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Bottillo I, Giordano C, Ciccone MP, Pignataro MG, Albi F, Parisi G, Formicola D, Grotta S, Ranocchi F, Giuli MV, Checquolo S, Masuelli L, Re F, Majore S, d'Amati G, Grammatico P. Dilated cardiomyopathy due to a novel combination of TTN and BAG3 genetic variants: From acute heart failure to subclinical phenotypes. Cardiovasc Pathol 2024; 73:107675. [PMID: 39059779 DOI: 10.1016/j.carpath.2024.107675] [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: 12/31/2023] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Dilated cardiomyopathy (DCM) is defined as left ventricular enlargement accompanied by systolic dysfunction not explained by abnormal loading conditions or coronary heart disease. The DCM clinical spectrum is broad, ranging from subclinical to severe presentation with progression to end stage heart failure. To date, different genetic loci have been found to have moderate/definitive evidence for causality in DCM and pathogenic variants in the TTN gene represent the main genetic determinant. Here, we describe a family in which the co-occurrence of two genetic hits, one in the TTN and one in the BAG3 gene, was associated with heterogeneous clinical presentation ranging from subclinical phenotypes to acute cardiogenic shock mimicking fulminant myocarditis. We hypothesize that at least some specific BAG3 genotypes could be related to DCM presenting with acute heart failure and suggest that patients and relatives carrying BAG3 pathogenic variants should be addressed to a tertiary-level heart care center.
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Affiliation(s)
- Irene Bottillo
- Division of Medical Genetics, Department of Experimental Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy.
| | - Carla Giordano
- Department of Radiology, Oncology and Pathology, Sapienza, University of Rome, Rome, Italy
| | - Maria Pia Ciccone
- Division of Medical Genetics, Department of Experimental Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
| | - Maria Gemma Pignataro
- Department of Radiology, Oncology and Pathology, Sapienza, University of Rome, Rome, Italy
| | - Fiammetta Albi
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Gabriella Parisi
- Department of Clinical Microbiology and Virology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Daniela Formicola
- Division of Medical Genetics, Department of Experimental Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
| | - Simona Grotta
- Division of Medical Genetics, Department of Experimental Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
| | - Federico Ranocchi
- Cardiac Surgery and Heart Transplantation Unit, San Camillo Hospital, Rome, Italy
| | - Maria Valeria Giuli
- Department of Medico-surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Saula Checquolo
- Department of Medico-surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Laura Masuelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Silvia Majore
- Division of Medical Genetics, Department of Experimental Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
| | - Giulia d'Amati
- Department of Radiology, Oncology and Pathology, Sapienza, University of Rome, Rome, Italy
| | - Paola Grammatico
- Division of Medical Genetics, Department of Experimental Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
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Xiao J, Dong Y, Jin J, Yuan Z, Wang C, Xiang R, Guo Y. A missense variant in MYOF is associated with ARVC and sudden cardiac death. Gene 2024; 902:148193. [PMID: 38253296 DOI: 10.1016/j.gene.2024.148193] [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: 10/31/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is rare autosomal dominant genetic disorder that leads to severe arrhythmia and sudden cardiac death. Although previous studies in clinical, pathological and genetics of ARVC established consensus diagnostic criteria and expanded the spectrum of pathogenic genes, there is still a proportion of patients with unclear causative factors. Here, whole-exome sequencing was employed to investigate the genetic etiology of a 15-year-old sudden cardiac death female caused by ARVC. A novel variant of MYOF (NM_013451.3: c.4723G > C: p.D1575H) was identified, which is a member of the Ferlin family of proteins is associated with cardiomyopathy. And the bioinformatics analysis predicted the pathogenicity of this variant. We report the first variant of MYOF in ARVC, which imply a vital role of MYOF in cardiomyopathy.
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Affiliation(s)
- Jiao Xiao
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China.
| | - Yi Dong
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha, China.
| | - Jieyuan Jin
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha, China.
| | - Zhuangzhuang Yuan
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha, China.
| | - Chenyu Wang
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha, China.
| | - Rong Xiang
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha, China.
| | - Yadong Guo
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China.
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3
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Jolfayi AG, Kohansal E, Ghasemi S, Naderi N, Hesami M, MozafaryBazargany M, Moghadam MH, Fazelifar AF, Maleki M, Kalayinia S. Exploring TTN variants as genetic insights into cardiomyopathy pathogenesis and potential emerging clues to molecular mechanisms in cardiomyopathies. Sci Rep 2024; 14:5313. [PMID: 38438525 PMCID: PMC10912352 DOI: 10.1038/s41598-024-56154-7] [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: 11/22/2023] [Accepted: 03/01/2024] [Indexed: 03/06/2024] Open
Abstract
The giant protein titin (TTN) is a sarcomeric protein that forms the myofibrillar backbone for the components of the contractile machinery which plays a crucial role in muscle disorders and cardiomyopathies. Diagnosing TTN pathogenic variants has important implications for patient management and genetic counseling. Genetic testing for TTN variants can help identify individuals at risk for developing cardiomyopathies, allowing for early intervention and personalized treatment strategies. Furthermore, identifying TTN variants can inform prognosis and guide therapeutic decisions. Deciphering the intricate genotype-phenotype correlations between TTN variants and their pathologic traits in cardiomyopathies is imperative for gene-based diagnosis, risk assessment, and personalized clinical management. With the increasing use of next-generation sequencing (NGS), a high number of variants in the TTN gene have been detected in patients with cardiomyopathies. However, not all TTN variants detected in cardiomyopathy cohorts can be assumed to be disease-causing. The interpretation of TTN variants remains challenging due to high background population variation. This narrative review aimed to comprehensively summarize current evidence on TTN variants identified in published cardiomyopathy studies and determine which specific variants are likely pathogenic contributors to cardiomyopathy development.
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Affiliation(s)
- Amir Ghaffari Jolfayi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Erfan Kohansal
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Serwa Ghasemi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloofar Naderi
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahshid Hesami
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Hosseini Moghadam
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Farjam Fazelifar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Kalayinia
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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4
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Báez-Ferrer N, Díaz-Flores-Estévez F, Pérez-Cejas A, Avanzas P, Lorca R, Abreu-González P, Domínguez-Rodríguez A. Natural History of Dilated Cardiomyopathy Due to c.77T>C (p.Val26Ala) in Emerin Protein. J Clin Med 2024; 13:660. [PMID: 38337354 PMCID: PMC10856282 DOI: 10.3390/jcm13030660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Introduction: Dilated cardiomyopathy (DCM) mainly affects young individuals and is the main indication of heart transplantation. The variant c.77T>C (p.Val26Ala) of the gene coding for emerin (EMD) in chromosome Xq28 has been catalogued as a pathogenic variant for the development of DCM, exhibiting an X-linked inheritance pattern. (2) Methods: A retrospective study was conducted covering the period 2015-2023 in patients with DCM of genetic origin. The primary endpoint was patient age at onset of the first composite major cardiac event, in the form of a first episode of heart failure, malignant ventricular arrhythmia, or end-stage heart failure, according to the presence of truncating variant in titin gene (TTNtv) versus the p.Val26Ala mutation in the EMD protein. (3) Results: A total of 31 and 22 patients were included in the EMD group and TTNtv group, respectively. The primary endpoint was significantly higher in the EMD group, with a hazard ratio of 4.16 (95% confidence interval: 1.83-9.46; p = 0.001). At 55 years of age, all the patients in the EMD group had already presented heart failure, nine presented malignant ventricular arrhythmia (29%), and 13 required heart transplantation (42%). (4) Conclusions: DCM secondary to the c.77T>C (p.Val26Ala) mutation in the EMD gene is associated to an increased risk of major cardiac events compared to patients with DCM due to TTNtv, with a large proportion of transplanted patients in the fifth decade of life.
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Affiliation(s)
- Néstor Báez-Ferrer
- Cardiology Department, Hospital Universitario de Canarias, 38320 Tenerife, Spain
| | - Felícitas Díaz-Flores-Estévez
- Department of Genetics, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (F.D.-F.-E.); (A.P.-C.)
- Department of Laboratory, Hospital Universitario de Canarias, 38320 Tenerife, Spain
| | - Antonia Pérez-Cejas
- Department of Genetics, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (F.D.-F.-E.); (A.P.-C.)
- Department of Laboratory, Hospital Universitario de Canarias, 38320 Tenerife, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain; (P.A.); (R.L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, 33003 Oviedo, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Rebeca Lorca
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain; (P.A.); (R.L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Departamento de Biología Funcional, Área de Fisiología, Universidad de Oviedo, 33003 Oviedo, Spain
- Unidad de Cardiopatías Familiares, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORs), 28029 Madrid, Spain
| | - Pedro Abreu-González
- Physiology Department, Faculty of Medicine, Universidad de La Laguna, 38200 Tenerife, Spain;
| | - Alberto Domínguez-Rodríguez
- Cardiology Department, Hospital Universitario de Canarias, 38320 Tenerife, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, 38300 Tenerife, Spain
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5
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Báez-Ferrer N, Díaz-Flores-Estévez F, Pérez-Cejas A. [Atrioventricular block in dilated cardiomyopathy and mutation in emerin gene]. Med Clin (Barc) 2023; 161:551-552. [PMID: 37596164 DOI: 10.1016/j.medcli.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Néstor Báez-Ferrer
- Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
| | | | - Antonia Pérez-Cejas
- Unidad de Genética, Laboratorio Central, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
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6
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Kim Y, Gunnarsdóttir OB, Viveiros A, Reichart D, Quiat D, Willcox JAL, Zhang H, Chen H, Curran JJ, Kim DH, Urschel S, McDonough B, Gorham J, DePalma SR, Seidman JG, Seidman CE, Oudit GY. Genetic Contribution to End-Stage Cardiomyopathy Requiring Heart Transplantation. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:452-461. [PMID: 37767697 DOI: 10.1161/circgen.123.004062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 08/11/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Many cardiovascular disorders propel the development of advanced heart failure that necessitates cardiac transplantation. When treatable causes are excluded, studies to define causes are often abandoned, resulting in a diagnosis of end-stage idiopathic cardiomyopathy. We studied whether DNA sequence analyses could identify unrecognized causes of end-stage nonischemic cardiomyopathy requiring heart transplantation and whether the prevalence of genetic causes differed from ambulatory cardiomyopathy cases. METHODS We performed whole exome and genome sequencing of 122 explanted hearts from 101 adult and 21 pediatric patients with idiopathic cardiomyopathy from a single center. Data were analyzed for pathogenic/likely pathogenic variants in nuclear and mitochondrial genomes and assessed for nonhuman microbial sequences. The frequency of damaging genetic variants was compared among cardiomyopathy cohorts with different clinical severity. RESULTS Fifty-four samples (44.3%) had pathogenic/likely pathogenic cardiomyopathy gene variants. The frequency of pathogenic variants was similar in pediatric (42.9%) and adult (43.6%) samples, but the distribution of mutated genes differed (P=8.30×10-4). The prevalence of causal genetic variants was significantly higher in end-stage than in previously reported ambulatory adult dilated cardiomyopathy cases (P<0.001). Among remaining samples with unexplained causes, no damaging mitochondrial variants were identified, but 28 samples contained parvovirus genome sequences, including 2 samples with 6- to 9-fold higher levels than the overall mean levels in other samples. CONCLUSIONS Pathogenic variants and viral myocarditis were identified in 45.9% of patients with unexplained end-stage cardiomyopathy. Damaging gene variants are significantly more frequent among transplant compared with patients with ambulatory cardiomyopathy. Genetic analyses can help define cause of end-stage cardiomyopathy to guide management and risk stratification of patients and family members.
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Affiliation(s)
- Yuri Kim
- Division of Cardiovascular Medicine, Brigham and Women's Hospital (Y.K., B.M., C.E.S.)
- Department of Genetics, Harvard Medical School, Boston, MA (Y.K., O.B.G., D.R., D.Q., J.A.L.W., J.J.C., J.G., S.R.D., J.G.S., C.E.S.)
| | - Oddný Brattberg Gunnarsdóttir
- Department of Genetics, Harvard Medical School, Boston, MA (Y.K., O.B.G., D.R., D.Q., J.A.L.W., J.J.C., J.G., S.R.D., J.G.S., C.E.S.)
| | - Anissa Viveiros
- Department of Medicine (A.V., H.Z., H.C., D.H.K., G.Y.O.), University of Alberta
- Mazankowski Alberta Heart Institute, Edmonton, Canada (A.V., H.Z., H.C., D.H.K., G.Y.O.)
| | - Daniel Reichart
- Department of Genetics, Harvard Medical School, Boston, MA (Y.K., O.B.G., D.R., D.Q., J.A.L.W., J.J.C., J.G., S.R.D., J.G.S., C.E.S.)
