A.L.); (G.C.); Tel.: +40-004-072-192-6230 (G.C.)
| | - Simona Sorana Cainap
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- 2nd Pediatric Department, Mother and Child Department, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
| | - Daniela Iacob
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- 3rd Pediatric Department, Mother and Child Department, Emergency Clinical Hospital for Children, 400217 Cluj-Napoca, Romania
| | - Cecilia Lazea
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- 1st Pediatric Department, Mother and Child Department, Emergency Clinical Hospital for Children, 400370 Cluj-Napoca, Romania
| | - Andrei Cismaru
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, 400337 Cluj-Napoca, Romania
| | - Alina Gabriela Negru
- Department of Cardiology, ‘Victor Babeș’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Dana Pop
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, 400347 Cluj-Napoca, Romania; (R.O.R.); (D.P.); (G.G.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
| | - Gabriel Gusetu
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, 400347 Cluj-Napoca, Romania; (R.O.R.); (D.P.); (G.G.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
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20
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Ware SM, Bhatnagar S, Dexheimer PJ, Wilkinson JD, Sridhar A, Fan X, Shen Y, Tariq M, Schubert JA, Colan SD, Shi L, Canter CE, Hsu DT, Bansal N, Webber SA, Everitt MD, Kantor PF, Rossano JW, Pahl E, Rusconi P, Lee TM, Towbin JA, Lal AK, Chung WK, Miller EM, Aronow B, Martin LJ, Lipshultz SE. The genetic architecture of pediatric cardiomyopathy. Am J Hum Genet 2022; 109:282-298. [PMID: 35026164 DOI: 10.1016/j.ajhg.2021.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/10/2021] [Indexed: 01/27/2023] Open
Abstract
To understand the genetic contribution to primary pediatric cardiomyopathy, we performed exome sequencing in a large cohort of 528 children with cardiomyopathy. Using clinical interpretation guidelines and targeting genes implicated in cardiomyopathy, we identified a genetic cause in 32% of affected individuals. Cardiomyopathy sub-phenotypes differed by ancestry, age at diagnosis, and family history. Infants < 1 year were less likely to have a molecular diagnosis (p < 0.001). Using a discovery set of 1,703 candidate genes and informatic tools, we identified rare and damaging variants in 56% of affected individuals. We see an excess burden of damaging variants in affected individuals as compared to two independent control sets, 1000 Genomes Project (p < 0.001) and SPARK parental controls (p < 1 × 10-16). Cardiomyopathy variant burden remained enriched when stratified by ancestry, variant type, and sub-phenotype, emphasizing the importance of understanding the contribution of these factors to genetic architecture. Enrichment in this discovery candidate gene set suggests multigenic mechanisms underlie sub-phenotype-specific causes and presentations of cardiomyopathy. These results identify important information about the genetic architecture of pediatric cardiomyopathy and support recommendations for clinical genetic testing in children while illustrating differences in genetic architecture by age, ancestry, and sub-phenotype and providing rationale for larger studies to investigate multigenic contributions.
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21
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Comprehensive Genetic Testing for Pediatric Hypertrophic Cardiomyopathy Reveals Clinical Management Opportunities and Syndromic Conditions. Pediatr Cardiol 2022; 43:616-623. [PMID: 34714385 PMCID: PMC8554517 DOI: 10.1007/s00246-021-02764-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) has historically been diagnosed phenotypically. Through genetic testing, identification of a molecular diagnosis (MolDx) is increasingly common but the impact on pediatric patients is unknown. This was a retrospective study of next-generation sequencing data for 602 pediatric patients with a clinician-reported history of HCM. Diagnostic yield was stratified by gene and self-reported race/ethnicity. A MolDx of HCM was identified in 242 (40%) individuals. Sarcomeric genes were the highest yielding, but pathogenic and/or likely pathogenic (P/LP) variants in syndromic genes were found in 36% of individuals with a MolDx, often in patients without documented clinical suspicion for a genetic syndrome. Among all MolDx, 73% were in genes with established clinical management recommendations and 2.9% were in genes that conferred eligibility for clinical trial enrollment. Black patients were the least likely to receive a MolDx. In the current era, genetic testing can impact management of HCM, beyond diagnostics or prognostics, through disease-specific guidelines or clinical trial eligibility. Genetic testing frequently can help identify syndromes in patients for whom syndromes may not be suspected. These findings highlight the importance of pursuing broad genetic testing, independent of suspicion based on phenotype. Lower rates of MolDx in Black patients may contribute to health inequities. Further research is needed evaluating the genetics of HCM in underrepresented/underserved populations. Additionally, research related to the impact of genetic testing on clinical management of other diseases is warranted.
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22
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Ware SM. Pediatric cardiomyopathy and the PCM Genes study: A summary with insights on genetic testing, variant interpretation, race and ethnicity. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Parker LE, Landstrom AP. The clinical utility of pediatric cardiomyopathy genetic testing: From diagnosis to a precision medicine-based approach to care. PROGRESS IN PEDIATRIC CARDIOLOGY 2021; 62. [PMID: 34776723 DOI: 10.1016/j.ppedcard.2021.101413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Pediatric-onset cardiomyopathies are rare yet cause significant morbidity and mortality in affected children. Genetic testing has a major role in the clinical evaluation of pediatric-onset cardiomyopathies, and identification of a variant in an associated gene can be used to confirm the clinical diagnosis and exclude syndromic causes that may warrant different treatment strategies. Further, risk-predictive testing of first-degree relatives can assess who is at-risk of disease and requires continued clinical follow-up. Aim of Review In this review, we seek to describe the current role of genetic testing in the clinical diagnosis and management of patients and families with the five major cardiomyopathies. Further, we highlight the ongoing development of precision-based approaches to diagnosis, prognosis, and treatment. Key Scientific Concepts of Review Emerging application of genotype-phenotype correlations opens the door for genetics to guide a precision medicine-based approach to prognosis and potentially for therapies. Despite advances in our understanding of the genetic etiology of cardiomyopathy and increased accessibility of clinical genetic testing, not all pediatric cardiomyopathy patients have a clear genetic explanation for their disease. Expanded genomic studies are needed to understand the cause of disease in these patients, improve variant classification and genotype-driven prognostic predictions, and ultimately develop truly disease preventing treatment.
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Affiliation(s)
- Lauren E Parker
- Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, United States
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, United States.,Department of Cell Biology, Duke University School of Medicine, Durham, NC, United States
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24
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Nakagama Y, Ito M. Towards Deeper Phenotyping of the Dilated Cardiomyopathies in Children - Where Are We Now, and Where Are We Heading? Circ J 2021; 86:116-117. [PMID: 34707032 DOI: 10.1253/circj.cj-21-0802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yu Nakagama
- Department of Parasitology & Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University.,Department of Pediatrics, Graduate School of Medicine, The University of Tokyo
| | - Masamichi Ito
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.,Department of Advanced Clinical Science and Therapeutics, Graduate School of Medicine, The University of Tokyo
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25
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Girolami F, Spinelli V, Passantino S, Bennati E, Calabri GB, Olivotto I, Favilli S. Hidden familial cardiomyopathies in children: Role of genetic testing. Int J Cardiol 2021; 340:55-58. [PMID: 34384838 DOI: 10.1016/j.ijcard.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Pediatric cardiomyopathies harbour significant phenotypic and genetic heterogeneity. Genetic testing is essential for the initial evaluation and the ongoing care of child and family, although challenges remain regarding its appropriate clinical implementation in minors. We here discuss the key role of genetic diagnosis in the clinical management of two patients.
