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Grebur K, Mester B, Fekete BA, Kiss AR, Gregor Z, Horváth M, Farkas-Sütő K, Csonka K, Bödör C, Merkely B, Vágó H, Szűcs A. Genetic, clinical and imaging implications of a noncompaction phenotype population with preserved ejection fraction. Front Cardiovasc Med 2024; 11:1337378. [PMID: 38380180 PMCID: PMC10876896 DOI: 10.3389/fcvm.2024.1337378] [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: 11/12/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction The genotype of symptomatic left ventricular noncompaction phenotype (LVNC) subjects with preserved left ventricular ejection fraction (LVEF) and its effect on clinical presentation are less well studied. We aimed to characterize the genetic, cardiac magnetic resonance (CMR) and clinical background, and genotype-phenotype relationship in LVNC with preserved LVEF. Methods We included 54 symptomatic LVNC individuals (LVEF: 65 ± 5%) whose samples were analyzed with a 174-gene next-generation sequencing panel and 54 control (C) subjects. The results were evaluated using the criteria of the American College of Medical Genetics and Genomics. Medical data suggesting a higher risk of cardiovascular complications were considered "red flags". Results Of the LVNC population, 24% carried pathogenic or likely pathogenic (P) mutations; 56% carried variants of uncertain significance (VUS); and 20% were free from cardiomyopathy-related mutations. Regarding the CMR parameters, the LVNC and C groups differed significantly, while the three genetic subgroups were comparable. We found a significant relationship between red flags and genotype; furthermore, the number of red flags in a single subject differed significantly among the genetic subgroups (p = 0.002) and correlated with the genotype (r = 0.457, p = 0.01). In 6 out of 7 LVNC subjects diagnosed in childhood, P or VUS mutations were found. Discussion The large number of P mutations and the association between red flags and genotype underline the importance of genetic-assisted risk stratification in symptomatic LVNC with preserved LVEF.
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Affiliation(s)
- Kinga Grebur
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Balázs Mester
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint András Fekete
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Anna Réka Kiss
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia Gregor
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Horváth
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Katalin Csonka
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Csaba Bödör
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Tsatsopoulou A, Protonotarios I, Xylouri Z, Papagiannis I, Anastasakis A, Germanakis I, Patrianakos A, Nyktari E, Gavras C, Papadopoulos G, Meditskou S, Lazarou E, Miliou A, Lazaros G. Cardiomyopathies in children: An overview. Hellenic J Cardiol 2023; 72:43-56. [PMID: 36870438 DOI: 10.1016/j.hjc.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/14/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Paediatric cardiomyopathies form a heterogeneous group of disorders characterized by structural and electrical abnormalities of the heart muscle, commonly due to a gene variant of the myocardial cell structure. Mostly inherited as a dominant or occasionally recessive trait, they might be part of a syndromic disorder of underlying metabolic or neuromuscular defects or combine early developing extracardiac abnormalities (i.e., Naxos disease). The annual incidence of 1 per 100,000 children appears higher during the first two years of life. Dilated and hypertrophic cardiomyopathy phenotypes share an incidence of 60% and 25%, respectively. Arrhythmogenic right ventricular cardiomyopathy (ARVC), restrictive cardiomyopathy, and left ventricular noncompaction are less commonly diagnosed. Adverse events such as severe heart failure, heart transplantation, or death usually appear early after the initial presentation. In ARVC patients, high-intensity aerobic exercise has been associated with worse clinical outcomes and increased penetrance in at-risk genotype-positive relatives. Acute myocarditis in children has an incidence of 1.4-2.1 cases/per 100,000 children per year, with a 6-14% mortality rate during the acute phase. A genetic defect is considered responsible for the progression to dilated cardiomyopathy phenotype. Similarly, a dilated or arrhythmogenic cardiomyopathy phenotype might emerge with an episode of acute myocarditis in childhood or adolescence. This review provides an overview of childhood cardiomyopathies focusing on clinical presentation, outcome, and pathology.