- Department of Medicine I, University Hospital, Ludwig Maximilian University of Munich, Germany (D.R.)
| | - Daniel Quiat
- Department of Genetics, Harvard Medical School, Boston, MA (Y.K., O.B.G., D.R., D.Q., J.A.L.W., J.J.C., J.G., S.R.D., J.G.S., C.E.S.)
- Department of Cardiology, Boston Children's Hospital, MA (D.Q.)
| | - Jon A L Willcox
- Department of Genetics, Harvard Medical School, Boston, MA (Y.K., O.B.G., D.R., D.Q., J.A.L.W., J.J.C., J.G., S.R.D., J.G.S., C.E.S.)
| | - Hao Zhang
- Department of Medicine (A.V., H.Z., H.C., D.H.K., G.Y.O.), University of Alberta
- Mazankowski Alberta Heart Institute, Edmonton, Canada (A.V., H.Z., H.C., D.H.K., G.Y.O.)
| | - Huachen Chen
- Department of Medicine (A.V., H.Z., H.C., D.H.K., G.Y.O.), University of Alberta
- Mazankowski Alberta Heart Institute, Edmonton, Canada (A.V., H.Z., H.C., D.H.K., G.Y.O.)
| | - Justin J Curran
- Department of Genetics, Harvard Medical School, Boston, MA (Y.K., O.B.G., D.R., D.Q., J.A.L.W., J.J.C., J.G., S.R.D., J.G.S., C.E.S.)
| | - Daniel H Kim
- Department of Medicine (A.V., H.Z., H.C., D.H.K., G.Y.O.), University of Alberta
- Mazankowski Alberta Heart Institute, Edmonton, Canada (A.V., H.Z., H.C., D.H.K., G.Y.O.)
| | - Simon Urschel
- Department of Pediatrics (S.U.), University of Alberta
- Stollery Children's Hospital, Edmonton, Alberta, Canada (S.U.)
| | - Barbara McDonough
- Division of Cardiovascular Medicine, Brigham and Women's Hospital (Y.K., B.M., C.E.S.)
- Howard Hughes Medical Institute, Chevy Chase, MD (B.M., S.R.D., C.E.S.)
| | - Joshua Gorham
- Department of Genetics, Harvard Medical School, Boston, MA (Y.K., O.B.G., D.R., D.Q., J.A.L.W., J.J.C., J.G., S.R.D., J.G.S., C.E.S.)
| | - Steven R DePalma
- Department of Genetics, Harvard Medical School, Boston, MA (Y.K., O.B.G., D.R., D.Q., J.A.L.W., J.J.C., J.G., S.R.D., J.G.S., C.E.S.)
- Howard Hughes Medical Institute, Chevy Chase, MD (B.M., S.R.D., C.E.S.)
| | - Jonathan G Seidman
- Department of Genetics, Harvard Medical School, Boston, MA (Y.K., O.B.G., D.R., D.Q., J.A.L.W., J.J.C., J.G., S.R.D., J.G.S., C.E.S.)
| | - Christine E Seidman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital (Y.K., B.M., C.E.S.)
- Department of Genetics, Harvard Medical School, Boston, MA (Y.K., O.B.G., D.R., D.Q., J.A.L.W., J.J.C., J.G., S.R.D., J.G.S., C.E.S.)
- Howard Hughes Medical Institute, Chevy Chase, MD (B.M., S.R.D., C.E.S.)
| | - Gavin Y Oudit
- Department of Medicine (A.V., H.Z., H.C., D.H.K., G.Y.O.), University of Alberta
- Mazankowski Alberta Heart Institute, Edmonton, Canada (A.V., H.Z., H.C., D.H.K., G.Y.O.)
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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: 371] [Impact Index Per Article: 371.0] [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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Hofmeyer M, Haas GJ, Jordan E, Cao J, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Huggins GS, Kinnamon DD, Ni H, Hershberger RE. Rare Variant Genetics and Dilated Cardiomyopathy Severity: The DCM Precision Medicine Study. Circulation 2023; 148:872-881. [PMID: 37641966 PMCID: PMC10530109 DOI: 10.1161/circulationaha.123.064847] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) can lead to advanced disease, defined herein as necessitating a durable left ventricular assist device or a heart transplant (LVAD/HT). DCM is known to have a genetic basis, but the association of rare variant genetics with advanced DCM has not been studied. METHODS We analyzed clinical and genetic sequence data from patients enrolled between 2016 and 2021 in the US multisite DCM Precision Medicine Study, which was a geographically diverse, multiracial, multiethnic cohort. Clinical evaluation included standardized patient interview and medical record query forms. DCM severity was classified into 3 groups: patients with advanced disease with LVAD/HT; patients with an implantable cardioverter defibrillator (ICD) only; or patients with no ICD or LVAD/HT. Rare variants in 36 DCM genes were classified as pathogenic or likely pathogenic or variants of uncertain significance. Confounding factors we considered included demographic characteristics, lifestyle factors, access to care, DCM duration, and comorbidities. Crude and adjusted associations between DCM severity and rare variant genetic findings were assessed using multinomial models with generalized logit link. RESULTS Patients' mean (SD) age was 51.9 (13.6) years; 42% were of African ancestry, 56% were of European ancestry, and 44% were female. Of 1198 patients, 347 had LVAD/HT, 511 had an ICD, and 340 had no LVAD/HT or ICD. The percentage of patients with pathogenic or likely pathogenic variants was 26.2%, 15.9%, and 15.0% for those with LVAD/HT, ICD only, or neither, respectively. After controlling for sociodemographic characteristics and comorbidities, patients with DCM with LVAD/HT were more likely than those without LVAD/HT or ICD to have DCM-related pathogenic or likely pathogenic rare variants (odds ratio, 2.3 [95% CI, 1.5-3.6]). The association did not differ by ancestry. Rare variant genetic findings were similar between patients with DCM with an ICD and those without LVAD/HT or ICD. CONCLUSIONS Advanced DCM was associated with higher odds of rare variants in DCM genes adjudicated as pathogenic or likely pathogenic, compared with individuals with less severe DCM. This finding may help assess the risk of outcomes in management of patients with DCM and their at-risk family members. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03037632.
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Affiliation(s)
- Mark Hofmeyer
- MedStar Health Research Institute, Medstar Washington Hospital Center, Washington, DC
| | - Garrie J. Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Elizabeth Jordan
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Jinwen Cao
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, NE
| | | | - W. H. Wilson Tang
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr. Transplant Center, Houston TX
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, VA
| | - Salpy V. Pamboukian
- University of Alabama, Birmingham, AL during study conduct, current affiliation, University of Washington, Seattle, WA
| | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson, AZ during study conduct, current affiliation, Washington University, St. Louis, MO
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stuart Katz
- New York University Langone Medical Center, New York, NY
| | - Stephen Pan
- New York University Langone Medical Center, New York, NY
- current affiliation, Department of Cardiology, Westchester Medical Center & New York Medical College, Valhalla, NY
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, FL
| | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles, CA
| | | | | | | | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - Daniel D. Kinnamon
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Hanyu Ni
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Ray E. Hershberger
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
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Salgado M, Díaz-Molina B, Cuesta-Llavona E, Aparicio A, Fernández M, Alonso V, Avanzas P, Pascual I, Neuhalfen D, Coto E, Gómez J, Lorca R. Opportunistic Genetic Screening for Familial Hypercholesterolemia in Heart Transplant Patients. J Clin Med 2023; 12:jcm12031233. [PMID: 36769882 PMCID: PMC9917546 DOI: 10.3390/jcm12031233] [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: 12/31/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Heart transplantation remains the gold standard for the treatment of advanced heart failure (HF). Identification of the etiology of HF is mandatory, as the specific pathology can determine subsequent treatment. Early identification of familial hypercholesterolemia (FH), the most common genetic disorder associated with premature cardiovascular disease, has a potential important impact on clinical management and public health. We evaluated the genetic information in the genes associated with FH in a cohort of 140 heart-transplanted patients. All patients underwent NGS genetic testing including LDLR, APOB, and PCSK9. We identified four carriers of rare pathogenic variants in LDLR and APOB. Although all four identified carriers had dyslipidemia, only the one carrying the pathogenic variant LDLR c.676T>C was transplanted due to CAD. Another patient with heart valvular disease was carrier of the controversial LDLR c.2096C>T. Two additional patients with non-ischemic dilated cardiomyopathy were carriers of variants in APOB (c.4672A>G and c.5600G>A). In our cohort, we identified the genetic cause of FH in patients that otherwise would not have been diagnosed. Opportunistic genetic testing for FH provides important information to perform personalized medicine and risk stratification not only for patients but also for relatives at concealed high cardiovascular risk. Including the LDLR gene in standard NGS cardiovascular diagnostics panels should be considered.
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Affiliation(s)
- María Salgado
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
| | - Beatriz Díaz-Molina
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Elías Cuesta-Llavona
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Andrea Aparicio
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
| | - María Fernández
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
| | - Vanesa Alonso
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33011 Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, 33003 Oviedo, Spain
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33011 Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, 33003 Oviedo, Spain
| | - David Neuhalfen
- Departamento de Medicina, Universidad de Oviedo, 33003 Oviedo, Spain
| | - Eliecer Coto
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33011 Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, 33003 Oviedo, Spain
- Unidad de Cardiopatías Familiares, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORs), 28029 Madrid, Spain
| | - Juan Gómez
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33011 Oviedo, Spain
- Unidad de Cardiopatías Familiares, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORs), 28029 Madrid, Spain
- CIBER-Enfermedades Respiratorias, 28029 Madrid, Spain
- Correspondence: (J.G.); (R.L.)
| | - Rebeca Lorca
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33011 Oviedo, Spain
- Unidad de Cardiopatías Familiares, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORs), 28029 Madrid, Spain
- Departamento de Morfología y Biología Celular, Universidad de Oviedo, 33003 Oviedo, Spain
- Correspondence: (J.G.); (R.L.)
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10
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DSP-Related Cardiomyopathy as a Distinct Clinical Entity? Emerging Evidence from an Italian Cohort. Int J Mol Sci 2023; 24:ijms24032490. [PMID: 36768812 PMCID: PMC9916412 DOI: 10.3390/ijms24032490] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Variants in desmoplakin gene (DSP MIM *125647) have been usually associated with Arrhythmogenic Cardiomyopathy (ACM), or Dilated Cardiomyopathy (DCM) inherited in an autosomal dominant manner. A cohort of 18 probands, characterized as heterozygotes for DSP variants by a target Next Generation Sequencing (NGS) cardiomyopathy panel, was analyzed. Cardiological, genetic data, and imaging features were retrospectively collected. A total of 16 DSP heterozygous pathogenic or likely pathogenic variants were identified, 75% (n = 12) truncating variants, n = 2 missense variants, n = 1 splicing variant, and n = 1 duplication variant. The mean age at diagnosis was 40.61 years (IQR 31-47.25), 61% of patients being asymptomatic (n = 11, New York Heart Association (NYHA) class I) and 39% mildly symptomatic (n = 7, NYHA class II). Notably, 39% of patients (n = 7) presented with a clinical history of presumed myocarditis episodes, characterized by chest pain, myocardial enzyme release, 12-lead electrocardiogram abnormalities with normal coronary arteries, which were recurrent in 57% of cases (n = 4). About half of the patients (55%, n = 10) presented with a varied degree of left ventricular enlargement (LVE), four showing biventricular involvement. Eleven patients (61%) underwent implantable cardioverter defibrillator (ICD) implantation, with a mean age of 46.81 years (IQR 36.00-64.00). Cardiac magnetic resonance imaging (CMRI) identified in all 18 patients a delayed enhancement (DE) area consistent with left ventricular (LV) myocardial fibrosis, with a larger localization and extent in patients presenting with recurrent episodes of myocardial injury. These clinical and genetic data confirm that DSP-related cardiomyopathy may represent a distinct clinical entity characterized by a high arrhythmic burden, variable degrees of LVE, Late Gadolinium Enhancement (LGE) with subepicardial distribution and episodes of myocarditis-like picture.