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Affiliation(s)
- F Girolami
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy.
| | - V Spinelli
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - S Passantino
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - E Bennati
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - G B Calabri
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - I Olivotto
- Cardiomyopathy Unit, University of Florence, Florence, Italy
| | - S Favilli
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
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26
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Tayal U, Ware JS, Lakdawala NK, Heymans S, Prasad SK. Understanding the genetics of adult-onset dilated cardiomyopathy: what a clinician needs to know. Eur Heart J 2021; 42:2384-2396. [PMID: 34153989 DOI: 10.1093/eurheartj/ehab286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/10/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022] Open
Abstract
There is increasing understanding of the genetic basis to dilated cardiomyopathy and in this review, we offer a practical primer for the practising clinician. We aim to help all clinicians involved in the care of patients with dilated cardiomyopathy to understand the clinical relevance of the genetic basis of dilated cardiomyopathy, introduce key genetic concepts, explain which patients and families may benefit from genetic testing, which genetic tests are commonly performed, how to interpret genetic results, and the clinical applications of results. We conclude by reviewing areas for future research in this dynamic field.
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Affiliation(s)
- Upasana Tayal
- National Heart Lung Institute, Imperial College London, UK.,Cardiovascular Research Centre, Royal Brompton & Harefield Hospitals, London, UK
| | - James S Ware
- National Heart Lung Institute, Imperial College London, UK.,Cardiovascular Research Centre, Royal Brompton & Harefield Hospitals, London, UK.,MRC London Institute of Medical Sciences, London, UK
| | - Neal K Lakdawala
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands.,Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, Leuven, KU, Belgium.,The Netherlands Heart Institute, Nl-HI, Utrecht, The Netherlands
| | - Sanjay K Prasad
- National Heart Lung Institute, Imperial College London, UK.,Cardiovascular Research Centre, Royal Brompton & Harefield Hospitals, London, UK
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27
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Vander Roest AS, Liu C, Morck MM, Kooiker KB, Jung G, Song D, Dawood A, Jhingran A, Pardon G, Ranjbarvaziri S, Fajardo G, Zhao M, Campbell KS, Pruitt BL, Spudich JA, Ruppel KM, Bernstein D. Hypertrophic cardiomyopathy β-cardiac myosin mutation (P710R) leads to hypercontractility by disrupting super relaxed state. Proc Natl Acad Sci U S A 2021. [PMID: 34117120 DOI: 10.1073/pnas.2025030118/suppl_file/pnas.2025030118.sm02.avi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited form of heart disease, associated with over 1,000 mutations, many in β-cardiac myosin (MYH7). Molecular studies of myosin with different HCM mutations have revealed a diversity of effects on ATPase and load-sensitive rate of detachment from actin. It has been difficult to predict how such diverse molecular effects combine to influence forces at the cellular level and further influence cellular phenotypes. This study focused on the P710R mutation that dramatically decreased in vitro motility velocity and actin-activated ATPase, in contrast to other MYH7 mutations. Optical trap measurements of single myosin molecules revealed that this mutation reduced the step size of the myosin motor and the load sensitivity of the actin detachment rate. Conversely, this mutation destabilized the super relaxed state in longer, two-headed myosin constructs, freeing more heads to generate force. Micropatterned human induced pluripotent derived stem cell (hiPSC)-cardiomyocytes CRISPR-edited with the P710R mutation produced significantly increased force (measured by traction force microscopy) compared with isogenic control cells. The P710R mutation also caused cardiomyocyte hypertrophy and cytoskeletal remodeling as measured by immunostaining and electron microscopy. Cellular hypertrophy was prevented in the P710R cells by inhibition of ERK or Akt. Finally, we used a computational model that integrated the measured molecular changes to predict the measured traction forces. These results confirm a key role for regulation of the super relaxed state in driving hypercontractility in HCM with the P710R mutation and demonstrate the value of a multiscale approach in revealing key mechanisms of disease.
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Affiliation(s)
- Alison Schroer Vander Roest
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
- Department of Bioengineering, School of Engineering and School of Medicine, Stanford University, Stanford, CA 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Chao Liu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Makenna M Morck
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Kristina Bezold Kooiker
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- School of Medicine, University of Washington, Seattle, WA 98109
| | - Gwanghyun Jung
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Dan Song
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Aminah Dawood
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Arnav Jhingran
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
| | - Gaspard Pardon
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
- Department of Bioengineering, School of Engineering and School of Medicine, Stanford University, Stanford, CA 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Sara Ranjbarvaziri
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Giovanni Fajardo
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Mingming Zhao
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Kenneth S Campbell
- Department of Physiology, University of Kentucky, Lexington, KY 40536
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY 40536
| | - Beth L Pruitt
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
- Department of Bioengineering, School of Engineering and School of Medicine, Stanford University, Stanford, CA 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Mechanical and Biomolecular Science and Engineering, University of California, Santa Barbara, CA 93106
| | - James A Spudich
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305;
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Kathleen M Ruppel
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Daniel Bernstein
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304;
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
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28
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Vander Roest AS, Liu C, Morck MM, Kooiker KB, Jung G, Song D, Dawood A, Jhingran A, Pardon G, Ranjbarvaziri S, Fajardo G, Zhao M, Campbell KS, Pruitt BL, Spudich JA, Ruppel KM, Bernstein D. Hypertrophic cardiomyopathy β-cardiac myosin mutation (P710R) leads to hypercontractility by disrupting super relaxed state. Proc Natl Acad Sci U S A 2021; 118:e2025030118. [PMID: 34117120 PMCID: PMC8214707 DOI: 10.1073/pnas.2025030118] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited form of heart disease, associated with over 1,000 mutations, many in β-cardiac myosin (MYH7). Molecular studies of myosin with different HCM mutations have revealed a diversity of effects on ATPase and load-sensitive rate of detachment from actin. It has been difficult to predict how such diverse molecular effects combine to influence forces at the cellular level and further influence cellular phenotypes. This study focused on the P710R mutation that dramatically decreased in vitro motility velocity and actin-activated ATPase, in contrast to other MYH7 mutations. Optical trap measurements of single myosin molecules revealed that this mutation reduced the step size of the myosin motor and the load sensitivity of the actin detachment rate. Conversely, this mutation destabilized the super relaxed state in longer, two-headed myosin constructs, freeing more heads to generate force. Micropatterned human induced pluripotent derived stem cell (hiPSC)-cardiomyocytes CRISPR-edited with the P710R mutation produced significantly increased force (measured by traction force microscopy) compared with isogenic control cells. The P710R mutation also caused cardiomyocyte hypertrophy and cytoskeletal remodeling as measured by immunostaining and electron microscopy. Cellular hypertrophy was prevented in the P710R cells by inhibition of ERK or Akt. Finally, we used a computational model that integrated the measured molecular changes to predict the measured traction forces. These results confirm a key role for regulation of the super relaxed state in driving hypercontractility in HCM with the P710R mutation and demonstrate the value of a multiscale approach in revealing key mechanisms of disease.