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Affiliation(s)
- Adalena Tsatsopoulou
- General Paediatrics and Clinical Research, Private Clinic, Naxos, Greece; Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Athens, Greece; Laboratory of Histology and Embryology, Department of Medicine, School of Life Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Protonotarios
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - Zafeirenia Xylouri
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - Ioannis Papagiannis
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Ioannis Germanakis
- Department of Paediatrics, University Hospital Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | | | | | | | | | - Soultana Meditskou
- Laboratory of Histology and Embryology, Department of Medicine, School of Life Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emilia Lazarou
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Antigoni Miliou
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - George Lazaros
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece.
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Meshkov AN, Myasnikov RP, Kiseleva AV, Kulikova OV, Sotnikova EA, Kudryavtseva MM, Zharikova AA, Koretskiy SN, Mershina EA, Ramensky VE, Zaicenoka M, Vyatkin YV, Kharlap MS, Nikityuk TG, Sinitsyn VE, Divashuk MG, Kutsenko VA, Basargina EN, Barskiy VI, Sdvigova NA, Skirko OP, Efimova IA, Pokrovskaya MS, Drapkina OM. Genetic landscape in Russian patients with familial left ventricular noncompaction. Front Cardiovasc Med 2023; 10:1205787. [PMID: 37342443 PMCID: PMC10278580 DOI: 10.3389/fcvm.2023.1205787] [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: 04/14/2023] [Accepted: 05/09/2023] [Indexed: 06/22/2023] Open
Abstract
Background Left ventricular noncompaction (LVNC) cardiomyopathy is a disorder that can be complicated by heart failure, arrhythmias, thromboembolism, and sudden cardiac death. The aim of this study is to clarify the genetic landscape of LVNC in a large cohort of well-phenotyped Russian patients with LVNC, including 48 families (n=214). Methods All index patients underwent clinical examination and genetic analysis, as well as family members who agreed to participate in the clinical study and/or in the genetic testing. The genetic testing included next generation sequencing and genetic classification according to ACMG guidelines. Results A total of 55 alleles of 54 pathogenic and likely pathogenic variants in 24 genes were identified, with the largest number in the MYH7 and TTN genes. A significant proportion of variants -8 of 54 (14.8%) -have not been described earlier in other populations and may be specific to LVNC patients in Russia. In LVNC patients, the presence of each subsequent variant is associated with increased odds of having more severe LVNC subtypes than isolated LVNC with preserved ejection fraction. The corresponding odds ratio is 2.77 (1.37 -7.37; p <0.001) per variant after adjustment for sex, age, and family. Conclusion Overall, the genetic analysis of LVNC patients, accompanied by cardiomyopathy-related family history analysis, resulted in a high diagnostic yield of 89.6%. These results suggest that genetic screening should be applied to the diagnosis and prognosis of LVNC patients.