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11
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Ranta-Aho J, Olive M, Vandroux M, Roticiani G, Dominguez C, Johari M, Torella A, Böhm J, Turon J, Nigro V, Hackman P, Laporte J, Udd B, Savarese M. Mutation update for the ACTN2 gene. Hum Mutat 2022; 43:1745-1756. [PMID: 36116040 PMCID: PMC10087778 DOI: 10.1002/humu.24470] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/29/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023]
Abstract
ACTN2 encodes alpha-actinin-2, a protein expressed in human cardiac and skeletal muscle. The protein, located in the sarcomere Z-disk, functions as a link between the anti-parallel actin filaments. This important structural protein also binds N-terminal titins, and thus contributes to sarcomere stability. Previously, ACTN2 mutations have been solely associated with cardiomyopathy, without skeletal muscle disease. Recently, however, ACTN2 mutations have been associated with novel congenital and distal myopathy. Previously reported variants are in varying locations across the gene, but the potential clustering effect of pathogenic locations is not clearly understood. Further, the genotype-phenotype correlations of these variants remain unclear. Here we review the previously reported ACTN2-related molecular and clinical findings and present an additional variant, c.1840-2A>T, that further expands the mutation and phenotypic spectrum. Our results show a growing body of clinical, genetic, and functional evidence, which underlines the central role of ACTN2 in the muscle tissue and myopathy. However, limited segregation and functional data are available to support the pathogenicity of most previously reported missense variants and clear-cut genotype-phenotype correlations are currently only demonstrated for some ACTN2-related myopathies.
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Affiliation(s)
- Johanna Ranta-Aho
- Folkhälsan Research Center, Helsinki, Finland.,Department of Medical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Montse Olive
- Department of Neurology, Neuromuscular Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Marie Vandroux
- IGBMC (Institut de Génétique et de Biologie Moléculaire et Cellulaire), Université de Strasbourg, Illkirch, France
| | | | - Cristina Dominguez
- Department of Neurology, Neuromuscular Unit, Hospital Universitario 12 de Octubre, Research Institute imas12, Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Mridul Johari
- Folkhälsan Research Center, Helsinki, Finland.,Department of Medical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Annalaura Torella
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Johann Böhm
- IGBMC (Institut de Génétique et de Biologie Moléculaire et Cellulaire), Université de Strasbourg, Illkirch, France
| | - Janina Turon
- Department of Neurology, Neuromuscular Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Peter Hackman
- Folkhälsan Research Center, Helsinki, Finland.,Department of Medical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Jocelyn Laporte
- IGBMC (Institut de Génétique et de Biologie Moléculaire et Cellulaire), Université de Strasbourg, Illkirch, France
| | - Bjarne Udd
- Folkhälsan Research Center, Helsinki, Finland.,Department of Medical Genetics, Medicum, University of Helsinki, Helsinki, Finland.,Department of Neurology, Vaasa Central Hospital, Vaasa, Finland
| | - Marco Savarese
- Folkhälsan Research Center, Helsinki, Finland.,Department of Medical Genetics, Medicum, University of Helsinki, Helsinki, Finland
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12
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Chang YH, Lin P, Lin JL, Huang HY, Hsu CK, Hsu CH. Case Report: A novel desmoplakin mutation in a taiwanese woman with familial dilated cardiomyopathy that necessitated heart transplantation. Front Genet 2022; 13:954931. [PMID: 36212137 PMCID: PMC9538354 DOI: 10.3389/fgene.2022.954931] [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: 05/27/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Around one-third of patients diagnosed with idiopathic dilated cardiomyopathy (DCM) turn out to be familial cases, in only a few of which the identification of a pathogenic/likely pathogenic variant could be achieved. Cardiomyopathy caused by desmoplakin gene mutations represents a distinct form with a high prevalence of left ventricle involvement. We report a novel desmoplakin mutation carried by two individuals in a Taiwanese family, in which the proband recovered well after heart transplantation and under medical control, while her son had received an implantable cardioverter defibrillator and has been under guideline-directed medical therapy. The present study broadens the genetic spectrum of this disease entity and strengthens the notion that a detailed family history with genetic study contributes to the early detection and treatment of inherited diseases.
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Affiliation(s)
- Yi-Han Chang
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- International Research Center of Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan
| | - Pei Lin
- Division of Cardiology, Department of Internal Medicine, Tainan Municipal An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Jia-Ling Lin
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hsin-Yu Huang
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Kai Hsu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- International Research Center of Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsin Hsu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Division of Critical Care, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Chih-Hsin Hsu,
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13
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Yang Q, Berkman AM, Ezekian JE, Rosamilia M, Rosenfeld JA, Liu P, Landstrom AP. Determining the Likelihood of Disease Pathogenicity Among Incidentally Identified Genetic Variants in Rare Dilated Cardiomyopathy-Associated Genes. J Am Heart Assoc 2022; 11:e025257. [PMID: 36129056 DOI: 10.1161/jaha.122.025257] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background As utilization of clinical exome sequencing (ES) has expanded, criteria for evaluating the diagnostic weight of incidentally identified variants are critical to guide clinicians and researchers. This is particularly important in genes associated with dilated cardiomyopathy (DCM), which can cause heart failure and sudden death. We sought to compare the frequency and distribution of incidentally identified variants in DCM-associated genes between a clinical referral cohort with those in control and known case cohorts to determine the likelihood of pathogenicity among those undergoing genetic testing for non-DCM indications. Methods and Results A total of 39 rare, non-TTN DCM-associated genes were identified and evaluated from a clinical ES testing referral cohort (n=14 005, Baylor Genetic Laboratories) and compared with a DCM case cohort (n=9442) as well as a control cohort of population variants (n=141 456) derived from the gnomAD database. Variant frequencies in each cohort were compared. Signal-to-noise ratios were calculated comparing the DCM and ES cohort with the gnomAD cohort. The likely pathogenic/pathogenic variant yield in the DCM cohort (8.2%) was significantly higher than in the ES cohort (1.9%). Based on signal-to-noise and correlation analysis, incidental variants found in FLNC, RBM20, MYH6, DSP, ABCC9, JPH2, and NEXN had the greatest chance of being DCM-associated. Conclusions The distribution of pathogenic variants between the ES cohort and the DCM case cohort was gene specific, and variants found in the ES cohort were similar to variants found in the control cohort. Incidentally identified variants in specific genes are more associated with DCM than others.
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Affiliation(s)
- Qixin Yang
- Department of Pediatrics, Division of Cardiology Duke University School of Medicine Durham NC.,Department of Cardiology The First Affiliated Hospital, College of Medicine, Zhejiang University Hangzhou China
| | - Amy M Berkman
- Department of Pediatrics, Division of Cardiology Duke University School of Medicine Durham NC
| | - Jordan E Ezekian
- Department of Pediatrics, Division of Cardiology Duke University School of Medicine Durham NC
| | - Michael Rosamilia
- Department of Pediatrics, Division of Cardiology Duke University School of Medicine Durham NC
| | - Jill A Rosenfeld
- Department of Molecular and Human Genetics Baylor College of Medicine and Baylor Genetics Laboratories Houston TX
| | - Pengfei Liu
- Department of Molecular and Human Genetics Baylor College of Medicine and Baylor Genetics Laboratories Houston TX
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Cardiology Duke University School of Medicine Durham NC.,Department of Cell Biology Duke University School of Medicine Durham NC
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14
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Escobar-Lopez L, Ochoa JP, Royuela A, Verdonschot JAJ, Dal Ferro M, Espinosa MA, Sabater-Molina M, Gallego-Delgado M, Larrañaga-Moreira JM, Garcia-Pinilla JM, Basurte-Elorz MT, Rodríguez-Palomares JF, Climent V, Bermudez-Jimenez FJ, Mogollón-Jiménez MV, Lopez J, Peña-Peña ML, Garcia-Alvarez A, López-Abel B, Ripoll-Vera T, Palomino-Doza J, Bayes-Genis A, Brugada R, Idiazabal U, Mirelis JG, Dominguez F, Henkens MTHM, Krapels IPC, Brunner HG, Paldino A, Zaffalon D, Mestroni L, Sinagra G, Heymans SRB, Merlo M, Garcia-Pavia P. Clinical Risk Score to Predict Pathogenic Genotypes in Patients With Dilated Cardiomyopathy. J Am Coll Cardiol 2022; 80:1115-1126. [PMID: 36109106 PMCID: PMC10804447 DOI: 10.1016/j.jacc.2022.06.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although genotyping allows family screening and influences risk-stratification in patients with nonischemic dilated cardiomyopathy (DCM) or isolated left ventricular systolic dysfunction (LVSD), its result is negative in a significant number of patients, limiting its widespread adoption. OBJECTIVES This study sought to develop and externally validate a score that predicts the probability for a positive genetic test result (G+) in DCM/LVSD. METHODS Clinical, electrocardiogram, and echocardiographic variables were collected in 1,015 genotyped patients from Spain with DCM/LVSD. Multivariable logistic regression analysis was used to identify variables independently predicting G+, which were summed to create the Madrid Genotype Score. The external validation sample comprised 1,097 genotyped patients from the Maastricht and Trieste registries. RESULTS A G+ result was found in 377 (37%) and 289 (26%) patients from the derivation and validation cohorts, respectively. Independent predictors of a G+ result in the derivation cohort were: family history of DCM (OR: 2.29; 95% CI: 1.73-3.04; P < 0.001), low electrocardiogram voltage in peripheral leads (OR: 3.61; 95% CI: 2.38-5.49; P < 0.001), skeletal myopathy (OR: 3.42; 95% CI: 1.60-7.31; P = 0.001), absence of hypertension (OR: 2.28; 95% CI: 1.67-3.13; P < 0.001), and absence of left bundle branch block (OR: 3.58; 95% CI: 2.57-5.01; P < 0.001). A score containing these factors predicted a G+ result, ranging from 3% when all predictors were absent to 79% when ≥4 predictors were present. Internal validation provided a C-statistic of 0.74 (95% CI: 0.71-0.77) and a calibration slope of 0.94 (95% CI: 0.80-1.10). The C-statistic in the external validation cohort was 0.74 (95% CI: 0.71-0.78). CONCLUSIONS The Madrid Genotype Score is an accurate tool to predict a G+ result in DCM/LVSD.
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Affiliation(s)
- Luis Escobar-Lopez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain
| | - Juan Pablo Ochoa
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain
| | - Ana Royuela
- Biostatistics Unit, Puerta de Hierro Biomedical Research Institute (IDIPHISA), CIBERESP, Madrid, Spain
| | - Job A J Verdonschot
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matteo Dal Ferro
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Maria Angeles Espinosa
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maria Sabater-Molina
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Inherited Cardiac Disease Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Maria Gallego-Delgado
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Department of Cardiology, Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, Spain
| | - Jose M Larrañaga-Moreira
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, 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
| | - Jose M Garcia-Pinilla
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Malaga, Spain
| | | | - José F Rodríguez-Palomares
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiovascular Diseases Unit, Department of Cardiology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vicente Climent
- Inherited Cardiovascular Diseases Unit, Department of Cardiology, Hospital General Universitario de Alicante, Institute of Health and Biomedical Research, Alicante, Spain
| | | | | | - Javier Lopez
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Instituto de Ciencias Del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Maria Luisa Peña-Peña
- Inherited Cardiac Diseases Unit, Hospital Universitario Virgen Del Rocío, Seville, Spain
| | - Ana Garcia-Alvarez
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; IDIBAPS, Hospital Clínic, Department of Cardiology, Universitat de Barcelona, Barcelona, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Bernardo López-Abel
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiac Diseases Unit, Cardiology Department, Hospital Universitario Son Llatzer and IdISBa, Palma de Mallorca, Spain
| | - Julian Palomino-Doza
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12. Madrid, Spain
| | - Antoni Bayes-Genis
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ramon Brugada
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Uxua Idiazabal
- Department of Cardiology, Clinica San Miguel, Pamplona, Spain
| | - Jesus G Mirelis
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain
| | - Fernando Dominguez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain
| | - Michiel T H M Henkens
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ingrid P C Krapels
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Han G Brunner
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands; GROW Institute for Developmental Biology and Cancer, Maastricht University, Maastricht, the Netherlands; Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alessia Paldino
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Denise Zaffalon
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Luisa Mestroni
- CU Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gianfranco Sinagra
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Stephane R B Heymans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands; Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Marco Merlo
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Spain.