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Affiliation(s)
- Alison Schroer Vander Roest
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
- Department of Bioengineering, School of Engineering and School of Medicine, Stanford University, Stanford, CA 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Chao Liu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Makenna M Morck
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Kristina Bezold Kooiker
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- School of Medicine, University of Washington, Seattle, WA 98109
| | - Gwanghyun Jung
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Dan Song
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Aminah Dawood
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Arnav Jhingran
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
| | - Gaspard Pardon
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
- Department of Bioengineering, School of Engineering and School of Medicine, Stanford University, Stanford, CA 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Sara Ranjbarvaziri
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Giovanni Fajardo
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Mingming Zhao
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Kenneth S Campbell
- Department of Physiology, University of Kentucky, Lexington, KY 40536
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY 40536
| | - Beth L Pruitt
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
- Department of Bioengineering, School of Engineering and School of Medicine, Stanford University, Stanford, CA 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Mechanical and Biomolecular Science and Engineering, University of California, Santa Barbara, CA 93106
| | - James A Spudich
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305;
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Kathleen M Ruppel
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Daniel Bernstein
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304;
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
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Hershberger RE, Cowan J, Jordan E, Kinnamon DD. The Complex and Diverse Genetic Architecture of Dilated Cardiomyopathy. Circ Res 2021; 128:1514-1532. [PMID: 33983834 DOI: 10.1161/circresaha.121.318157] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our insight into the diverse and complex nature of dilated cardiomyopathy (DCM) genetic architecture continues to evolve rapidly. The foundations of DCM genetics rest on marked locus and allelic heterogeneity. While DCM exhibits a Mendelian, monogenic architecture in some families, preliminary data from our studies and others suggests that at least 20% to 30% of DCM may have an oligogenic basis, meaning that multiple rare variants from different, unlinked loci, determine the DCM phenotype. It is also likely that low-frequency and common genetic variation contribute to DCM complexity, but neither has been examined within a rare variant context. Other types of genetic variation are also likely relevant for DCM, along with gene-by-environment interaction, now established for alcohol- and chemotherapy-related DCM. Collectively, this suggests that the genetic architecture of DCM is broader in scope and more complex than previously understood. All of this elevates the impact of DCM genetics research, as greater insight into the causes of DCM can lead to interventions to mitigate or even prevent it and thus avoid the morbid and mortal scourge of human heart failure.
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Affiliation(s)
- Ray E Hershberger
- Divisions of Cardiovascular Medicine (R.E.H.), The Ohio State University Wexner Medical Center, Columbus.,Human Genetics (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus.,Department of Internal Medicine and the Davis Heart and Lung Research Institute (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus
| | - Jason Cowan
- Human Genetics (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus.,Department of Internal Medicine and the Davis Heart and Lung Research Institute (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus
| | - Elizabeth Jordan
- Human Genetics (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus.,Department of Internal Medicine and the Davis Heart and Lung Research Institute (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus
| | - Daniel D Kinnamon
- Human Genetics (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus.,Department of Internal Medicine and the Davis Heart and Lung Research Institute (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus
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30
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Genetic variant burden and adverse outcomes in pediatric cardiomyopathy. Pediatr Res 2021; 89:1470-1476. [PMID: 32746448 PMCID: PMC8256333 DOI: 10.1038/s41390-020-1101-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/07/2020] [Accepted: 07/22/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous genetic research in pediatric cardiomyopathy (CM) has focused on pathogenic variants for diagnostic purposes, with limited data evaluating genotype-outcome correlations. We explored whether greater genetic variant burden (pathogenic or variants of unknown significance, VUS) correlates with worse outcomes. METHODS Children with dilated CM (DCM) and hypertrophic CM (HCM) who underwent multigene testing between 2010 and 2018 were included. Composite endpoint was freedom from major adverse cardiac event (MACE). RESULTS Three hundred and thirty-eight subjects were included [49% DCM, median age 5.7 (interquartile range (IQR) 0.2-13.4) years, 51% HCM, median age 3.0 (IQR 0.1-12.5) years]. Pathogenic variants alone were not associated with MACE in either cohort (DCM p = 0.44; HCM p = 0.46). In DCM, VUS alone [odds ratio (OR) 4.0, 95% confidence interval (CI) 1.9-8.3] and in addition to pathogenic variants (OR 5.2, 95% CI 1.7-15.9) was associated with MACE. The presence of VUS alone or in addition to pathogenic variants were not associated with MACE in HCM (p = 0.22 and p = 0.33, respectively). CONCLUSION Increased genetic variant burden (pathogenic variants and VUS) is associated with worse clinical outcomes in DCM but not HCM. Genomic variants that influence DCM onset may be distinct from those driving disease progression, highlighting the potential value of universal genetic testing to improve risk stratification. IMPACT In pediatric CM, inconsistent findings historically have been shown between genotype and phenotype severity when only pathogenic variants have been considered. Increased genetic variant burden (including both pathogenic variants and VUS) is associated with worse clinical outcomes in DCM but not HCM. Genomic variants that influence CM onset may be distinct from those variants that drive disease progression and influence outcomes in phenotype-positive individuals. Incorporation of both pathogenic variants and VUS may improve risk stratification models in pediatric CM.
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31
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Ware SM, Wilkinson JD, Tariq M, Schubert JA, Sridhar A, Colan SD, Shi L, Canter CE, Hsu DT, Webber SA, Dodd DA, Everitt MD, Kantor PF, Addonizio LJ, Jefferies JL, Rossano JW, Pahl E, Rusconi P, Chung WK, Lee T, Towbin JA, Lal AK, Bhatnagar S, Aronow B, Dexheimer PJ, Martin LJ, Miller EM, Sleeper LA, Razoky H, Czachor J, Lipshultz SE. Genetic Causes of Cardiomyopathy in Children: First Results From the Pediatric Cardiomyopathy Genes Study. J Am Heart Assoc 2021; 10:e017731. [PMID: 33906374 PMCID: PMC8200745 DOI: 10.1161/jaha.120.017731] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Pediatric cardiomyopathy is a genetically heterogeneous disease with substantial morbidity and mortality. Current guidelines recommend genetic testing in children with hypertrophic, dilated, or restrictive cardiomyopathy, but practice variations exist. Robust data on clinical testing practices and diagnostic yield in children are lacking. This study aimed to identify the genetic causes of cardiomyopathy in children and to investigate clinical genetic testing practices. Methods and Results Children with familial or idiopathic cardiomyopathy were enrolled from 14 institutions in North America. Probands underwent exome sequencing. Rare sequence variants in 37 known cardiomyopathy genes were assessed for pathogenicity using consensus clinical interpretation guidelines. Of the 152 enrolled probands, 41% had a family history of cardiomyopathy. Of 81 (53%) who had undergone clinical genetic testing for cardiomyopathy before enrollment, 39 (48%) had a positive result. Genetic testing rates varied from 0% to 97% between sites. A positive family history and hypertrophic cardiomyopathy subtype were associated with increased likelihood of genetic testing (P=0.005 and P=0.03, respectively). A molecular cause was identified in an additional 21% of the 63 children who did not undergo clinical testing, with positive results identified in both familial and idiopathic cases and across all phenotypic subtypes. Conclusions A definitive molecular genetic diagnosis can be made in a substantial proportion of children for whom the cause and heritable nature of their cardiomyopathy was previously unknown. Practice variations in genetic testing are great and should be reduced. Improvements can be made in comprehensive cardiac screening and predictive genetic testing in first‐degree relatives. Overall, our results support use of routine genetic testing in cases of both familial and idiopathic cardiomyopathy. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01873963.