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Affiliation(s)
- Alexey N. Meshkov
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- National Medical Research Center for Cardiology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Hereditary Metabolic Diseases Laboratory, Research Centre for Medical Genetics, Moscow, Russia
- Department of General and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Roman P. Myasnikov
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Anna V. Kiseleva
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Olga V. Kulikova
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Evgeniia A. Sotnikova
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Maria M. Kudryavtseva
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Anastasia A. Zharikova
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, Moscow, Russia
| | - Sergey N. Koretskiy
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Elena A. Mershina
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - Vasily E. Ramensky
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, Moscow, Russia
| | - Marija Zaicenoka
- Phystech School of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
| | - Yuri V. Vyatkin
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk, Russia
| | - Maria S. Kharlap
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Tatiana G. Nikityuk
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Valentin E. Sinitsyn
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - Mikhail G. Divashuk
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Laboratory of Applied Genomics and Crop Breeding, All-Russia Research Institute of Agricultural Biotechnology, Moscow, Russia
| | - Vladimir A. Kutsenko
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, Moscow, Russia
| | | | | | | | - Olga P. Skirko
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Irina A. Efimova
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Maria S. Pokrovskaya
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Oxana M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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Kulikova OV, Myasnikov RP, Meshkov AN, Mershina EA, Kiseleva AV, Sotnikova EA, Kudryavtseva MM, Kharlap MS, Divashuk MG, Zharikova AA, Angarsky RK, Koretsky SN, Filatova DА, Sinitsyn VE, Drapkina OM. RBM20 nucleotide sequence variant in a family with a dilated phenotype of left ventricular non-compaction. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2022-3470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aim. To demonstrate two generations of a family with a progressive course of left ventricular non-compaction (LVNC) and the presence of a RBM20 gene variant.Material and methods. Based on the multicenter registry of patients with LVNC, a family with LVNC with a dilated phenotype was selected at the National Medical Research Center for Therapy and Preventive Medicine. Next generation sequencing was performed on a Nextseq 550 systen (Illumina, USA). For clinical interpretation, nucleotide sequence variants in the genes associated with LVNC development were selected according to the available literature data, with frequencies <0,5% in the gnomAD database. The identified variants were verified using Sanger sequencing on an Applied Biosystem 3500 Genetic Analyzer (Thermo Fisher Scientific, USA).Results. The article presents the results of clinical, paraclinical and molecular genetic studies of two generations of a family diagnosed with LVNC with a dilated phenotype and the progression of isolated LVNC to a dilated type. As a result of a molecular genetic study, all family members with the LVNC were found to have a likely pathogenic variant in the RBM20 NP_001127835.2:p.Pro638Leu (rs267607003) gene. RBM20 is a key splicing regulator that controls the processing of several important transcripts predominantly expressed in striated muscle, especially cardiac tissue. RBM20 gene variants can lead to disruption of splicing at several points and, as a result, to cardiomyopathy progression. Most known pathogenic RBM20 variants are associated with dilated cardiomyopathy; however, a number of studies have found RBM20 gene variants in patients with LVNC. The segregation of nucleotide sequence variant with symptoms in two generations testifies in favor of the association of the detected variant with LVNC development.Conclusion. Currently, the boundaries of the cardiomyopathy genetics are expanding. Pathogenic and likely pathogenic RBM20 gene variants are associated primarily with a dilated phenotype and a high risk of sudden cardiac death. The article presents the results of a survey of two generations of a family with LVNC and progressive myocardial remodeling.
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Affiliation(s)
- O. V. Kulikova
- National Medical Research Center for Therapy and Preventive Medicine
| | - R. P. Myasnikov
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. N. Meshkov
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. A. Mershina
- Medical Research and Educational Center, Lomonosov Moscow State University
| | - A. V. Kiseleva
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. A. Sotnikova
- National Medical Research Center for Therapy and Preventive Medicine
| | | | - M. S. Kharlap
- National Medical Research Center for Therapy and Preventive Medicine
| | - M. G. Divashuk
- National Medical Research Center for Therapy and Preventive Medicine; Kurchatov Center for Genome Research, All-Russia Research Institute of Agricultural Biotechnology
| | - A. A. Zharikova
- National Medical Research Center for Therapy and Preventive Medicine; Lomonosov Moscow State University
| | - R. K. Angarsky
- National Medical Research Center for Therapy and Preventive Medicine
| | - S. N. Koretsky
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. А. Filatova
- Medical Research and Educational Center, Lomonosov Moscow State University
| | - V. E. Sinitsyn
- Medical Research and Educational Center, Lomonosov Moscow State University
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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Raman SV, Markl M, Patel AR, Bryant J, Allen BD, Plein S, Seiberlich N. 30-minute CMR for common clinical indications: a Society for Cardiovascular Magnetic Resonance white paper. J Cardiovasc Magn Reson 2022; 24:13. [PMID: 35232470 PMCID: PMC8886348 DOI: 10.1186/s12968-022-00844-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/16/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite decades of accruing evidence supporting the clinical utility of cardiovascular magnetic resonance (CMR), adoption of CMR in routine cardiovascular practice remains limited in many regions of the world. Persistent use of long scan times of 60 min or more contributes to limited adoption, though techniques available on most scanners afford routine CMR examination within 30 min. Incorporating such techniques into standardize protocols can answer common clinical questions in daily practice, including those related to heart failure, cardiomyopathy, ventricular arrhythmia, ischemic heart disease, and non-ischemic myocardial injury. BODY: In this white paper, we describe CMR protocols of 30 min or shorter duration with routine techniques with or without stress perfusion, plus specific approaches in patient and scanner room preparation for efficiency. Minimum requirements for the scanner gradient system, coil hardware and pulse sequences are detailed. Recent advances such as quantitative myocardial mapping and other add-on acquisitions can be incorporated into the proposed protocols without significant extension of scan duration for most patients. CONCLUSION Common questions in clinical cardiovascular practice can be answered in routine CMR protocols under 30 min; their incorporation warrants consideration to facilitate increased access to CMR worldwide.