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15
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Herrero-Galán E, Martínez-Martín I, Sánchez-González C, Vicente N, Bonzón-Kulichenko E, Calvo E, Suay-Corredera C, Pricolo MR, Fernández-Trasancos Á, Velázquez-Carreras D, Careaga CB, Abdellatif M, Sedej S, Rainer PP, Giganti D, Pérez-Jiménez R, Vázquez J, Alegre-Cebollada J. Basal oxidation of conserved cysteines modulates cardiac titin stiffness and dynamics. Redox Biol 2022; 52:102306. [PMID: 35367810 PMCID: PMC8971355 DOI: 10.1016/j.redox.2022.102306] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 01/11/2023] Open
Abstract
Titin, as the main protein responsible for the passive stiffness of the sarcomere, plays a key role in diastolic function and is a determinant factor in the etiology of heart disease. Titin stiffness depends on unfolding and folding transitions of immunoglobulin-like (Ig) domains of the I-band, and recent studies have shown that oxidative modifications of cryptic cysteines belonging to these Ig domains modulate their mechanical properties in vitro. However, the relevance of this mode of titin mechanical modulation in vivo remains largely unknown. Here, we describe the high evolutionary conservation of titin mechanical cysteines and show that they are remarkably oxidized in murine cardiac tissue. Mass spectrometry analyses indicate a similar landscape of basal oxidation in murine and human myocardium. Monte Carlo simulations illustrate how disulfides and S-thiolations on these cysteines increase the dynamics of the protein at physiological forces, while enabling load- and isoform-dependent regulation of titin stiffness. Our results demonstrate the role of conserved cysteines in the modulation of titin mechanical properties in vivo and point to potential redox-based pathomechanisms in heart disease.
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Affiliation(s)
| | | | | | - Natalia Vicente
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Elena Bonzón-Kulichenko
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Enrique Calvo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | | | | | | | | | - Simon Sedej
- Division of Cardiology, Medical University of Graz, Graz, Austria; Faculty of Medicine, University of Maribor, Maribor, Slovenia; BioTechMed Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria; BioTechMed Graz, Graz, Austria
| | - David Giganti
- Department of Biochemistry & Molecular Pharmacology and Institute for Systems Genetics, NYU Langone Health, New York, NY, United States
| | - Raúl Pérez-Jiménez
- CIC NanoGUNE BRTA, San Sebastian, Spain; Ikerbasque Foundation for Science, Bilbao, Spain
| | - Jesús Vázquez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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16
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Arbustini E, Behr ER, Carrier L, van Duijn C, Evans P, Favalli V, van der Harst P, Haugaa KH, Jondeau G, Kääb S, Kaski JP, Kavousi M, Loeys B, Pantazis A, Pinto Y, Schunkert H, Di Toro A, Thum T, Urtis M, Waltenberger J, Elliott P. Interpretation and actionability of genetic variants in cardiomyopathies: a position statement from the European Society of Cardiology Council on cardiovascular genomics. Eur Heart J 2022; 43:1901-1916. [PMID: 35089333 DOI: 10.1093/eurheartj/ehab895] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/03/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
This document describes the contribution of clinical criteria to the interpretation of genetic variants using heritable Mendelian cardiomyopathies as an example. The aim is to assist cardiologists in defining the clinical contribution to a genetic diagnosis and the interpretation of molecular genetic reports. The identification of a genetic variant of unknown or uncertain significance is a limitation of genetic testing, but current guidelines for the interpretation of genetic variants include essential contributions from clinical family screening that can establish a de novo assignment of the variant or its segregation with the phenotype in the family. A partnership between clinicians and patients helps to solve major uncertainties and provides reliable and clinically actionable information.
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Affiliation(s)
- Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elijah R Behr
- Cardiology Research Section and Cardiovascular Clinical Academic Group, Institute of Molecular and Clinical Sciences, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK
| | - Lucie Carrier
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Cornelia van Duijn
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paul Evans
- Department of Infection, Immunity and Cardiovascular Disease, and INSIGNEO Institute, University of Sheffield, Sheffield S10 2RX, UK
| | | | - Pim van der Harst
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, Oslo 0424, Norway
- University of Oslo, Boks 1072 Blindern, Oslo 0316, Norway
| | - Guillaume Jondeau
- CNMR Syndrome de Marfan et apparentés, Member of VASCERN, AP-HP Hopital Bichat, Service de Cardiologie, 46 rue Henri Huchard, Paris 75018, France
- INSERM LVTS U1148, Paris 75018, France
- Université de Paris, Paris, France
| | - Stefan Kääb
- Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany
- German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany
| | - Juan Pablo Kaski
- Institute of Cardiovascular Science, University College London, London, UK
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bart Loeys
- Cardiogenomics, Center for Medical Genetics, Antwerp University Hospital/University of Antwerp, Antwerp, Belgium
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antonis Pantazis
- The Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Yigal Pinto
- Department of Experimental Cardiology, University of Amsterdam, Amsterdam University Medical Center, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, München, Germany
- Deutsches Zentrum für Herz- und Kreislaufforschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Alessandro Di Toro
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
- Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Mario Urtis
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Johannes Waltenberger
- Department of Cardiology and Cardiovascular Medicine, Medical Faculty, University of Münster, Münster, Germany
- Cardiovascular Medicine, Hirslanden Klinik Im Park, Seestrasse 220, Zürich 8027, Switzerland
| | - Perry Elliott
- Barts Heart Centre St Bartholomew's Hospital, London, UK
- Institute for Cardiovascular Science, University College London, London, UK
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17
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Genetic Screening of a Large Panel of Genes Associated with Cardiac Disease in a Spanish Heart Transplanted Cohort. CARDIOGENETICS 2022. [DOI: 10.3390/cardiogenetics12020018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In this study we performed a next generation sequencing of 210 genes in 140 patients with cardiac failure requiring a heart transplantation. We identified a total of 48 candidate variants in 47 patients. Forty-three patients (90%) presented a single variant, and fourpatients (10%) were carriers of two variants. After refining the classification, we identified a pathogenic or likely pathogenic variant in 13 patients (10% of our cohort). In 34 additional cases (25%) the variants were classified as of unknown significance (VUS). In reference to the cause of cardiac failure in the 13 carriers of pathogenic variants, 5 were of dilated non-ischemic cause, 4 hypertrophic and 1 restrictive cardiomyopathy. In the ischemic cases (n = 3) no family history of cardiac disease was recorded, while nineof the non-ischemic had other relatives who were also diagnosed. In conclusion, the NGS of a cardiac transplanted cohort identified a definite or very likely genetic cause in 10% of the cases. Most of them had a family history of cardiac disease, and were thus previously studied as part of a routine screening by a genetic counselor. Pathogenic variants in cases without a family history of cardiac disease were mainly of ischemic origin.
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18
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Diagnostic yield of genetic testing in heart transplant recipients with prior cardiomyopathy. J Heart Lung Transplant 2022; 41:1218-1227. [PMID: 35581137 PMCID: PMC9512016 DOI: 10.1016/j.healun.2022.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 01/15/2023] Open
Abstract
Background The importance of genetic testing for cardiomyopathies has increased in the last decade. However, in heart transplant patients with former cardiomyopathy, genetic testing in retrospect is not routinely performed. We hypothesize that the yield of genetic testing in this population is considerable, and will have a major impact for both patients and relatives. Methods Patients that underwent heart transplantation (HTx) between 1995 and 2020 and were still in follow-up, were offered genetic testing if the primary etiology was non-ischemic cardiomyopathy. Next generation sequencing (NGS) of known cardiomyopathy genes was performed and variants were classified as variant of unknown significance (class 3), likely pathogenic (class 4) or pathogenic (class 5) variant. Results Of the 99 HTx patients in active follow-up, only 6 patients had a genetic diagnosis at the time of HTx. In this study, 31 selected patients with prior non-ischemic cardiomyopathy underwent genetic testing post HTx. 23/31 patients (74.2%) carried a variant that was classified as class 3 or higher. In 12/31 patients a class 4/5 variant (38.7%) was identified, and in 11/31 patients (35.5%) a class 3 variant. Class 5 Variants in TTN were the most prevalent (7/31), followed by class 5 variants in MYBPC3 (2/31). A positive family history was present in 21/31 (67.7%) and a second precipitating factor (e.g., alcohol abuse, pregnancy) was present in 17/31 patients (54.8%). Diagnostic yield of genetic testing was similar between patients with or without familial history and/or second hit. Through cascade screening 48 family members were screened for presence of a class 4/5 variant, of whom 19 (39.6%) were genotype positive, of whom 10 (52.6%) showed a cardiac phenotype. Appropriate follow-up was offered. Conclusions Genetic testing for cardiomyopathy genes established a molecular diagnosis in 38.7% of patients post HTx. These results highlight the importance of genetic testing in this population as it is still often overlooked in patients that already underwent HTx in the past. Genetic testing is highly recommended, independent of family history or second precipitating factors, as it might identify relatives at risk.
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Chen V, Knight BP, McNally EM. Case report: DSP truncation variant p. R1951X leads to arrhythmogenic left ventricular cardiomyopathy. Eur Heart J Case Rep 2022; 6:ytac105. [PMID: 35474678 PMCID: PMC9026210 DOI: 10.1093/ehjcr/ytac105] [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: 08/06/2021] [Revised: 09/21/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
Background Standardized diagnostic criteria for arrhythmogenic left ventricular cardiomyopathy (ALVC) have been recently proposed. The criteria emphasize structural left ventricle (LV) myocardial change on contrast-enhanced imaging and require the identification of gene variants associated with arrhythmogenic cardiomyopathy. Case summary A 21-year-old man presented for evaluation of exertional syncope and was found to have monomorphic ventricular tachycardia (VT) and an episode of polymorphic VT that degenerated to ventricular fibrillatory cardiac arrest. Documented premature ventricular contractions were of left bundle branch block, inferior axis morphology. Ventricular arrhythmias were successfully suppressed with β-blockade, amiodarone, and lidocaine, and a subcutaneous implantable cardioverter-defibrillator was implanted. Cardiac magnetic resonance imaging demonstrated normal-appearing right ventricle, reduced LV ejection fraction, and sub-epicardial scarring of basal-anterior and anterolateral LV segments. Endomyocardial biopsy showed lymphocytic myocarditis, and genetic testing revealed a pathogenic truncating mutation in the DSP gene, which encodes desmoplakin; this variant was also identified in the patient’s mother who carried a diagnosis of non-ischaemic cardiomyopathy. These findings are consistent with a diagnosis of ALVC. Discussion The clinical presentation of ALVC can be very dramatic. The differential for sub-epicardial LV myocardial fibrosis includes myocarditis, sarcoidosis, and in those with a suspicious family history or characteristic electrocardiogram findings, genetic cardiomyopathy. Prompt referral to a genetic counsellor can be lifesaving to patients and their family members.
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Affiliation(s)
- Vincent Chen
- Division of Cardiology, Bluhm Cardiovascular Institute, Department of Medicine , Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bradley P Knight
- Division of Cardiology, Bluhm Cardiovascular Institute, Department of Medicine , Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth M McNally
- Division of Cardiology, Bluhm Cardiovascular Institute, Department of Medicine , Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine , 303 E. Superior St. SQ6-516, Chicago, IL 60611, USA
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Vogiatzi G, Lazaros G, Oikonomou E, Lazarou E, Vavuranakis E, Tousoulis D. Role of genetic testing in cardiomyopathies: Α primer for cardiologists. World J Cardiol 2022; 14:29-39. [PMID: 35126870 PMCID: PMC8788175 DOI: 10.4330/wjc.v14.i1.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/18/2021] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
Recent advances in cardiovascular genetics have transformed genetic testing into a valuable part of management of families with inherited cardiomyopathies. As novel mutations have been identified, understanding when to consider genetic testing has emerged as an important consideration in the management of these cases. Specific genetic testing has a paramount importance in the risk stratification of family members, in the prognosis of probands at higher risk of a serious phenotype expression, and finally in the identification of new mutations, all of which are discussed in this review. The indications for each type of cardiomyopathy are described, along with the limitations of genetic testing. Finally, the importance of public sharing of variants in large data sets is emphasized. The ultimate aim of this review is to present key messages about the genetic testing process in order to minimize potential harms and provide suggestions to specialized clinicians who act as a part of a multidisciplinary team in order to offer the best care to families with inherited cardiomyopathies.