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Affiliation(s)
- Stephanie M Ware
- Departments of Pediatrics and Medical and Molecular Genetics Indiana University School of Medicine Indianapolis IN
| | | | - Muhammad Tariq
- Faculty of Applied Medical Sciences University of Tabuk Kingdom of Saudi Arabia
| | - Jeffrey A Schubert
- Departments of Pediatrics and Medical and Molecular Genetics Indiana University School of Medicine Indianapolis IN
| | - Arthi Sridhar
- Departments of Pediatrics and Medical and Molecular Genetics Indiana University School of Medicine Indianapolis IN
| | - Steven D Colan
- Department of Cardiology and Harvard Medical School Boston Children's Hospital Boston MA
| | - Ling Shi
- New England Research Institutes Watertown MA
| | | | - Daphne T Hsu
- Albert Einstein College of Medicine and Children's Hospital at Montefiore Bronx NY
| | - Steven A Webber
- Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville TN
| | - Debra A Dodd
- Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville TN
| | | | - Paul F Kantor
- Keck School of Medicine and Children's Hospital Los Angeles University of Southern California Los Angeles CA
| | | | | | | | - Elfriede Pahl
- Ann and Robert H. Lurie Children's Hospital Chicago IL
| | - Paolo Rusconi
- University of Miami Miller School of Medicine Miami FL
| | | | - Teresa Lee
- Columbia University Medical Center New York NY
| | | | | | - Surbhi Bhatnagar
- University of Cincinnati School of Medicine and Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Bruce Aronow
- University of Cincinnati School of Medicine and Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Phillip J Dexheimer
- University of Cincinnati School of Medicine and Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Lisa J Martin
- University of Cincinnati School of Medicine and Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Erin M Miller
- University of Cincinnati School of Medicine and Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Lynn A Sleeper
- Department of Cardiology and Harvard Medical School Boston Children's Hospital Boston MA
| | - Hiedy Razoky
- Wayne State University School of Medicine Detroit MI
| | - Jason Czachor
- Wayne State University School of Medicine Detroit MI
| | - Steven E Lipshultz
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo NY.,John R. Oishei Children's Hospital Buffalo NY
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Ferreira CR, Blau N. Clinical and biochemical footprints of inherited metabolic diseases. IV. Metabolic cardiovascular disease. Mol Genet Metab 2021; 132:112-118. [PMID: 33388235 PMCID: PMC7867625 DOI: 10.1016/j.ymgme.2020.12.290] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022]
Abstract
Inherited metabolic diseases account for 15-20% of all cases of pediatric cardiomyopathy, with a high mortality of 15-47%. Metabolic diseases can also commonly be associated with other types of cardiovascular involvement such as arrhythmias, valvulopathy or vasculopathy. We reviewed and updated the list of known metabolic etiologies associated with cardiovascular involvement, and found 246 relevant inborn errors of metabolism. This represents the fourth of a series of articles attempting to create and maintain a comprehensive list of clinical and metabolic differential diagnoses according to system involvement.
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Affiliation(s)
- Carlos R Ferreira
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Nenad Blau
- Division of Metabolism, University Children's Hospital, Zürich, Switzerland.
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Risi C, Schäfer LU, Belknap B, Pepper I, White HD, Schröder GF, Galkin VE. High-Resolution Cryo-EM Structure of the Cardiac Actomyosin Complex. Structure 2021; 29:50-60.e4. [PMID: 33065066 PMCID: PMC7796959 DOI: 10.1016/j.str.2020.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/29/2020] [Accepted: 09/25/2020] [Indexed: 12/31/2022]
Abstract
Heart contraction depends on a complicated array of interactions between sarcomeric proteins required to convert chemical energy into mechanical force. Cyclic interactions between actin and myosin molecules, controlled by troponin and tropomyosin, generate the sliding force between the actin-based thin and myosin-based thick filaments. Alterations in this sophisticated system due to missense mutations can lead to cardiovascular diseases. Numerous structural studies proposed pathological mechanisms of missense mutations at the myosin-myosin, actin-tropomyosin, and tropomyosin-troponin interfaces. However, despite the central role of actomyosin interactions a detailed structural description of the cardiac actomyosin interface remained unknown. Here, we report a cryo-EM structure of a cardiac actomyosin complex at 3.8 Å resolution. The structure reveals the molecular basis of cardiac diseases caused by missense mutations in myosin and actin proteins.
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Affiliation(s)
- Cristina Risi
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA 23507, USA
| | - Luisa U Schäfer
- Institute of Biological Information Processing (IBI-7), Forschungszentrum Jülich, 52425 Jülich, Germany
| | - Betty Belknap
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA 23507, USA
| | - Ian Pepper
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA 23507, USA
| | - Howard D White
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA 23507, USA
| | - Gunnar F Schröder
- Institute of Biological Information Processing (IBI-7), Forschungszentrum Jülich, 52425 Jülich, Germany; Physics Department, Heinrich-Heine Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - Vitold E Galkin
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
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Monda E, Rubino M, Lioncino M, Di Fraia F, Pacileo R, Verrillo F, Cirillo A, Caiazza M, Fusco A, Esposito A, Fimiani F, Palmiero G, Pacileo G, Calabrò P, Russo MG, Limongelli G. Hypertrophic Cardiomyopathy in Children: Pathophysiology, Diagnosis, and Treatment of Non-sarcomeric Causes. Front Pediatr 2021; 9:632293. [PMID: 33718303 PMCID: PMC7947260 DOI: 10.3389/fped.2021.632293] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a myocardial disease characterized by left ventricular hypertrophy not solely explained by abnormal loading conditions. Despite its rare prevalence in pediatric age, HCM carries a relevant risk of mortality and morbidity in both infants and children. Pediatric HCM is a large heterogeneous group of disorders. Other than mutations in sarcomeric genes, which represent the most important cause of HCM in adults, childhood HCM includes a high prevalence of non-sarcomeric causes, including inherited errors of metabolism (i.e., glycogen storage diseases, lysosomal storage diseases, and fatty acid oxidation disorders), malformation syndromes, neuromuscular diseases, and mitochondrial disease, which globally represent up to 35% of children with HCM. The age of presentation and the underlying etiology significantly impact the prognosis of children with HCM. Moreover, in recent years, different targeted approaches for non-sarcomeric etiologies of HCM have emerged. Therefore, the etiological diagnosis is a fundamental step in designing specific management and therapy in these subjects. The present review aims to provide an overview of the non-sarcomeric causes of HCM in children, focusing on the pathophysiology, clinical features, diagnosis, and treatment of these rare disorders.
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Affiliation(s)
- Emanuele Monda
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marta Rubino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Michele Lioncino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Di Fraia
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberta Pacileo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Verrillo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annapaola Cirillo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Adelaide Fusco
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Augusto Esposito
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabio Fimiani
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Palmiero
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Pacileo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Giovanna Russo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London, United Kingdom
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Abstract
Paediatric cardiomyopathy is a progressive and often lethal disorder and the most common cause of heart failure in children. Despite their severe outcomes, their genetic etiology is still poorly characterised. The current study aimed at uncovering the genetic background of idiopathic primary hypertrophic cardiomyopathy in a cohort of Egyptian children using targeted next-generation sequencing. The study included 24 patients (15 males and 9 females) presented to the cardiomyopathy clinic of Cairo University Children's Hospital with a median age of 2.75 (0.5-14) years. Consanguinity was positive in 62.5% of patients. A family history of hypertrophic cardiomyopathy was present in 20.8% of patients. Ten rare variants were detected in eight patients; two pathogenic variants (8.3%) in MBPC3 and MYH7, and eight variants of uncertain significance in MYBPC3, TTN, VCL, MYL2, CSRP3, and RBM20.Here, we report on the first national study in Egypt that analysed sarcomeric and non-sarcomeric variants in a cohort of idiopathic paediatric hypertrophic cardiomyopathy patients using next-generation sequencing. The current pilot study suggests that paediatric hypertrophic cardiomyopathy in Egypt might have a particular genetic background, especially with the high burden of consanguinity. Including the genetic testing in the routine diagnostic service is important for a better understanding of the pathophysiology of the disease, proper patient management, and at-risk detection. Genome-wide tests (whole exome/genome sequencing) might be better than the targeted sequencing approach to test primary hypertrophic cardiomyopathy patients in addition to its ability for the identification of novel genetic causes.
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Abstract
PURPOSE OF REVIEW Cardiomyopathies are rare in the pediatric population, but significantly impact on morbidity and mortality. The present review aims to provide an overview of cardiomyopathies in children and some practical guidelines for their prognostic stratification and management. RECENT FINDINGS Pediatric cardiomyopathies may present as isolated cardiac muscle disease or in the context of complex clinical syndromes. The etiologic characterization represents an important step in the diagnosis and treatment of cardiomyopathies because of its impact on prognosis and on therapeutic measures. Indeed, replacement therapy is nowadays widely available and changes the natural history of the disease. More complex is the management of isolated cardiomyopathies, which lack specific therapies, mainly aimed at symptomatic relief. In this context, heart transplantation shows excellent outcomes in children, but wait-list mortality is still very high. Device therapy for sudden cardiac death prevention and the use of mechanical assist devices are becoming more common in the clinical practice and may help to reduce mortality. SUMMARY Providing insight into pediatric cardiomyopathies classification helps in the prognostication and management of such diseases. Recent years witnessed a significant improvement in mortality, but future research is still needed to improve quality of life and life expectations in the pediatric population.