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Affiliation(s)
- Subha V. Raman
- Division of Cardiovascular Medicine and Krannert CV Research Center, Indiana University School of Medicine, Indianapolis, IN USA
- Cardiovascular Institute, IU Health, Indianapolis, IN USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL USA
| | - Amit R. Patel
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL USA
| | - Jennifer Bryant
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Bradley D. Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI 48109 USA
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Yu S, Chen X, Yang K, Wang J, Zhao K, Dong W, Yan W, Su G, Zhao S. Correlation between left ventricular fractal dimension and impaired strain assessed by cardiac MRI feature tracking in patients with left ventricular noncompaction and normal left ventricular ejection fraction. Eur Radiol 2021; 32:2594-2603. [PMID: 34779872 DOI: 10.1007/s00330-021-08346-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/23/2021] [Accepted: 09/24/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the correlation between the extent of excessive trabeculation assessed by fractal dimension (FD) and myocardial contractility assessed by cardiac MRI feature tracking in patients with left ventricular noncompaction (LVNC) and normal left ventricular ejection fraction (LVEF). METHODS Forty-one LVNC patients with normal LVEF (≥ 50%) and 41 healthy controls were retrospectively included. All patients fulfilled three available diagnostic criteria on MRI. Cardiac MRI feature tracking was performed on cine images to determine left ventricular (LV) peak strains in three directions: global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain (GLS). The complexity of excessive trabeculation was quantified by fractal analysis on short-axis cine stacks. RESULTS Compared with controls, patients with LVNC had impaired GRS, GCS, and GLS (all p < 0.05). The global, maximal, and regional FD values of the LVNC population were all significantly higher than those of the controls (all p < 0.05). Global FD was positively correlated with the end-diastolic volume index, end-systolic volume index, and stroke volume index (r = 0.483, 0.505, and 0.335, respectively, all p < 0.05), but negatively correlated with GRS and GCS (r = - 0.458 and 0.508, respectively, both p < 0.001). Moreover, apical FD was also weakly associated with LVEF and GLS (r = - 0.249 and 0.252, respectively, both p < 0.05). CONCLUSION In patients with LVNC, LV systolic dysfunction was detected early by cardiac MRI feature tracking despite the presence of normal LVEF and was associated with excessive trabecular complexity assessed by FD. KEY POINTS • Left ventricular global strain was already impaired in patients with extremely prominent excessive trabeculation but normal left ventricular ejection fraction. • An increased fractal dimension was associated with impaired deformation in left ventricular noncompaction.