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Affiliation(s)
- Georgia Vogiatzi
- The Third Department of Cardiology, Sotiria Hospital, Athens 11527, Greece
| | - George Lazaros
- The First Department of Cardiology, Hippokration Hospital, Athens 11526, Greece
| | - Evangelos Oikonomou
- The First Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Emilia Lazarou
- The First Department of Cardiology, Hippokration Hospital, Athens 11526, Greece
| | | | - Dimitris Tousoulis
- The First Department of Cardiology, Hippokration Hospital, Athens 11526, Greece
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21
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Díez-López C, Salazar-Mendiguchía J, García-Romero E, Fuentes L, Lupón J, Bayés-Genis A, Manito N, de Antonio M, Moliner P, Zamora E, Catalá-Ruiz P, Caínzos-Achirica M, Comín-Colet J, González-Costello J. Clinical Determinants and Prognosis of Left Ventricular Reverse Remodelling in Non-Ischemic Dilated Cardiomyopathy. J Cardiovasc Dev Dis 2022; 9:jcdd9010020. [PMID: 35050230 PMCID: PMC8778173 DOI: 10.3390/jcdd9010020] [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: 11/08/2021] [Revised: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 02/01/2023] Open
Abstract
Aims: Non-ischaemic dilated cardiomyopathy (NIDCM) is characterized by left ventricular (LV) chamber enlargement and systolic dysfunction in the absence of coronary artery disease. Left ventricular reverse remodelling (LVRR) is the ability of a dilated ventricle to restore its normal size, shape and function. We sought to determine the frequency, clinical predictors and prognostic implications of LVRR, in a cohort of heart failure (HF) patients with NIDCM. Methods: We conducted a multicentre observational, retrospective cohort study of patients with NIDCM, with prospective serial echocardiography evaluations. LVRR was defined as an increase of ≥15% in left ventricular ejection fraction (LVEF) or as a LVEF increase ≥ 10% plus reduction of LV end-systolic diameter index ≥ 20%. We used multivariable logistic regression analyses to identify the baseline clinical predictors of LVRR and evaluate the prognostic impact of LVRR. Results: LVRR was achieved in 42.5% of 527 patients with NIDCM during the first year of follow-up (median LVEF 49%, median change +22%), Alcoholic aetiology, HF duration, baseline LVEF and the absence of LBBB (plus NT-proBNP levels when in the model), were the strongest predictors of LVRR. During a median follow-up of 47 months, 134 patients died (25.4%) and 7 patients (1.3%) received a heart transplant. Patients with LVRR presented better outcomes, regardless of other clinical conditions. Conclusions: In patients with NIDCM, LVRR was frequent and was associated with improved prognosis. Major clinical predictors of LVRR were alcoholic cardiomyopathy, absence of LBBB, shorter HF duration, and lower baseline LVEF and NT-proBNP levels. Our study advocates for clinical phenotyping of non-ischaemic dilated cardiomyopathy and intense gold-standard treatment optimization of patients according to current guidelines and recommendations in specialized HF units.
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Affiliation(s)
- Carles Díez-López
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (C.D.-L.); (J.S.-M.); (E.G.-R.); (N.M.); (P.C.-R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Department of Medicine, University of Barcelona, 08907 Barcelona, Spain
| | - Joel Salazar-Mendiguchía
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (C.D.-L.); (J.S.-M.); (E.G.-R.); (N.M.); (P.C.-R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
| | - Elena García-Romero
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (C.D.-L.); (J.S.-M.); (E.G.-R.); (N.M.); (P.C.-R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Lara Fuentes
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Josep Lupón
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.L.); (A.B.-G.); (E.Z.)
- CIBERCV (CB16/11/00403), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Antoni Bayés-Genis
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.L.); (A.B.-G.); (E.Z.)
- CIBERCV (CB16/11/00403), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Nicolás Manito
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (C.D.-L.); (J.S.-M.); (E.G.-R.); (N.M.); (P.C.-R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
| | - Marta de Antonio
- CIBERCV (CB16/11/00403), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Pedro Moliner
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Department of Medicine, University of Barcelona, 08907 Barcelona, Spain
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Elisabet Zamora
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.L.); (A.B.-G.); (E.Z.)
- CIBERCV (CB16/11/00403), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Pablo Catalá-Ruiz
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (C.D.-L.); (J.S.-M.); (E.G.-R.); (N.M.); (P.C.-R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Miguel Caínzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD 21093, USA;
- RTI Health Solutions, Pharmacoepidemiology and Risk Management, 08028 Barcelona, Spain
| | - Josep Comín-Colet
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Department of Medicine, University of Barcelona, 08907 Barcelona, Spain
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - José González-Costello
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (C.D.-L.); (J.S.-M.); (E.G.-R.); (N.M.); (P.C.-R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Department of Medicine, University of Barcelona, 08907 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-607-078
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Wang Y, Han B, Fan Y, Yi Y, Lv J, Wang J, Yang X, Jiang D, Zhao L, Zhang J, Yuan H. Next-Generation Sequencing Reveals Novel Genetic Variants for Dilated Cardiomyopathy in Pediatric Chinese Patients. Pediatr Cardiol 2022; 43:110-120. [PMID: 34350506 DOI: 10.1007/s00246-021-02698-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022]
Abstract
Dilated cardiomyopathy (DCM) is a myocardial disease characterized by bilateral or left ventricular cardiac dilation and systolic dysfunction that can lead to heart failure and sudden cardiac death in children. Many studies have focused on genetic variation in DCM-related genes in adult populations; however, the mutational landscape in pediatric DCM patients remains undetermined, especially in the Chinese population. We applied next-generation sequencing (NGS) technology to genetically analyze 46 pediatric DCM patients to reveal genotype-phenotype correlations. Our results indicated DCM-associated pathogenic mutations in 10 genes related to the structure or function of the sarcomere, desmosome, and cytoskeleton. We also identified 6 pathogenic mutations (5 novel) in the Titin (TTN) gene that resulted in truncated TTN variants in 6 (13%) out of 46 patients. Correlations between TTN mutations and clinical outcomes were assessed. Our data indicate that one-third of pediatric DCM cases are caused by genetic mutations. The role of TTN variants should not be underestimated in pediatric DCM and age-dependent pathogenic penetrance of these mutations should be considered for familial DCM cases. We argue that genetic testing of DCM cases is valuable for predicting disease severity, prognosis, and recurrence risk, and for screening first-degree relatives.
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Affiliation(s)
- Yan Wang
- Department of Pediatrics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, People's Republic of China
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, People's Republic of China
| | - Bo Han
- Department of Pediatrics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, People's Republic of China.
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, People's Republic of China.
| | - Youfei Fan
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, People's Republic of China
| | - Yingchun Yi
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, People's Republic of China
| | - Jianli Lv
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, People's Republic of China
| | - Jing Wang
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, People's Republic of China
| | - Xiaofei Yang
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, People's Republic of China
| | - Diandong Jiang
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, People's Republic of China
| | - Lijian Zhao
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, People's Republic of China
| | - Jianjun Zhang
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, People's Republic of China
| | - Hui Yuan
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, People's Republic of China
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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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The Role of Z-disc Proteins in Myopathy and Cardiomyopathy. Int J Mol Sci 2021; 22:ijms22063058. [PMID: 33802723 PMCID: PMC8002584 DOI: 10.3390/ijms22063058] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
The Z-disc acts as a protein-rich structure to tether thin filament in the contractile units, the sarcomeres, of striated muscle cells. Proteins found in the Z-disc are integral for maintaining the architecture of the sarcomere. They also enable it to function as a (bio-mechanical) signalling hub. Numerous proteins interact in the Z-disc to facilitate force transduction and intracellular signalling in both cardiac and skeletal muscle. This review will focus on six key Z-disc proteins: α-actinin 2, filamin C, myopalladin, myotilin, telethonin and Z-disc alternatively spliced PDZ-motif (ZASP), which have all been linked to myopathies and cardiomyopathies. We will summarise pathogenic variants identified in the six genes coding for these proteins and look at their involvement in myopathy and cardiomyopathy. Listing the Minor Allele Frequency (MAF) of these variants in the Genome Aggregation Database (GnomAD) version 3.1 will help to critically re-evaluate pathogenicity based on variant frequency in normal population cohorts.
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25
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Auxerre-Plantié E, Nielsen T, Grunert M, Olejniczak O, Perrot A, Özcelik C, Harries D, Matinmehr F, Dos Remedios C, Mühlfeld C, Kraft T, Bodmer R, Vogler G, Sperling SR. Identification of MYOM2 as a candidate gene in hypertrophic cardiomyopathy and Tetralogy of Fallot, and its functional evaluation in the Drosophila heart. Dis Model Mech 2020; 13:dmm045377. [PMID: 33033063 PMCID: PMC7758640 DOI: 10.1242/dmm.045377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/01/2020] [Indexed: 01/11/2023] Open
Abstract
The causal genetic underpinnings of congenital heart diseases, which are often complex and multigenic, are still far from understood. Moreover, there are also predominantly monogenic heart defects, such as cardiomyopathies, with known disease genes for the majority of cases. In this study, we identified mutations in myomesin 2 (MYOM2) in patients with Tetralogy of Fallot (TOF), the most common cyanotic heart malformation, as well as in patients with hypertrophic cardiomyopathy (HCM), who do not exhibit any mutations in the known disease genes. MYOM2 is a major component of the myofibrillar M-band of the sarcomere, and a hub gene within interactions of sarcomere genes. We show that patient-derived cardiomyocytes exhibit myofibrillar disarray and reduced passive force with increasing sarcomere lengths. Moreover, our comprehensive functional analyses in the Drosophila animal model reveal that the so far uncharacterized fly gene CG14964 [herein referred to as Drosophila myomesin and myosin binding protein (dMnM)] may be an ortholog of MYOM2, as well as other myosin binding proteins. Its partial loss of function or moderate cardiac knockdown results in cardiac dilation, whereas more severely reduced function causes a constricted phenotype and an increase in sarcomere myosin protein. Moreover, compound heterozygous combinations of CG14964 and the sarcomere gene Mhc (MYH6/7) exhibited synergistic genetic interactions. In summary, our results suggest that MYOM2 not only plays a critical role in maintaining robust heart function but may also be a candidate gene for heart diseases such as HCM and TOF, as it is clearly involved in the development of the heart.This article has an associated First Person interview with Emilie Auxerre-Plantié and Tanja Nielsen, joint first authors of the paper.
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Affiliation(s)
- Emilie Auxerre-Plantié
- Cardiovascular Genetics, Charité - Universitätsmedizin Berlin, 13125 Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Tanja Nielsen
- Cardiovascular Genetics, Charité - Universitätsmedizin Berlin, 13125 Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Development, Aging and Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
- Department of Biology, Chemistry, and Pharmacy, Freie Universität Berlin, 14195 Berlin, Germany
| | - Marcel Grunert
- Cardiovascular Genetics, Charité - Universitätsmedizin Berlin, 13125 Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Olga Olejniczak
- Cardiovascular Genetics, Charité - Universitätsmedizin Berlin, 13125 Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Department of Biology, Chemistry, and Pharmacy, Freie Universität Berlin, 14195 Berlin, Germany
| | - Andreas Perrot
- Cardiovascular Genetics, Charité - Universitätsmedizin Berlin, 13125 Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, 13125 Berlin, Germany
| | - Cemil Özcelik
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, 13125 Berlin, Germany
| | - Dennis Harries
- Medical School of Hannover, Institute of Molecular and Cell Physiology, 30625 Hannover, Germany
| | - Faramarz Matinmehr
- Medical School of Hannover, Institute of Molecular and Cell Physiology, 30625 Hannover, Germany
| | - Cristobal Dos Remedios
- Anatomy and Histology, School of Medical Sciences, Bosch Institute, University of Sydney, Camperdown, Sydney, New South Wales 2006, Australia
| | - Christian Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School, 30625 Hannover, Germany
| | - Theresia Kraft
- Medical School of Hannover, Institute of Molecular and Cell Physiology, 30625 Hannover, Germany
| | - Rolf Bodmer
- Development, Aging and Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Georg Vogler
- Cardiovascular Genetics, Charité - Universitätsmedizin Berlin, 13125 Berlin, Germany
- Development, Aging and Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Silke R Sperling
- Cardiovascular Genetics, Charité - Universitätsmedizin Berlin, 13125 Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Department of Biology, Chemistry, and Pharmacy, Freie Universität Berlin, 14195 Berlin, Germany
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Possible Susceptibility Genes for Intervention against Chemotherapy-Induced Cardiotoxicity. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:4894625. [PMID: 33110473 PMCID: PMC7578723 DOI: 10.1155/2020/4894625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/07/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022]
Abstract
Recent therapeutic advances have significantly improved the short- and long-term survival rates in patients with heart disease and cancer. Survival in cancer patients may, however, be accompanied by disadvantages, namely, increased rates of cardiovascular events. Chemotherapy-related cardiac dysfunction is an important side effect of anticancer therapy. While advances in cancer treatment have increased patient survival, treatments are associated with cardiovascular complications, including heart failure (HF), arrhythmias, cardiac ischemia, valve disease, pericarditis, and fibrosis of the pericardium and myocardium. The molecular mechanisms of cardiotoxicity caused by cancer treatment have not yet been elucidated, and they may be both varied and complex. By identifying the functional genetic variations responsible for this toxicity, we may be able to improve our understanding of the potential mechanisms and pathways of treatment, paving the way for the development of new therapies to target these toxicities. Data from studies on genetic defects and pharmacological interventions have suggested that many molecules, primarily those regulating oxidative stress, inflammation, autophagy, apoptosis, and metabolism, contribute to the pathogenesis of cardiotoxicity induced by cancer treatment. Here, we review the progress of genetic research in illuminating the molecular mechanisms of cancer treatment-mediated cardiotoxicity and provide insights for the research and development of new therapies to treat or even prevent cardiotoxicity in patients undergoing cancer treatment. The current evidence is not clear about the role of pharmacogenomic screening of susceptible genes. Further studies need to done in chemotherapy-induced cardiotoxicity.