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Abstract
PURPOSE OF REVIEW The goal of this paper is to provide an overview of contemporary knowledge specific to the causes, management, and outcome of heart failure in children. RECENT FINDINGS While recently there have been subtle improvements in heart failure outcomes in children, these improvements lag significantly behind that of adults. There is a growing body of literature suggesting that pediatric heart failure is a unique disease process with age- and disease-specific myocardial adaptations. In addition, the heterogenous etiologies of heart failure in children contribute to differential response to therapies and challenge the ability to obtain meaningful results from prospective clinical trials. Consideration of novel clinical trial designs with achievable but clinically relevant endpoints and focused study of the mechanisms underlying pediatric heart failure secondary to cardiomyopathies and structural heart disease are essential if we hope to advance care and identify targeted and effective therapies.
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Affiliation(s)
| | - Anastacia M Garcia
- Division of Cardiology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Roni M Jacobsen
- Division of Cardiology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Shelley D Miyamoto
- Division of Cardiology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.
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Al-Hassnan ZN, Almesned A, Tulbah S, Alakhfash A, Alhadeq F, Alruwaili N, Alkorashy M, Alhashem A, Alrashdan A, Faqeih E, Alkhalifi SM, Al Humaidi Z, Sogaty S, Azhari N, Bakhaider AM, Al Asmari A, Awaji A, Albash B, Alhabdan M, Alghamdi MA, Alshuaibi W, Al-Hassnan RZ, Alshenqiti A, Alqahtani A, Shinwari Z, Rbabeh M, Takroni S, Alomrani A, Albert Brotons DC, AlQwaee AM, Almanea W, Alfadley FA, Alfayyadh M, Alwadai A. Categorized Genetic Analysis in Childhood-Onset Cardiomyopathy. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 13:504-514. [PMID: 32870709 DOI: 10.1161/circgen.120.002969] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Childhood-onset cardiomyopathy is a heterogeneous group of conditions the cause of which is largely unknown. The influence of consanguinity on the genetics of cardiomyopathy has not been addressed at a large scale. METHODS To unravel the genetic cause of childhood-onset cardiomyopathy in a consanguineous population, a categorized approach was adopted. Cases with childhood-onset cardiomyopathy were consecutively recruited. Based on the likelihood of founder mutation and on the clinical diagnosis, genetic test was categorized to either (1) targeted genetic test with targeted mutation test, single-gene test, or multigene panel for Noonan syndrome, or (2) untargeted genetic test with whole-exome sequencing or whole-genome sequencing. Several bioinformatics tools were used to filter the variants. RESULTS Two-hundred five unrelated probands with various forms of cardiomyopathy were evaluated. The median age of presentation was 10 months. In 30.2% (n=62), targeted genetic test had a yield of 82.7% compared with 33.6% for whole-exome sequencing/whole-genome sequencing (n=143) giving an overall yield of 53.7%. Strikingly, 96.4% of the variants were homozygous, 9% of which were found in 4 dominant genes. Homozygous variants were also detected in 7 novel candidates (ACACB, AASDH, CASZ1, FLII, RHBDF1, RPL3L, ULK1). CONCLUSIONS Our work demonstrates the impact of consanguinity on the genetics of childhood-onset cardiomyopathy, the value of adopting a categorized population-sensitive genetic approach, and the opportunity of uncovering novel genes. Our data suggest that if a founder mutation is not suspected, adopting whole-exome sequencing/whole-genome sequencing as a first-line test should be considered.
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Affiliation(s)
- Zuhair N Al-Hassnan
- Cardiovascular Genetics Program (Z.N.A.-H., S. Tulbah, F.A., N. Alruwaili, M. Alkorashy, A. Alqahtani, Z.S., M.R., S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh.,Department of Medical Genetics (Z.N.A.-H., S. Tulbah, A. Alqahtani, S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Z.N.A.-H., A. Alhashem)
| | | | - Sahar Tulbah
- Cardiovascular Genetics Program (Z.N.A.-H., S. Tulbah, F.A., N. Alruwaili, M. Alkorashy, A. Alqahtani, Z.S., M.R., S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh.,Department of Medical Genetics (Z.N.A.-H., S. Tulbah, A. Alqahtani, S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh
| | - Ali Alakhfash
- Prince Sultan Cardiac Centre, Qassim (A. Almesned, A. Alakhfash, A.M.A.)
| | - Faten Alhadeq
- Cardiovascular Genetics Program (Z.N.A.-H., S. Tulbah, F.A., N. Alruwaili, M. Alkorashy, A. Alqahtani, Z.S., M.R., S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh.,Department of Genetics (Z.N.A.-H., F.A., M. Alkorashy), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh
| | - Nadiah Alruwaili
- Cardiovascular Genetics Program (Z.N.A.-H., S. Tulbah, F.A., N. Alruwaili, M. Alkorashy, A. Alqahtani, Z.S., M.R., S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh.,Heart Center (N. Alruwaili, M. Alhabdan, M.R., D.C.A.B., F.A.A., M. Alfayyadh), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh
| | - Maarab Alkorashy
- Cardiovascular Genetics Program (Z.N.A.-H., S. Tulbah, F.A., N. Alruwaili, M. Alkorashy, A. Alqahtani, Z.S., M.R., S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh.,Heart Center (N. Alruwaili, M. Alhabdan, M.R., D.C.A.B., F.A.A., M. Alfayyadh), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh.,Department of Genetics (Z.N.A.-H., F.A., M. Alkorashy), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh
| | - Amal Alhashem
- Division of Medical Genetics, Department of Pediatrics, Prince Sultan Medical Military City, Riyadh (A. Alhashem).,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Z.N.A.-H., A. Alhashem)
| | - Ahmad Alrashdan
- Department of Pediatrics, King Salman Specialist Hospital, Hail (A. Alrashdan)
| | - Eissa Faqeih
- Medical Genetics, King Fahad Medical City, Children's Specialist Hospital, Riyadh (E.F., A.A.a.)
| | - Salwa M Alkhalifi
- Pediatrics Department, Maternity & Children's Hospital, Dammam (S.M.A., Z.A.h.)
| | - Zainab Al Humaidi
- Department of Genetics (Z.N.A.-H., F.A., M. Alkorashy), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh.,Pediatrics Department, Maternity & Children's Hospital, Dammam (S.M.A., Z.A.h.)
| | | | | | - Abdulrahman M Bakhaider
- Prince Sultan Cardiac Centre, Qassim (A. Almesned, A. Alakhfash, A.M.A.).,Jeddah East Hospital, Jeddah (A.M.B.)
| | - Ali Al Asmari
- Medical Genetics, King Fahad Medical City, Children's Specialist Hospital, Riyadh (E.F., A.A.a.)
| | - Ali Awaji
- King Fahad Central Hospital, Jazan, Saudi Arabia (A. Awaji)
| | | | | | - Malak A Alghamdi
- Medical Generics Division, Department of Pediatrics, College of Medicine, King Saudi University Hospital (M.A.A., W. Alshuaibi)
| | - Walaa Alshuaibi
- Medical Generics Division, Department of Pediatrics, College of Medicine, King Saudi University Hospital (M.A.A., W. Alshuaibi)
| | - Raghad Z Al-Hassnan
- College of Computer & Information Sciences, King Saud University (R.Z.A.-H.)
