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Bermudez-Jimenez FJ, Protonotarios A, García-Hernández S, Pérez Asensio A, Rampazzo A, Zorio E, Brodehl A, Arias MA, Macías-Ruiz R, Fernández-Armenta J, Remior Perez P, Muñoz-Esparza C, Pilichou K, Bauce B, Merino JL, Moliner-Abós C, Ochoa JP, Barriales-Villa R, Garcia-Pavia P, Lopes LR, Syrris P, Corrado D, Elliott PM, McKenna WJ, Jimenez-Jaimez J. Phenotype and Clinical Outcomes in Desmin-Related Arrhythmogenic Cardiomyopathy. JACC Clin Electrophysiol 2024; 10:1178-1190. [PMID: 38727660 DOI: 10.1016/j.jacep.2024.02.031] [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: 11/02/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Desmin (DES) pathogenic variants cause a small proportion of arrhythmogenic cardiomyopathy (ACM). Outcomes data on DES-related ACM are scarce. OBJECTIVES This study sought to provide information on the clinical phenotype and outcomes of patients with ACM caused by pathogenic variants of the DES gene in a multicenter cohort. METHODS We collected phenotypic and outcomes data from 16 families with DES-related ACM from 10 European centers. We assessed in vitro DES aggregates. Major cardiac events were compared to historical controls with lamin A/C truncating variant (LMNA-tv) and filament C truncating variant (FLNC-tv) ACM. RESULTS Of 82 patients (54% males, median age: 36 years), 11 experienced sudden cardiac death (SCD) (n = 7) or heart failure death (HFd)/heart transplantation (HTx) (n = 4) before clinical evaluation. Among 68 survivors, 59 (86%) presented signs of cardiomyopathy, with left ventricular (LV) dominant (50%) or biventricular (34%) disease. Mean LV ejection fraction was 51% ± 13%; 36 of 53 had late gadolinium enhancement (ring-like pattern in 49%). During a median of 6.73 years (Q1-Q3: 3.55-9.52 years), the composite endpoint (sustained ventricular tachycardia, aborted SCD, implantable cardioverter-defibrillator therapy, SCD, HFd, and HTx) was achieved in 15 additional patients with HFd/HTx (n = 5) and SCD/aborted SCD/implantable cardioverter-defibrillator therapy/sustained ventricular tachycardia (n = 10). Male sex (P = 0.004), nonsustained ventricular tachycardia (P = 0.017) and LV ejection fraction ≤50% (P = 0.012) were associated with the composite endpoint. Males with DES variants had similar outcomes to historical FLNC-tv and LMNA-tv controls. However, females showed better outcomes than those with LMNA-tv. In vitro experiments showed the characteristic finding of DES aggregates in 7 of 12 variants. CONCLUSIONS DES ACM is associated with poor outcomes which can be predicted with potentially successful treatments, underscoring the importance of familial evaluation and genetic studies to identify at risk individuals.
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Affiliation(s)
- Francisco J Bermudez-Jimenez
- Department of Cardiology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria. ibs.GRANADA, Granada, Spain
| | - Alexandros Protonotarios
- Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, London, United Kingdom; Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Soledad García-Hernández
- Instituto de Investigación Biomédica de A Coruña (INIBIC, CIBERCV), A Coruña, Spain; Health in Code SL, Cardiología, A Coruña, Spain
| | - Ana Pérez Asensio
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, Spain
| | - Alessandra Rampazzo
- Departments of Biology and Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Esther Zorio
- Inherited Cardiac Diseases Unit, Cardiology Department at Hospital Universitario y Politécnico La Fe and Research Group on Inherited Heart Diseases, Sudden Death and Mechanisms of Disease (CaFaMuSMe), Barcelona, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Andreas Brodehl
- Erich and Hanna Klessmann Institute for Cardiovascular Research & Development, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Miguel A Arias
- Arrhythmia Unit, Hospital Universitario de Toledo, Toledo, Spain
| | - Rosa Macías-Ruiz
- Department of Cardiology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria. ibs.GRANADA, Granada, Spain
| | - Juan Fernández-Armenta
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, Spain
| | - Paloma Remior Perez
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Inherited Cardiac Disease Unit, Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - Carmen Muñoz-Esparza
- Inherited Cardiac Disease Unit, Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - Kalliopi Pilichou
- Departments of Biology and Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Barbara Bauce
- Departments of Biology and Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Jose L Merino
- Viamed Santa Elena and La Paz University Hospitals, Idipaz, Madrid, Spain
| | - Carlos Moliner-Abós
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; IIB-SantPau, CIBERCV, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Juan P Ochoa
- Instituto de Investigación Biomédica de A Coruña (INIBIC, CIBERCV), A Coruña, Spain; Health in Code SL, Cardiología, A Coruña, Spain
| | - Roberto Barriales-Villa
- Instituto de Investigación Biomédica de A Coruña (INIBIC, CIBERCV), A Coruña, Spain; Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Spain
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; Inherited Cardiac Disease Unit, Hospital Universitario Virgen Arrixaca, Murcia, Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Luis R Lopes
- Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, London, United Kingdom; Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Petros Syrris
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Domenico Corrado
- Departments of Biology and Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Perry M Elliott
- Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, London, United Kingdom; Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - William J McKenna
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, United Kingdom; Instituto de Investigación Biomédica de A Coruña (INIBIC, CIBERCV), A Coruña, Spain
| | - Juan Jimenez-Jaimez
- Department of Cardiology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria. ibs.GRANADA, Granada, Spain.
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