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27
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Abstract
PURPOSE OF REVIEW Dilated cardiomyopathy (DCM) frequently involves an underlying genetic etiology, but the clinical approach for genetic diagnosis and application of results in clinical practice can be complex. RECENT FINDINGS International sequence databases described the landscape of genetic variability across populations, which informed guidelines for the interpretation of DCM gene variants. New evidence indicates that loss-of-function mutations in filamin C (FLNC) contribute to DCM and portend high risk of ventricular arrhythmia. A clinical framework aids in referring patients for DCM genetic testing and applying results to patient care. Results of genetic testing can change medical management, particularly in a subset of genes that increase risk for life-threatening ventricular arrhythmias, and can influence decisions for defibrillator therapy. Clinical screening and cascade genetic testing of family members should be diligently pursued to identify those at risk of developing DCM.
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Affiliation(s)
- Lisa D Wilsbacher
- Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg School of Medicine, Simpson Querrey Biomedical Research Center 8-404, 303 E. Superior St, Chicago, IL, 60611, USA.
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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28
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Peña-Peña ML, Ochoa JP, Barriales-Villa R, Cicerchia M, Palomino-Doza J, Salazar-Mendiguchia J, Lamounier A, Trujillo JP, Garcia-Giustiniani D, Fernandez X, Ortiz-Genga M, Monserrat L, Crespo-Leiro MG. Clinical utility of genetic testing in patients with dilated cardiomyopathy. Med Clin (Barc) 2020; 156:485-495. [PMID: 32826072 DOI: 10.1016/j.medcli.2020.05.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES Dilated cardiomyopathy (DCM) is the most frequent cause of heart transplantation. The prevalence of familial disease can reach 50%. Our objective was to describe the genetic basis of DCM in a cohort with a high proportion of transplanted patients. METHODS We included patients with DCM and genetic testing performed using next-generation sequencing (NGS) that included at least 80 genes. Clinical data, family history and genetic results were retrospectively analysed. When possible, assessment of first-degree relatives was carried out. RESULTS Eighty-seven DCM patients and 308 relatives from 70 families were evaluated. Clinical prevalence of familial disease was 37% (32 patients). Forty-four percent of patients (38 patients) had required heart transplantation. A relevant variant was found in 43 patients (49%), 25 patients (29%) carried variants of unknown significance and in 19 patients (22%) the study was negative. Most genetic variants were found in sarcomeric genes and the yield of genetic testing was higher in patients with familial DCM. CONCLUSIONS The yield of genetic testing in our DCM cohort was high, reaching 69% in familial cases. Mutational spectrum was heterogeneous and the identification of the specific aetiology of the disease often provided prognostic information.
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Affiliation(s)
- Maria Luisa Peña-Peña
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, España; Universidad de A Coruña (UDC), A Coruña, España.
| | - Juan Pablo Ochoa
- Instituto de Investigación Biomédica de A Coruña (INIBIC), Comité Científico, Health in Code, A Coruña, España
| | - Roberto Barriales-Villa
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), Universidad de A Coruña (UDC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| | - Marcos Cicerchia
- Instituto de Investigación Biomédica de A Coruña (INIBIC), Comité Científico, Health in Code, A Coruña, España
| | - Julián Palomino-Doza
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Joel Salazar-Mendiguchia
- Instituto de Investigación Biomédica de A Coruña (INIBIC), Comité Científico, Health in Code, A Coruña, España
| | - Arsonval Lamounier
- Instituto de Investigación Biomédica de A Coruña (INIBIC), Comité Científico, Health in Code, A Coruña, España
| | - Juan Pablo Trujillo
- Instituto de Investigación Biomédica de A Coruña (INIBIC), Comité Científico, Health in Code, A Coruña, España
| | - Diego Garcia-Giustiniani
- Instituto de Investigación Biomédica de A Coruña (INIBIC), Comité Científico, Health in Code, A Coruña, España
| | - Xusto Fernandez
- Instituto de Investigación Biomédica de A Coruña (INIBIC), Comité Científico, Health in Code, A Coruña, España
| | - Martin Ortiz-Genga
- Instituto de Investigación Biomédica de A Coruña (INIBIC), Comité Científico, Health in Code, A Coruña, España
| | - Lorenzo Monserrat
- Instituto de Investigación Biomédica de A Coruña (INIBIC), Comité Científico, Health in Code, A Coruña, España
| | - Maria Generosa Crespo-Leiro
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), Universidad de A Coruña (UDC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
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29
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Verdonschot JAJ, Vanhoutte EK, Claes GRF, Helderman-van den Enden ATJM, Hoeijmakers JGJ, Hellebrekers DMEI, de Haan A, Christiaans I, Lekanne Deprez RH, Boen HM, van Craenenbroeck EM, Loeys BL, Hoedemaekers YM, Marcelis C, Kempers M, Brusse E, van Waning JI, Baas AF, Dooijes D, Asselbergs FW, Barge-Schaapveld DQCM, Koopman P, van den Wijngaard A, Heymans SRB, Krapels IPC, Brunner HG. A mutation update for the FLNC gene in myopathies and cardiomyopathies. Hum Mutat 2020; 41:1091-1111. [PMID: 32112656 PMCID: PMC7318287 DOI: 10.1002/humu.24004] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/12/2020] [Accepted: 02/25/2020] [Indexed: 12/11/2022]
Abstract
Filamin C (FLNC) variants are associated with cardiac and muscular phenotypes. Originally, FLNC variants were described in myofibrillar myopathy (MFM) patients. Later, high‐throughput screening in cardiomyopathy cohorts determined a prominent role for FLNC in isolated hypertrophic and dilated cardiomyopathies (HCM and DCM). FLNC variants are now among the more prevalent causes of genetic DCM. FLNC‐associated DCM is associated with a malignant clinical course and a high risk of sudden cardiac death. The clinical spectrum of FLNC suggests different pathomechanisms related to variant types and their location in the gene. The appropriate functioning of FLNC is crucial for structural integrity and cell signaling of the sarcomere. The secondary protein structure of FLNC is critical to ensure this function. Truncating variants with subsequent haploinsufficiency are associated with DCM and cardiac arrhythmias. Interference with the dimerization and folding of the protein leads to aggregate formation detrimental for muscle function, as found in HCM and MFM. Variants associated with HCM are predominantly missense variants, which cluster in the ROD2 domain. This domain is important for binding to the sarcomere and to ensure appropriate cell signaling. We here review FLNC genotype–phenotype correlations based on available evidence.
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Affiliation(s)
- Job A J Verdonschot
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Els K Vanhoutte
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Godelieve R F Claes
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Debby M E I Hellebrekers
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Amber de Haan
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Imke Christiaans
- Department of Clinical Genetics, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Clinical Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ronald H Lekanne Deprez
- Department of Clinical Genetics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Hanne M Boen
- Department of Cardiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | | | - Bart L Loeys
- Department of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Yvonne M Hoedemaekers
- Department of Clinical Genetics, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Carlo Marcelis
- Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marlies Kempers
- Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jaap I van Waning
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Annette F Baas
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis Dooijes
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Arthur van den Wijngaard
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stephane R B Heymans
- Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium.,The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Ingrid P C Krapels
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Han G Brunner
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Genetics and Cell Biology, GROW Institute for Developmental Biology and Cancer, Maastricht University Medical Centre, Maastricht, The Netherlands
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30
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Figueira Gonçalves JM. Patología cardiovascular en el paciente con enfermedad pulmonar obstructiva crónica de las islas Canarias. «El mojo picón de nuestras papas». Arch Bronconeumol 2020; 56:57-58. [DOI: 10.1016/j.arbres.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
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31
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Dilated Cardiomyopathy Due to BLC2-Associated Athanogene 3 (BAG3) Mutations. J Am Coll Cardiol 2019; 72:2471-2481. [PMID: 30442290 DOI: 10.1016/j.jacc.2018.08.2181] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND The BAG3 (BLC2-associated athanogene 3) gene codes for an antiapoptotic protein located on the sarcomere Z-disc. Mutations in BAG3 are associated with dilated cardiomyopathy (DCM), but only a small number of cases have been reported to date, and the natural history of BAG3 cardiomyopathy is poorly understood. OBJECTIVES This study sought to describe the phenotype and prognosis of BAG3 mutations in a large multicenter DCM cohort. METHODS The study cohort comprised 129 individuals with a BAG3 mutation (62% males, 35.1 ± 15.0 years of age) followed at 18 European centers. Localization of BAG3 in cardiac tissue was analyzed in patients with truncating BAG3 mutations using immunohistochemistry. RESULTS At first evaluation, 57.4% of patients had DCM. After a median follow-up of 38 months (interquartile range: 7 to 95 months), 68.4% of patients had DCM and 26.1% who were initially phenotype-negative developed DCM. Disease penetrance in individuals >40 years of age was 80% at last evaluation, and there was a trend towards an earlier onset of DCM in men (age 34.6 ± 13.2 years vs. 40.7 ± 12.2 years; p = 0.053). The incidence of adverse cardiac events (death, left ventricular assist device, heart transplantation, and sustained ventricular arrhythmia) was 5.1% per year among individuals with DCM. Male sex, decreased left ventricular ejection fraction. and increased left ventricular end-diastolic diameter were associated with adverse cardiac events. Myocardial tissue from patients with a BAG3 mutation showed myofibril disarray and a relocation of BAG3 protein in the sarcomeric Z-disc. CONCLUSIONS DCM caused by mutations in BAG3 is characterized by high penetrance in carriers >40 years of age and a high risk of progressive heart failure. Male sex, decreased left ventricular ejection fraction, and enlarged left ventricular end-diastolic diameter are associated with adverse outcomes in patients with BAG3 mutations.
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32
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Lamounier Júnior A, Ferrari F, Max R, Ritt LEF, Stein R. Importance of Genetic Testing in Dilated Cardiomyopathy: Applications and Challenges in Clinical Practice. Arq Bras Cardiol 2019; 113:274-281. [PMID: 31483024 PMCID: PMC6777894 DOI: 10.5935/abc.20190144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/13/2019] [Accepted: 04/10/2019] [Indexed: 12/29/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is a clinical syndrome characterized by left ventricular dilatation and contractile dysfunction. It is the most common cause of heart failure in young adults. The advent of next-generation sequencing has contributed to the discovery of a large amount of genomic data related to DCM. Mutations involving genes that encode cytoskeletal proteins, the sarcomere, and ion channels account for approximately 40% of cases previously classified as idiopathic DCM. In this scenario, geneticists and cardiovascular genetics specialists have begun to work together, building knowledge and establishing more accurate diagnoses. However, proper interpretation of genetic results is essential and multidisciplinary teams dedicated to the management and analysis of the obtained information should be considered. In this review, we approach genetic factors associated with DCM and their prognostic relevance and discuss how the use of genetic testing, when well recommended, can help cardiologists in the decision-making process.