| | | | - Aisha Alqahtani
- Cardiovascular Genetics Program (Z.N.A.-H., S. Tulbah, F.A., N. Alruwaili, M. Alkorashy, A. Alqahtani, Z.S., M.R., S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh.,Department of Medical Genetics (Z.N.A.-H., S. Tulbah, A. Alqahtani, S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh
| | - Zarghuna Shinwari
- Cardiovascular Genetics Program (Z.N.A.-H., S. Tulbah, F.A., N. Alruwaili, M. Alkorashy, A. Alqahtani, Z.S., M.R., S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh
| | - Monther Rbabeh
- Cardiovascular Genetics Program (Z.N.A.-H., S. Tulbah, F.A., N. Alruwaili, M. Alkorashy, A. Alqahtani, Z.S., M.R., S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh.,Heart Center (N. Alruwaili, M. Alhabdan, M.R., D.C.A.B., F.A.A., M. Alfayyadh), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh
| | - Saud Takroni
- Cardiovascular Genetics Program (Z.N.A.-H., S. Tulbah, F.A., N. Alruwaili, M. Alkorashy, A. Alqahtani, Z.S., M.R., S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh.,Department of Medical Genetics (Z.N.A.-H., S. Tulbah, A. Alqahtani, S. Takroni), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh
| | | | - Dimpna C Albert Brotons
- Heart Center (N. Alruwaili, M. Alhabdan, M.R., D.C.A.B., F.A.A., M. Alfayyadh), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh
| | | | - Waleed Almanea
- Pediatric Cardiology, Security Forces Hospital (W. Almanea)
| | - Fadel A Alfadley
- Heart Center (N. Alruwaili, M. Alhabdan, M.R., D.C.A.B., F.A.A., M. Alfayyadh), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh
| | - Majid Alfayyadh
- Heart Center (N. Alruwaili, M. Alhabdan, M.R., D.C.A.B., F.A.A., M. Alfayyadh), King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh
| | - Abdullah Alwadai
- Heart Failure & Transplant Program, Prince Sultan Cardiac Center (A. Alwadai)
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Herkert JC, Verhagen JM, Yotti R, Haghighi A, Phelan DG, James PA, Brown NJ, Stutterd C, Macciocca I, Leong K, Bulthuis ML, van Bever Y, van Slegtenhorst MA, Boven LG, Roberts AE, Agarwal R, Seidman J, Lakdawala NK, Fernández-Avilés F, Burke MA, Pierpont ME, Braunlin E, Ḉağlayan AO, Barge-Schaapveld DQ, Birnie E, van Osch-Gevers L, van Langen IM, Jongbloed JD, Lockhart PJ, Amor DJ, Seidman CE, van de Laar IM. Expanding the clinical and genetic spectrum of ALPK3 variants: Phenotypes identified in pediatric cardiomyopathy patients and adults with heterozygous variants. Am Heart J 2020; 225:108-119. [PMID: 32480058 DOI: 10.1016/j.ahj.2020.03.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 03/14/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Biallelic damaging variants in ALPK3, encoding alpha-protein kinase 3, cause pediatric-onset cardiomyopathy with manifestations that are incompletely defined. METHODS AND RESULTS We analyzed clinical manifestations of damaging biallelic ALPK3 variants in 19 pediatric patients, including nine previously published cases. Among these, 11 loss-of-function (LoF) variants, seven compound LoF and deleterious missense variants, and one homozygous deleterious missense variant were identified. Among 18 live-born patients, 8 exhibited neonatal dilated cardiomyopathy (44.4%; 95% CI: 21.5%-69.2%) that subsequently transitioned into ventricular hypertrophy. The majority of patients had extracardiac phenotypes, including contractures, scoliosis, cleft palate, and facial dysmorphisms. We observed no association between variant type or location, disease severity, and/or extracardiac manifestations. Myocardial histopathology showed focal cardiomyocyte hypertrophy, subendocardial fibroelastosis in patients under 4 years of age, and myofibrillar disarray in adults. Rare heterozygous ALPK3 variants were also assessed in adult-onset cardiomyopathy patients. Among 1548 Dutch patients referred for initial genetic analyses, we identified 39 individuals with rare heterozygous ALPK3 variants (2.5%; 95% CI: 1.8%-3.4%), including 26 missense and 10 LoF variants. Among 149 U.S. patients without pathogenic variants in 83 cardiomyopathy-related genes, we identified six missense and nine LoF ALPK3 variants (10.1%; 95% CI: 5.7%-16.1%). LoF ALPK3 variants were increased in comparison to matched controls (Dutch cohort, P = 1.6×10-5; U.S. cohort, P = 2.2×10-13). CONCLUSION Biallelic damaging ALPK3 variants cause pediatric cardiomyopathy manifested by DCM transitioning to hypertrophy, often with poor contractile function. Additional extracardiac features occur in most patients, including musculoskeletal abnormalities and cleft palate. Heterozygous LoF ALPK3 variants are enriched in adults with cardiomyopathy and may contribute to their cardiomyopathy. Adults with ALPK3 LoF variants therefore warrant evaluations for cardiomyopathy.
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Bi-allelic missense disease-causing variants in RPL3L associate neonatal dilated cardiomyopathy with muscle-specific ribosome biogenesis. Hum Genet 2020; 139:1443-1454. [PMID: 32514796 PMCID: PMC7519902 DOI: 10.1007/s00439-020-02188-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/27/2020] [Indexed: 12/16/2022]
Abstract
Dilated cardiomyopathy (DCM) belongs to the most frequent forms of cardiomyopathy mainly characterized by cardiac dilatation and reduced systolic function. Although most cases of DCM are classified as sporadic, 20–30% of cases show a heritable pattern. Familial forms of DCM are genetically heterogeneous, and mutations in several genes have been identified that most commonly play a role in cytoskeleton and sarcomere-associated processes. Still, a large number of familial cases remain unsolved. Here, we report five individuals from three independent families who presented with severe dilated cardiomyopathy during the neonatal period. Using whole-exome sequencing (WES), we identified causative, compound heterozygous missense variants in RPL3L (ribosomal protein L3-like) in all the affected individuals. The identified variants co-segregated with the disease in each of the three families and were absent or very rare in the human population, in line with an autosomal recessive inheritance pattern. They are located within the conserved RPL3 domain of the protein and were classified as deleterious by several in silico prediction software applications. RPL3L is one of the four non-canonical riboprotein genes and it encodes the 60S ribosomal protein L3-like protein that is highly expressed only in cardiac and skeletal muscle. Three-dimensional homology modeling and in silico analysis of the affected residues in RPL3L indicate that the identified changes specifically alter the interaction of RPL3L with the RNA components of the 60S ribosomal subunit and thus destabilize its binding to the 60S subunit. In conclusion, we report that bi-allelic pathogenic variants in RPL3L are causative of an early-onset, severe neonatal form of dilated cardiomyopathy, and we show for the first time that cytoplasmic ribosomal proteins are involved in the pathogenesis of non-syndromic cardiomyopathies.