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Affiliation(s)
- Shiqin Yu
- MR Center, Fuwai Hospital, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xiuyu Chen
- MR Center, Fuwai Hospital, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Kai Yang
- MR Center, Fuwai Hospital, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jiaxin Wang
- MR Center, Fuwai Hospital, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, 518055, China
| | - Wenhao Dong
- MR Center, Fuwai Hospital, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Weipeng Yan
- MR Center, Fuwai Hospital, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Guohai Su
- Department of Cardiology, Jinan Central Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, No. 105 Jiefang Road, Jinan, 250013, Shandong, China.
| | - Shihua Zhao
- MR Center, Fuwai Hospital, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
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Rohde S, Muslem R, Kaya E, Dalinghaus M, van Waning JI, Majoor-Krakauer D, Towbin J, Caliskan K. State-of-the art review: Noncompaction cardiomyopathy in pediatric patients. Heart Fail Rev 2021; 27:15-28. [PMID: 33715140 PMCID: PMC8739285 DOI: 10.1007/s10741-021-10089-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 12/13/2022]
Abstract
Noncompaction cardiomyopathy (NCCM) is a disease characterized by hypertrabeculation, commonly hypothesized due to an arrest in compaction during fetal development. In 2006, NCCM was classified as a distinct form of cardiomyopathy (CMP) by the American Heart Association. NCCM in childhood is more frequently familial than when diagnosed in adulthood and is associated with other congenital heart diseases (CHDs), other genetic CMPs, and neuromuscular diseases (NMDs). It is yet a rare cardiac diseased with an estimated incidence of 0.12 per 100.000 in children up to 10 years of age. Diagnosing NCCM can be challenging due to non-uniform diagnostic criteria, unawareness, presumed other CMPs, and presence of CHD. Therefore, the incidence of NCCM in children might be an underestimation. Nonetheless, NCCM is the third most common cardiomyopathy in childhood and is associated with heart failure, arrhythmias, and/or thromboembolic events. This state-of-the-art review provides an overview on pediatric NCCM. In addition, we discuss the natural history, epidemiology, genetics, clinical presentation, outcome, and therapeutic options of NCCM in pediatric patients, including fetuses, neonates, infants, and children. Furthermore, we provide a simple classification of different forms of the disease. Finally, the differences between the pediatric population and the adult population are described.
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Affiliation(s)
- Sofie Rohde
- Thoraxcenter, Department of Cardiology, Erasmus University Medical Center, Room RG 431, 3015 GD, Rotterdam, The Netherlands
| | - Rahatullah Muslem
- Thoraxcenter, Department of Cardiology, Erasmus University Medical Center, Room RG 431, 3015 GD, Rotterdam, The Netherlands
| | - Emrah Kaya
- Thoraxcenter, Department of Cardiology, Erasmus University Medical Center, Room RG 431, 3015 GD, Rotterdam, The Netherlands
| | - Michel Dalinghaus
- Division of Pediatric Cardiology, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jaap I van Waning
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jeffery Towbin
- The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Kadir Caliskan
- Thoraxcenter, Department of Cardiology, Erasmus University Medical Center, Room RG 431, 3015 GD, Rotterdam, The Netherlands.