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Affiliation(s)
- Arsonval Lamounier Júnior
- Health in Code S.L., Scientific Department, A Coruña -
Spain
- Universidade da Coruña, GRINCAR (Cardiovascular Research
Group), A Coruña - Spain
| | - Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, Hospital
de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto
Alegre, RS - Brazil
- Exercise Cardiology Research Group (CardioEx), Hospital de
Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto
Alegre, RS - Brazil
| | - Renato Max
- Hospital Universitário Onofre Lopes, Natal, RN - Brazil
| | - Luiz Eduardo Fonteles Ritt
- Escola Bahiana de Medicina e Saúde Pública, Salvador,
BA - Brazil
- Hospital Cárdio Pulmonar, Salvador, BA - Brazil
| | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, Hospital
de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto
Alegre, RS - Brazil
- Exercise Cardiology Research Group (CardioEx), Hospital de
Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto
Alegre, RS - Brazil
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33
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HAND2 loss-of-function mutation causes familial dilated cardiomyopathy. Eur J Med Genet 2019; 62:103540. [DOI: 10.1016/j.ejmg.2018.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/29/2018] [Accepted: 09/10/2018] [Indexed: 12/29/2022]
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34
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Martins E, Sousa A, Canedo P, Leite S, Pinto R, Campelo M, Amorim S, Moura B, Lopes JM, Machado JC, Silva Cardoso J. Genetic variants identified by target next-generation sequencing in heart transplant patients with dilated cardiomyopathy. Rev Port Cardiol 2019; 38:441-447. [PMID: 31303467 DOI: 10.1016/j.repc.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 02/03/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Dilated cardiomyopathy (DCM) is a myocardial disease that can progress to a terminal stage, requiring heart transplantation. In this work we aim to contribute to knowledge of genetic variants in adult patients undergoing heart transplantation due to end-stage DCM, reporting the results obtained in our single-center tertiary hospital series using target next-generation sequencing (NGS). METHODS AND RESULTS Genetic variants were screened in 15 genes, preselected based on variants previously identified in DCM patients. Thirteen unrelated patients were included, nine (69%) male, mean age at diagnosis 33±13 years, eight (62%) with familial DCM. Nine genetic variants were identified in six (46%) patients: five in LMNA, two in LBD3, one in TNNT2 and one in TCAP. These variants were new in most patients. The majority were classified as of uncertain significance. Two patients were double and triple heterozygotes in the LBD3 and LMNA genes, respectively. CONCLUSION Our results highlight the potential of NGS in the genetic characterization of DCM patients. LMNA is one of the most frequently mutated genes and should be included in all target gene assessments of end-stage DCM patients until more data are available.
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Affiliation(s)
- Elisabete Martins
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Institute for Innovation and Health Research (I3S), Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.
| | - Alexandra Sousa
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Center for Research in Health Technologies and Services (Cintesis), Porto, Portugal; Department of Cardiology, Santa Maria Maior Hospital, Barcelos, Portugal
| | - Paulo Canedo
- Institute for Innovation and Health Research (I3S), Porto, Portugal
| | - Sérgio Leite
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - Roberto Pinto
- Department of Cardiology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Manuel Campelo
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Center for Research in Health Technologies and Services (Cintesis), Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Sandra Amorim
- Center for Research in Health Technologies and Services (Cintesis), Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | | | - José Manuel Lopes
- Institute for Innovation and Health Research (I3S), Porto, Portugal; Department of Pathology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Departament de Pathology and Oncology, Faculty of Medicine, Porto, Portugal
| | - José Carlos Machado
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Institute for Innovation and Health Research (I3S), Porto, Portugal
| | - José Silva Cardoso
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Center for Research in Health Technologies and Services (Cintesis), Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
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35
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Garcia-Pavia P, Kim Y, Restrepo-Cordoba MA, Lunde IG, Wakimoto H, Smith AM, Toepfer CN, Getz K, Gorham J, Patel P, Ito K, Willcox JA, Arany Z, Li J, Owens AT, Govind R, Nuñez B, Mazaika E, Bayes-Genis A, Walsh R, Finkelman B, Lupon J, Whiffin N, Serrano I, Midwinter W, Wilk A, Bardaji A, Ingold N, Buchan R, Tayal U, Pascual-Figal DA, de Marvao A, Ahmad M, Garcia-Pinilla JM, Pantazis A, Dominguez F, John Baksi A, O’Regan DP, Rosen SD, Prasad SK, Lara-Pezzi E, Provencio M, Lyon AR, Alonso-Pulpon L, Cook SA, DePalma SR, Barton PJ, Aplenc R, Seidman JG, Ky B, Ware JS, Seidman CE. Genetic Variants Associated With Cancer Therapy-Induced Cardiomyopathy. Circulation 2019; 140:31-41. [PMID: 30987448 PMCID: PMC6613726 DOI: 10.1161/circulationaha.118.037934] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cancer therapy-induced cardiomyopathy (CCM) is associated with cumulative drug exposures and preexisting cardiovascular disorders. These parameters incompletely account for substantial interindividual susceptibility to CCM. We hypothesized that rare variants in cardiomyopathy genes contribute to CCM. METHODS We studied 213 patients with CCM from 3 cohorts: retrospectively recruited adults with diverse cancers (n=99), prospectively phenotyped adults with breast cancer (n=73), and prospectively phenotyped children with acute myeloid leukemia (n=41). Cardiomyopathy genes, including 9 prespecified genes, were sequenced. The prevalence of rare variants was compared between CCM cohorts and The Cancer Genome Atlas participants (n=2053), healthy volunteers (n=445), and an ancestry-matched reference population. Clinical characteristics and outcomes were assessed and stratified by genotypes. A prevalent CCM genotype was modeled in anthracycline-treated mice. RESULTS CCM was diagnosed 0.4 to 9 years after chemotherapy; 90% of these patients received anthracyclines. Adult patients with CCM had cardiovascular risk factors similar to the US population. Among 9 prioritized genes, patients with CCM had more rare protein-altering variants than comparative cohorts ( P≤1.98e-04). Titin-truncating variants (TTNtvs) predominated, occurring in 7.5% of patients with CCM versus 1.1% of The Cancer Genome Atlas participants ( P=7.36e-08), 0.7% of healthy volunteers ( P=3.42e-06), and 0.6% of the reference population ( P=5.87e-14). Adult patients who had CCM with TTNtvs experienced more heart failure and atrial fibrillation ( P=0.003) and impaired myocardial recovery ( P=0.03) than those without. Consistent with human data, anthracycline-treated TTNtv mice and isolated TTNtv cardiomyocytes showed sustained contractile dysfunction unlike wild-type ( P=0.0004 and P<0.002, respectively). CONCLUSIONS Unrecognized rare variants in cardiomyopathy-associated genes, particularly TTNtvs, increased the risk for CCM in children and adults, and adverse cardiac events in adults. Genotype, along with cumulative chemotherapy dosage and traditional cardiovascular risk factors, improves the identification of patients who have cancer at highest risk for CCM. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01173341; AAML1031; NCT01371981.
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Affiliation(s)
- Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro, Madrid, Spain (P.G.-P., M.A.R.-C., F.D., L.A.-P.)
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
- University Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain (P.G.-P.)
| | - Yuri Kim
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
- Massachusetts General Hospital, Boston (Y.K.)
| | - Maria Alejandra Restrepo-Cordoba
- Hospital Universitario Puerta de Hierro, Madrid, Spain (P.G.-P., M.A.R.-C., F.D., L.A.-P.)
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
| | - Ida G. Lunde
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
- Oslo University Hospital and University of Oslo, Norway (I.G.L.)
| | - Hiroko Wakimoto
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
| | - Amanda M. Smith
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Christopher N. Toepfer
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
- University of Oxford (C.N.T.)
| | - Kelly Getz
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Joshua Gorham
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
| | - Parth Patel
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
- Brigham and Women's Hospital, Boston MA (P.P., C.E.S.)
| | - Kaoru Ito
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
| | - Jonathan A. Willcox
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
| | - Zoltan Arany
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Jian Li
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Anjali T. Owens
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Risha Govind
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Beatriz Nuñez
- Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Spain (B.N., M.P.)
| | - Erica Mazaika
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Antoni Bayes-Genis
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
- Hospital Universitario Germans Trias i Pujol, Badalona, Spain (A.B.-G., J. Lupon)
| | - Roddy Walsh
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Brian Finkelman
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Josep Lupon
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
- Hospital Universitario Germans Trias i Pujol, Badalona, Spain (A.B.-G., J. Lupon)
| | - Nicola Whiffin
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
- MRC London Institute of Medical Sciences, Imperial College UK (N.W., D.P.O., S.A.C., J.S.W., C.E.S., A.d.M.)
| | - Isabel Serrano
- Hospital Universitario de Tarragona Joan XXIII. IISPV, Rovira Virgili University, Spain (I.S., A.B.)
| | - William Midwinter
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Alicja Wilk
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Alfredo Bardaji
- Hospital Universitario de Tarragona Joan XXIII. IISPV, Rovira Virgili University, Spain (I.S., A.B.)
| | - Nathan Ingold
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Rachel Buchan
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Upasana Tayal
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Domingo A. Pascual-Figal
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
- Hospital Universitario Virgen de la Arrixaca, University of Murcia. Spain (D.A.P.-F.)
| | - Antonio de Marvao
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
- MRC London Institute of Medical Sciences, Imperial College UK (N.W., D.P.O., S.A.C., J.S.W., C.E.S., A.d.M.)
| | - Mian Ahmad
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Jose Manuel Garcia-Pinilla
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
- Hospital Universitario Virgen de la Victoria, IBIMA, Malaga, Spain (J.M.G.-P.)
| | - Antonis Pantazis
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Fernando Dominguez
- Hospital Universitario Puerta de Hierro, Madrid, Spain (P.G.-P., M.A.R.-C., F.D., L.A.-P.)
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
| | - A. John Baksi
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Declan P. O’Regan
- MRC London Institute of Medical Sciences, Imperial College UK (N.W., D.P.O., S.A.C., J.S.W., C.E.S., A.d.M.)
| | - Stuart D. Rosen
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Sanjay K. Prasad
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Enrique Lara-Pezzi
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (E.L.-P.)
| | - Mariano Provencio
- Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Spain (B.N., M.P.)
| | - Alexander R. Lyon
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Luis Alonso-Pulpon
- Hospital Universitario Puerta de Hierro, Madrid, Spain (P.G.-P., M.A.R.-C., F.D., L.A.-P.)
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
| | - Stuart A. Cook
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- MRC London Institute of Medical Sciences, Imperial College UK (N.W., D.P.O., S.A.C., J.S.W., C.E.S., A.d.M.)
- National Heart Centre Singapore and Duke-National University of Singapore (S.A.C.)
| | - Steven R. DePalma
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
- Howard Hughes Medical Institute, Chevy Chase, MD (S.R.D., C.E.S.)
| | - Paul J.R. Barton
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Richard Aplenc
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Jonathan G. Seidman
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
| | - Bonnie Ky
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - James S. Ware
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
- MRC London Institute of Medical Sciences, Imperial College UK (N.W., D.P.O., S.A.C., J.S.W., C.E.S., A.d.M.)
| | - Christine E. Seidman
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
- MRC London Institute of Medical Sciences, Imperial College UK (N.W., D.P.O., S.A.C., J.S.W., C.E.S., A.d.M.)
- Howard Hughes Medical Institute, Chevy Chase, MD (S.R.D., C.E.S.)
- Brigham and Women's Hospital, Boston MA (P.P., C.E.S.)
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Genetic variants identified by target next-generation sequencing in heart transplant patients with dilated cardiomyopathy. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Peña-Peña ML, Monserrat L. Papel de la genética en la estratificación del riesgo de pacientes con miocardiopatía dilatada no isquémica. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Peña-Peña ML, Monserrat L. Risk Stratification in Patients With Nonisquemic Dilated Cardiomyopathy. The Role of Genetic Testing. ACTA ACUST UNITED AC 2019; 72:333-340. [PMID: 30792015 DOI: 10.1016/j.rec.2018.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/24/2018] [Indexed: 12/28/2022]
Abstract
Dilated cardiomyopathy is inherited in nearly 50% of cases. More than 90 genes have been associated with this disease, which is one of the main causes of heart transplant and has been associated with an increased risk of sudden cardiac death. Risk stratification in these patients continues to be challenging. The identification of the specific etiology of the disease is very useful for the early detection of mutation carriers. Genetic study often provides prognostic information and can determine the therapeutic approach. Wide phenotypic variability is observed depending on the mutated gene, the type of mutation, and the presence of additional genetic and environmental factors.
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Affiliation(s)
- Maria Luisa Peña-Peña
- Unidad de Cardiopatías Familiares, Departamento de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain; Departamento de Cardiología, Health in Code, A Coruña, Spain.
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Faridi R, Tona R, Brofferio A, Hoa M, Olszewski R, Schrauwen I, Assir MZ, Bandesha AA, Khan AA, Rehman AU, Brewer C, Ahmed W, Leal SM, Riazuddin S, Boyden SE, Friedman TB. Mutational and phenotypic spectra of KCNE1 deficiency in Jervell and Lange-Nielsen Syndrome and Romano-Ward Syndrome. Hum Mutat 2019; 40:162-176. [PMID: 30461122 PMCID: PMC6328321 DOI: 10.1002/humu.23689] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/01/2018] [Accepted: 11/15/2018] [Indexed: 11/11/2022]
Abstract
KCNE1 encodes a regulatory subunit of the KCNQ1 potassium channel-complex. Both KCNE1 and KCNQ1 are necessary for normal hearing and cardiac ventricular repolarization. Recessive variants in these genes are associated with Jervell and Lange-Nielson syndrome (JLNS1 and JLNS2), a cardio-auditory syndrome characterized by congenital profound sensorineural deafness and a prolonged QT interval that can cause ventricular arrhythmias and sudden cardiac death. Some normal-hearing carriers of heterozygous missense variants of KCNE1 and KCNQ1 have prolonged QT intervals, a dominantly inherited phenotype designated Romano-Ward syndrome (RWS), which is also associated with arrhythmias and elevated risk of sudden death. Coassembly of certain mutant KCNE1 monomers with wild-type KCNQ1 subunits results in RWS by a dominant negative mechanism. This paper reviews variants of KCNE1 and their associated phenotypes, including biallelic truncating null variants of KCNE1 that have not been previously reported. We describe three homozygous nonsense mutations of KCNE1 segregating in families ascertained ostensibly for nonsyndromic deafness: c.50G>A (p.Trp17*), c.51G>A (p.Trp17*), and c.138C>A (p.Tyr46*). Some individuals carrying missense variants of KCNE1 have RWS. However, heterozygotes for loss-of-function variants of KCNE1 may have normal QT intervals while biallelic null alleles are associated with JLNS2, indicating a complex genotype-phenotype spectrum for KCNE1 variants.