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Quiat D, Witkowski L, Zouk H, Daly KP, Roberts AE. Retrospective Analysis of Clinical Genetic Testing in Pediatric Primary Dilated Cardiomyopathy: Testing Outcomes and the Effects of Variant Reclassification. J Am Heart Assoc 2020; 9:e016195. [PMID: 32458740 PMCID: PMC7428992 DOI: 10.1161/jaha.120.016195] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/27/2020] [Indexed: 12/13/2022]
Abstract
Background Genetic testing in pediatric primary dilated cardiomyopathy (DCM) patients has identified numerous disease-causing variants, but few studies have evaluated genetic testing outcomes in this population in the context of patient and familial clinical data or assessed the clinical implications of temporal changes in genetic testing results. Methods and Results We performed a retrospective analysis of all patients with primary DCM who presented to our institution between 2008 and 2018. Variants identified by genetic testing were reevaluated for pathogenicity on the basis of current guidelines for variant classification. A total of 73 patients with primary DCM presented to our institution and 63 (86%) were probands that underwent cardiomyopathy-specific gene testing. A disease-causing variant was identified in 19 of 63 (30%) of cases, with at least 9/19 (47%) variants occurring de novo. Positive family history was not associated with identification of a causal variant. Reclassification of variants resulted in the downgrading of a large proportion of variants of uncertain significance and did not identify any new disease-causing variants. Conclusions Clinical genetic testing identifies a causal variant in one third of pediatric patients with primary DCM. Variant reevaluation significantly decreased the number of variants of uncertain significance, but a large burden of variants of uncertain significance remain. These results highlight the need for periodic reanalysis of genetic testing results, additional investigation of genotype-phenotype correlations in DCM through large, multicenter genetic studies, and development of improved tools for functional characterization of variants of uncertain significance.
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Affiliation(s)
- Daniel Quiat
- Department of CardiologyBoston Children’s HospitalBostonMA
- Harvard Medical SchoolBostonMA
| | - Leora Witkowski
- Laboratory for Molecular MedicinePartner’s HealthcareCambridgeMA
- Harvard Medical SchoolBostonMA
| | - Hana Zouk
- Laboratory for Molecular MedicinePartner’s HealthcareCambridgeMA
- Harvard Medical SchoolBostonMA
| | | | - Amy E. Roberts
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsDivision of GeneticsBoston Children’s HospitalBostonMA
- Harvard Medical SchoolBostonMA
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Parrott A, Khoury PR, Shikany AR, Lorts A, Villa CR, Miller EM. Investigation of de novo variation in pediatric cardiomyopathy. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:116-123. [PMID: 31912959 DOI: 10.1002/ajmg.c.31764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 12/20/2022]
Abstract
Pediatric cardiomyopathies can be caused by variants in genes encoding the sarcomere and cytoskeleton in cardiomyocytes. Variants are typically inherited in an autosomal dominant manner with variable expressivity. De novo variants have been reported, however their overall frequency is largely unknown. We sought to determine the rate of de novo, pathogenic and likely pathogenic (P/LP) variants in children with a diagnosis of hypertrophic, dilated, or restrictive cardiomyopathy (HCM, DCM, or RCM), and to compare disease outcomes between individuals with and without a de novo variant. A retrospective record review identified 126 individuals with HCM (55%), DCM (37%), or RCM (8%) ≤18 years of age who had genetic testing. Overall, 50 (40%) had positive genetic testing and 18% of P/LP variants occurred de novo. The rate of de novo variation in those with RCM (80%) was higher than in those with HCM (9%) or DCM (20%). There was evidence of germline mosaicism in one family with RCM. Individuals with de novo variants were more likely than those without to have a history of arrhythmia (p = .049), sudden cardiac arrest (p = .024), hospitalization (p = .041), and cardiac transplantation (p = .030). The likelihood of de novo variation and impact on family risk and screening should be integrated into genetic counseling.
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Affiliation(s)
- Ashley Parrott
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Philip R Khoury
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Amy R Shikany
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Angela Lorts
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Chet R Villa
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erin M Miller
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Rojnueangnit K, Sirichongkolthong B, Wongwandee R, Khetkham T, Noojarern S, Khongkraparn A, Wattanasirichaigoon D. Identification of Gene Mutations in Primary Pediatric Cardiomyopathy by Whole Exome Sequencing. Pediatr Cardiol 2020; 41:165-174. [PMID: 31712860 DOI: 10.1007/s00246-019-02240-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
Pediatric primary cardiomyopathy is rare but serious, having high mortality; hypertrophic and dilated types are the most common. Its etiology has been mainly considered idiopathic; however, next generation sequencing techniques have revealed nearly half of idiopathic pediatric cases arose from specific genetic mutations. Therefore, our study aimed to identify the genetic causes of primary idiopathic cardiomyopathy. Newborns to 15-year old patients with this condition were recruited between March 2016 and May 2017 at Thammasat University Hospital. Complete patient history and physical examination data were collected by a geneticist with cardiac examinations and echocardiograms by pediatric cardiologists. Whole exome sequencing was performed for all. Of the 12 patients enrolled, 5 cases were dilated type and 7 hypertrophic. Two with dilated type were excluded during follow-up as cause was determined (hypocalcemia and pacemaker induced). A list of 118 genes for cardiomyopathy was analyzed in the remaining 10 cases. Pathogenic and likely pathogenic mutations were identified in 5 patients: HRAS, PTPN11, SOS1, FLNC and TXNRD2; half our patients were not actually idiopathic. Despite its high cost, genetic testing is useful for determining familial risk as well as predicting patient cardiomyopathy progress.
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Affiliation(s)
- Kitiwan Rojnueangnit
- Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
| | | | - Ratthapon Wongwandee
- Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Thanitchet Khetkham
- Divison of Forensic Medicine, Thammasat University Hospital, Pathumthani, Thailand
| | - Saisuda Noojarern
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Arthaporn Khongkraparn
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Duangrurdee Wattanasirichaigoon
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Vera CD, Johnson CA, Walklate J, Adhikari A, Svicevic M, Mijailovich SM, Combs AC, Langer SJ, Ruppel KM, Spudich JA, Geeves MA, Leinwand LA. Myosin motor domains carrying mutations implicated in early or late onset hypertrophic cardiomyopathy have similar properties. J Biol Chem 2019; 294:17451-17462. [PMID: 31582565 DOI: 10.1074/jbc.ra119.010563] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/18/2019] [Indexed: 02/01/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a common genetic disorder characterized by left ventricular hypertrophy and cardiac hyper-contractility. Mutations in the β-cardiac myosin heavy chain gene (β-MyHC) are a major cause of HCM, but the specific mechanistic changes to myosin function that lead to this disease remain incompletely understood. Predicting the severity of any β-MyHC mutation is hindered by a lack of detailed examinations at the molecular level. Moreover, because HCM can take ≥20 years to develop, the severity of the mutations must be somewhat subtle. We hypothesized that mutations that result in early onset disease would have more severe changes in function than do later onset mutations. Here, we performed steady-state and transient kinetic analyses of myosins carrying one of seven missense mutations in the motor domain. Of these seven, four were previously identified in early onset cardiomyopathy screens. We used the parameters derived from these analyses to model the ATP-driven cross-bridge cycle. Contrary to our hypothesis, the results indicated no clear differences between early and late onset HCM mutations. Despite the lack of distinction between early and late onset HCM, the predicted occupancy of the force-holding actin·myosin·ADP complex at [Actin] = 3 K app along with the closely related duty ratio (the fraction of myosin in strongly attached force-holding states), and the measured ATPases all changed in parallel (in both sign and degree of change) compared with wildtype (WT) values. Six of the seven HCM mutations were clearly distinct from a set of previously characterized DCM mutations.