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Left Ventricular Noncompaction Is a Myocardial Phenotype: Cardiomyopathy—Yes or No? Can J Cardiol 2021; 37:366-369. [DOI: 10.1016/j.cjca.2020.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023] Open
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9
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Schultze-Berndt A, Kühnisch J, Herbst C, Seidel F, Al-Wakeel-Marquard N, Dartsch J, Theisen S, Knirsch W, Jenni R, Greutmann M, Oechslin E, Berger F, Klaassen S. Reduced Systolic Function and Not Genetic Variants Determine Outcome in Pediatric and Adult Left Ventricular Noncompaction Cardiomyopathy. Front Pediatr 2021; 9:722926. [PMID: 34540771 PMCID: PMC8447880 DOI: 10.3389/fped.2021.722926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Left ventricular noncompaction cardiomyopathy (LVNC CMP) is a genetic cardiomyopathy. Genotype-phenotype correlation and clinical outcome of genetic variants in pediatric and adult LVNC CMP patients are still unclear. Methods: The retrospective multicenter study was conducted in unrelated index patients with LVNC CMP, diagnosed between the years 1987 and 2017, and all available family members. All index patients underwent next-generation sequencing for genetic variants in 174 target genes using the Illumina TruSight Cardio Sequencing Panel. Major adverse cardiac events (MACE) included mechanical circulatory support, heart transplantation, survivor of cardiac death, and/or all-cause death as combined endpoint. Results: Study population included 149 LVNC CMP patients with a median age of 27.8 (9.2-44.8) years at diagnosis; 58% of them were symptomatic, 18% suffered from non-sustained and sustained arrhythmias, and 17% had an implantable cardioverter defibrillator (ICD) implanted. 55/137 patients (40%) were ≤ 18 years at diagnosis. A total of 134 variants were identified in 87/113 (77%) index patients. 93 variants were classified as variant of unknown significance (VUS), 24 as likely pathogenic and 15 as pathogenic. The genetic yield of (likely) pathogenic variants was 35/113 (31%) index patients. Variants occurred most frequently in MYH7 (n=19), TTN (n = 10) and MYBPC3 (n = 8). Altogether, sarcomere gene variants constituted 42.5% (n = 57) of all variants. The presence or absence of (likely) pathogenic variants or variants in specific genes did not allow risk stratification for MACE. Reduced left ventricular (LV) systolic function and increased left ventricular end-diastolic diameter (LVEDD) were risk factors for event-free survival in the Kaplan-Meier analysis. Through multivariate analysis we identified reduced LV systolic function as the main risk factor for MACE. Patients with reduced LV systolic function were at a 4.6-fold higher risk for MACE. Conclusions: Genetic variants did not predict the risk of developing a MACE, neither in the pediatric nor in the adult cohort. Multivariate analysis emphasized reduced LV systolic function as the main independent factor that is elevating the risk for MACE. Genetic screening is useful for cascade screening to identify family members at risk for developing LVNC CMP.
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Affiliation(s)
- Alina Schultze-Berndt
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jirko Kühnisch
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Christopher Herbst
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Franziska Seidel
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Department of Congenital Heart Disease - Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Nadya Al-Wakeel-Marquard
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Department of Congenital Heart Disease - Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Josephine Dartsch
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Theisen
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Walter Knirsch
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rolf Jenni
- University of Zurich, Zurich, Switzerland
| | - Matthias Greutmann
- Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease Program, University Health Network/Toronto General Hospital, Peter Munk Cardiac Centre, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Felix Berger
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Department of Congenital Heart Disease - Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Sabine Klaassen
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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Jensen B, Christoffels VM, Moorman AFM. An Appreciation of Anatomy in the Molecular World. J Cardiovasc Dev Dis 2020; 7:E44. [PMID: 33076272 PMCID: PMC7712948 DOI: 10.3390/jcdd7040044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022] Open
Abstract
Robert H. Anderson is one of the most important and accomplished cardiac anatomists of the last decades, having made major contributions to our understanding of the anatomy of normal hearts and the pathologies of acquired and congenital heart diseases. While cardiac anatomy as a research discipline has become largely subservient to molecular biology, anatomists like Professor Anderson demonstrate anatomy has much to offer. Here, we provide cases of early anatomical insights on the heart that were rediscovered, and expanded on, by molecular techniques: migration of neural crest cells to the heart was deduced from histological observations (1908) and independently shown again with experimental interventions; pharyngeal mesoderm is added to the embryonic heart (1973) in what is now defined as the molecularly distinguishable second heart field; chambers develop from the heart tube as regional pouches in what is now considered the ballooning model by the molecular identification of regional differentiation and proliferation. The anatomical discovery of the conduction system by Purkinje, His, Tawara, Keith, and Flack is a special case because the main findings were never neglected in later molecular studies. Professor Anderson has successfully demonstrated that sound knowledge of anatomy is indispensable for proper understanding of cardiac development.
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Affiliation(s)
- Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Meibergdreef 15, 1105AZ Amsterdam, The Netherlands; (V.M.C.); (A.F.M.M.)
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