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Affiliation(s)
- Carlos D Vera
- BioFrontiers Institute and Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, Colorado 80309
| | - Chloe A Johnson
- School of Biosciences, University of Kent, Canterbury CT2 7NJ, United Kingdom
| | - Jonathan Walklate
- School of Biosciences, University of Kent, Canterbury CT2 7NJ, United Kingdom
| | - Arjun Adhikari
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California 94305
| | | | | | - Ariana C Combs
- BioFrontiers Institute and Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, Colorado 80309
| | - Stephen J Langer
- BioFrontiers Institute and Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, Colorado 80309
| | - Kathleen M Ruppel
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California 94305
| | - James A Spudich
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California 94305
| | - Michael A Geeves
- School of Biosciences, University of Kent, Canterbury CT2 7NJ, United Kingdom
| | - Leslie A Leinwand
- BioFrontiers Institute and Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, Colorado 80309
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45
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Clinical utility of exome sequencing in infantile heart failure. Genet Med 2019; 22:423-426. [PMID: 31527676 DOI: 10.1038/s41436-019-0654-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/30/2019] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Pediatric cardiomyopathy is rare, has a broad differential diagnosis, results in high morbidity and mortality, and has suboptimal diagnostic yield using next-generation sequencing panels. Exome sequencing has reported diagnostic yields ranging from 30% to 57% for neonates in intensive care units. We aimed to characterize the clinical utility of exome sequencing in infantile heart failure. METHODS Infants diagnosed with acute heart failure prior to 1 year old over a period of 34 months at a large tertiary children's hospital were recruited. Demographic and diagnostic information was obtained from medical records. Fifteen eligible patients were enrolled. RESULTS Dilated cardiomyopathy was the predominant cardiac diagnosis, seen in 60% of patients. A molecular diagnosis was identified in 66.7% of patients (10/15). Of those diagnoses, 70% would not have been detected using multigene next-generation sequencing panels focused on cardiomyopathy or arrhythmia disease genes. Genetic testing changed medical decision-making in 53% of all cases and 80% of positive cases, and was especially beneficial when testing was expedited. CONCLUSION Given the broad differential diagnosis and critical status of infants with heart failure, rapid exome sequencing provides timely diagnoses, changes medical management, and should be the first-tier molecular test.
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Baban A, Olivini N, Lepri FR, Calì F, Mucciolo M, Digilio MC, Calcagni G, di Mambro C, Dallapiccola B, Adorisio R, Novelli A, Drago F. SOS1 mutations in Noonan syndrome: Cardiomyopathies and not only congenital heart defects! Report of six patients including two novel variants and literature review. Am J Med Genet A 2019; 179:2083-2090. [PMID: 31368652 DOI: 10.1002/ajmg.a.61312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/27/2019] [Accepted: 07/16/2019] [Indexed: 12/17/2022]
Abstract
Noonan syndrome (NS) is caused by mutations in more than 10 genes, mainly PTPN11, SOS1, RAF1, and RIT1. Congenital heart defects and cardiomyopathy (CMP) are associated with significant morbidity and mortality in NS. Although hypertrophic CMP has "classically" been reported in association to RAF1, RIT1, and PTPN11 variants, SOS1 appears to be poorly related to CMP. Patients with NS attending our Center from January 2013 to June 2018 were eligible for inclusion if they carried SOS1 variants and presented with-or developed-CMP. Literature review describing the co-existence of SOS1 mutation and CMP was also performed. We identified six patients with SOS1 variants and CMP (male to female ratio 2:1) including two novel variants. CMP spectrum encompassed: (a) dilated CMP, (b) nonobstructive hypertrophic CMPs, and (c) obstructive hypertrophic CMPs. Survival is 100%. Literature review included 16 SOS1 mutated in CMP. CMP, mainly hypertrophic, has been often reported in association to RAF1, RIT1, and PTPN11 variants. Differently from previous reports, due to the frequent association of SOS1 variants and CMP in our single center experience, we suggest potential underestimated proportion of SOS1 in pediatric CMPs.
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Affiliation(s)
- Anwar Baban
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Nicole Olivini
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Francesca Romana Lepri
- Medical Genetics Laboratory, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Federica Calì
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Mafalda Mucciolo
- Medical Genetics Laboratory, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Maria C Digilio
- Medical Genetics Laboratory, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Giulio Calcagni
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Corrado di Mambro
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Bruno Dallapiccola
- Scientific Directorate, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Rachele Adorisio
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Antonio Novelli
- Medical Genetics Laboratory, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
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Lipshultz SE, Law YM, Asante-Korang A, Austin ED, Dipchand AI, Everitt MD, Hsu DT, Lin KY, Price JF, Wilkinson JD, Colan SD. Cardiomyopathy in Children: Classification and Diagnosis: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e9-e68. [PMID: 31132865 DOI: 10.1161/cir.0000000000000682] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this scientific statement from the American Heart Association, experts in the field of cardiomyopathy (heart muscle disease) in children address 2 issues: the most current understanding of the causes of cardiomyopathy in children and the optimal approaches to diagnosis cardiomyopathy in children. Cardiomyopathies result in some of the worst pediatric cardiology outcomes; nearly 40% of children who present with symptomatic cardiomyopathy undergo a heart transplantation or die within the first 2 years after diagnosis. The percentage of children with cardiomyopathy who underwent a heart transplantation has not declined over the past 10 years, and cardiomyopathy remains the leading cause of transplantation for children >1 year of age. Studies from the National Heart, Lung, and Blood Institute-funded Pediatric Cardiomyopathy Registry have shown that causes are established in very few children with cardiomyopathy, yet genetic causes are likely to be present in most. The incidence of pediatric cardiomyopathy is ≈1 per 100 000 children. This is comparable to the incidence of such childhood cancers as lymphoma, Wilms tumor, and neuroblastoma. However, the published research and scientific conferences focused on pediatric cardiomyopathy are sparcer than for those cancers. The aim of the statement is to focus on the diagnosis and classification of cardiomyopathy. We anticipate that this report will help shape the future research priorities in this set of diseases to achieve earlier diagnosis, improved clinical outcomes, and better quality of life for these children and their families.
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48
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Al Senaidi K, Joshi N, Al-Nabhani M, Al-Kasbi G, Al Farqani A, Al-Thihli K, Al-Maawali A. Phenotypic spectrum of ALPK3-related cardiomyopathy. Am J Med Genet A 2019; 179:1235-1240. [PMID: 31074094 DOI: 10.1002/ajmg.a.61176] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/08/2019] [Accepted: 04/15/2019] [Indexed: 12/17/2022]
Abstract
Cardiomyopathies are clinically heterogeneous disorders and are the leading cause of cardiovascular morbidity and mortality. Different etiologies have a significant impact on prognosis. Recently, novel biallelic loss-of-function pathogenic variants in alpha-kinase 3 (ALPK3) were implicated in causing early-onset pediatric cardiomyopathy (cardiomyopathy, familial hypertrophic 27; OMIM 618052). To date, eight patients, all presented during early childhood, were reported with biallelic ALPK3 pathogenic variants. We describe the molecular and clinical phenotype characterization of familial cardiomyopathy on one family with six affected individuals. We identified homozygosity for an ALPK3 deleterious sequence variant (NM_020778.4:c.639G>A:p.Trp213*) in all the affected individuals. They presented with either dilated cardiomyopathy that progressed to hypertrophic cardiomyopathy (HCM) or HCM with left ventricular noncompaction. The age of presentation in our cohort extends between infancy to the fourth decade. The phenotypic severity decreases with the progression of age.
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Affiliation(s)
- Khalfan Al Senaidi
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Niranjan Joshi
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Maryam Al-Nabhani
- Department of Genetics, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ghalia Al-Kasbi
- Department of Genetics, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Khalid Al-Thihli
- Department of Genetics, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.,Genetic and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Oman
| | - Almundher Al-Maawali
- Department of Genetics, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.,Genetic and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Oman
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50
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Vasilescu C, Ojala TH, Brilhante V, Ojanen S, Hinterding HM, Palin E, Alastalo TP, Koskenvuo J, Hiippala A, Jokinen E, Jahnukainen T, Lohi J, Pihkala J, Tyni TA, Carroll CJ, Suomalainen A. Genetic Basis of Severe Childhood-Onset Cardiomyopathies. J Am Coll Cardiol 2018; 72:2324-2338. [DOI: 10.1016/j.jacc.2018.08.2171] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/09/2018] [Accepted: 08/12/2018] [Indexed: 11/26/2022]
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