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Affiliation(s)
- Rabia Faridi
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
- National Centre of Excellence in Molecular Biology, University of the Punjab, Lahore 54550, Pakistan
| | - Risa Tona
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Alessandra Brofferio
- Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA
| | - Michael Hoa
- Auditory Development and Restoration Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rafal Olszewski
- Auditory Development and Restoration Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Isabelle Schrauwen
- Center for Statistical Genetics, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Muhammad Z.K. Assir
- Allama Iqbal Medical Research Centre, Jinnah Hospital Complex, Lahore 54550, Pakistan
| | - Akhtar A. Bandesha
- Cardiology Department, The Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Asma A. Khan
- National Centre of Excellence in Molecular Biology, University of the Punjab, Lahore 54550, Pakistan
| | - Atteeq U. Rehman
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Carmen Brewer
- Audiology Unit, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health, Bethesda, MD 20892, USA
| | - Wasim Ahmed
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan
| | - Suzanne M. Leal
- Center for Statistical Genetics, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sheikh Riazuddin
- Allama Iqbal Medical Research Centre, Jinnah Hospital Complex, Lahore 54550, Pakistan
| | - Steven E. Boyden
- Section on Genetics of Communication Disorders, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Thomas B. Friedman
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
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Molecular analysis of inherited cardiomyopathy using next generation semiconductor sequencing technologies. J Transl Med 2018; 16:241. [PMID: 30165862 PMCID: PMC6117967 DOI: 10.1186/s12967-018-1605-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/13/2018] [Indexed: 01/16/2023] Open
Abstract
Background Cardiomyopathies are the most common clinical and genetic heterogeneity cardiac diseases, and genetic contribution in particular plays a major role in patients with primary cardiomyopathies. The aim of this study is to investigate cases of inherited cardiomyopathy (IC) for potential disease-causing mutations in 64 genes reported to be associated with IC. Methods A total of 110 independent cases or families diagnosed with various primary cardiomyopathies, including hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, left ventricular non-compaction, and undefined cardiomyopathy, were collected after informed consent. A custom designed panel, including 64 genes, was screened using next generation sequencing on the Ion Torrent PGM platform. The best candidate disease-causing variants were verified by Sanger sequencing. Results A total of 78 variants in 73 patients were identified. After excluding the variants predicted to be benign and VUS, 26 pathogenic or likely pathogenic variants were verified in 26 probands (23.6%), including a homozygous variant in the SLC25A4 gene. Of these variants, 15 have been reported in the Human Gene Mutation Database or ClinVar database, while 11 are novel. The majority of variants were observed in the MYH7 (8/26) and MYBPC3 (6/26) gene. Titin (TTN) truncating mutations account for 13% in our dilated cardiomyopathy cases (3/23). Conclusions This study provides an overview of the genetic aberrations in this cohort of Chinese IC patients and demonstrates the power of next generation sequencing in IC. Genetic results can provide precise clinical diagnosis and guidance regarding medical care for some individuals. Electronic supplementary material The online version of this article (10.1186/s12967-018-1605-5) contains supplementary material, which is available to authorized users.
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Plasma microRNAs as biomarkers for Lamin A/C-related dilated cardiomyopathy. J Mol Med (Berl) 2018; 96:845-856. [PMID: 30008018 DOI: 10.1007/s00109-018-1666-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 12/21/2022]
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Abstract
PURPOSE OF REVIEW As rapid genetic testing has become increasingly accessible in a timely fashion, more genetic mutations are identified in inherited conditions such as cardiomyopathies. Understanding when to consider genetic testing is an important part of the management of patients whose presentations vary from decompensated heart failure to sudden cardiac death. RECENT FINDINGS We describe the benefits of genetic testing for risk stratification of family members, prognostication of probands, and identification of novel disease-causing mutations and examine the possible role of genetic predisposition in seemingly acquired cardiomyopathies such as peripartum and anthracycline-induced cardiomyopathy. SUMMARY Genetic screening for the recognition of family members who have inherited a cardiomyopathy is important, and testing may identify patients at higher risk of sudden death. However, genetic testing does have its limitations, such as the identification of variants of unknown significance that often complicate the clinical picture.
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Lamp M, Origone P, Geroldi A, Verdiani S, Gotta F, Caponnetto C, Devigili G, Verriello L, Scialò C, Cabona C, Canosa A, Vanni I, Bellone E, Eleopra R, Mandich P. Twenty years of molecular analyses in amyotrophic lateral sclerosis: genetic landscape of Italian patients. Neurobiol Aging 2018. [DOI: 10.1016/j.neurobiolaging.2018.01.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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High proportion of genetic cases in patients with advanced cardiomyopathy including a novel homozygous Plakophilin 2-gene mutation. PLoS One 2017; 12:e0189489. [PMID: 29253866 PMCID: PMC5734774 DOI: 10.1371/journal.pone.0189489] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/27/2017] [Indexed: 11/19/2022] Open
Abstract
Cardiomyopathies might lead to end-stage heart disease with the requirement of drastic treatments like bridging up to transplant or heart transplantation. A not precisely known proportion of these diseases are genetically determined. We genotyped 43 index-patients (30 DCM, 10 ARVC, 3 RCM) with advanced or end stage cardiomyopathy using a gene panel which covered 46 known cardiomyopathy disease genes. Fifty-three variants with possible impact on disease in 33 patients were identified. Of these 27 (51%) were classified as likely pathogenic or pathogenic in the MYH7, MYL2, MYL3, NEXN, TNNC1, TNNI3, DES, LMNA, PKP2, PLN, RBM20, TTN, and CRYAB genes. Fifty-six percent (n = 24) of index-patients carried a likely pathogenic or pathogenic mutation. Of these 75% (n = 18) were familial and 25% (n = 6) sporadic cases. However, severe cardiomyopathy seemed to be not characterized by a specific mutation profile. Remarkably, we identified a novel homozygous PKP2-missense variant in a large consanguineous family with sudden death in early childhood and several members with heart transplantation in adolescent age.
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Yuan F, Qiu ZH, Wang XH, Sun YM, Wang J, Li RG, Liu H, Zhang M, Shi HY, Zhao L, Jiang WF, Liu X, Qiu XB, Qu XK, Yang YQ. MEF2C loss-of-function mutation associated with familial dilated cardiomyopathy. ACTA ACUST UNITED AC 2017; 56:502-511. [PMID: 28902616 DOI: 10.1515/cclm-2017-0461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/11/2017] [Indexed: 12/13/2022]
Abstract
Abstract
Background:
The MADS-box transcription factor myocyte enhancer factor 2C (MEF2C) is required for the cardiac development and postnatal adaptation and in mice-targeted disruption of the MEF2C gene results in dilated cardiomyopathy (DCM). However, in humans, the association of MEF2C variation with DCM remains to be investigated.
Methods:
The coding regions and splicing boundaries of the MEF2C gene were sequenced in 172 unrelated patients with idiopathic DCM. The available close relatives of the index patient harboring an identified MEF2C mutation and 300 unrelated, ethnically matched healthy individuals used as controls were genotyped for MEF2C. The functional effect of the mutant MEF2C protein was characterized in contrast to its wild-type counterpart by using a dual-luciferase reporter assay system.
Results:
A novel heterozygous MEF2C mutation, p.Y157X, was detected in an index patient with adult-onset DCM. Genetic screen of the mutation carrier’s family members revealed that the mutation co-segregated with DCM, which was transmitted as an autosomal dominant trait with complete penetrance. The non-sense mutation was absent in 300 control individuals. Functional analyses unveiled that the mutant MEF2C protein had no transcriptional activity. Furthermore, the mutation abolished the synergistic transactivation between MEF2C and GATA4 as well as HAND1, two other transcription factors that have been associated with DCM.
Conclusions:
This study indicates MEF2C as a new gene responsible for human DCM, which provides novel insight into the mechanism underpinning DCM, suggesting potential implications for development of innovative prophylactic and therapeutic strategies for DCM, the most prevalent form of primary myocardial disease.
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Affiliation(s)
- Fang Yuan
- Department of Emergency Medicine, Shanghai Tongren Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , P.R. China
| | - Zhao-Hui Qiu
- Department of Cardiology, Shanghai Tongren Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , P.R. China
| | - Xing-Hua Wang
- Department of Cardiology, Renji Hospital, School of Medicine , Shanghai Jiao Tong University , Shanghai , P.R. China
| | - Yu-Min Sun
- Department of Cardiology, Shanghai Jing’an District Central Hospital , Fudan University , Shanghai , P.R. China
| | - Jun Wang
- Department of Cardiology, Shanghai Jing’an District Central Hospital , Fudan University , Shanghai , P.R. China
| | - Ruo-Gu Li
- Department of Cardiology, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai , P.R. China
| | - Hua Liu
- Department of Cardiology, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai , P.R. China
| | - Min Zhang
- Department of Cardiology, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai , P.R. China
| | - Hong-Yu Shi
- Department of Cardiology, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai , P.R. China
| | - Liang Zhao
- Department of Cardiology, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai , P.R. China
| | - Wei-Feng Jiang
- Department of Cardiology, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai , P.R. China
| | - Xu Liu
- Department of Cardiology, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai , P.R. China
| | - Xing-Biao Qiu
- Department of Cardiology, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai , P.R. China
| | - Xin-Kai Qu
- Department of Cardiology, Shanghai Chest Hospital , Shanghai Jiao Tong University , 241 West Huaihai Road , Shanghai 200030 , P.R. China , Phone: +86 21 62821990, Fax: +86 21 62821105
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Chest Hospital , Shanghai Jiao Tong University , 241 West Huaihai Road , Shanghai 200030 , P.R. China , Phone: +86 21 62821990, Fax: +86 21 62821105
- Department of Cardiovascular Research Laboratory, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai , P.R. China
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Xu JH, Gu JY, Guo YH, Zhang H, Qiu XB, Li RG, Shi HY, Liu H, Yang XX, Xu YJ, Qu XK, Yang YQ. Prevalence and Spectrum of NKX2-5 Mutations Associated With Sporadic Adult-Onset Dilated Cardiomyopathy. Int Heart J 2017; 58:521-529. [PMID: 28690296 DOI: 10.1536/ihj.16-440] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dilated cardiomyopathy (DCM), the most common form of primary myocardial disease, is a leading cause of congestive heart failure and the most common indication for heart transplantation. Recently, NKX2-5 mutations have been involved in the pathogenesis of familial DCM. However, the prevalence and spectrum of NKX2-5 mutations associated with sporadic DCM remain to be evaluated. In this study, the coding regions and flanking introns of the NKX2-5 gene, which encodes a cardiac transcription factor pivotal for cardiac development and structural remodeling, were sequenced in 210 unrelated patients with sporadic adult-onset DCM. A total of 300 unrelated healthy individuals used as controls were also genotyped for NKX2-5. The functional effect of the mutant NKX2-5 was investigated using a dual-luciferase reporter assay system. As a result, two novel heterozygous NKX2-5 mutations, p.R139W and p.E167X, were identified in 2 unrelated patients with sporadic adult-onset DCM, with a mutational prevalence of approximately 0.95%. The mutations were absent in 600 referential chromosomes and the altered amino acids were completely conserved evolutionarily across species. Functional assays revealed that the NKX2-5 mutants were associated with significantly reduced transcriptional activity. Furthermore, the mutations abrogated the synergistic activation between NKX2-5 and GATA4 as well as TBX20, two other cardiac key transcription factors that have been causally linked to adult-onset DCM. This study is the first to associate NKX2-5 loss-of-function mutations with enhanced susceptibility to sporadic DCM, which provides novel insight into the molecular etiology underpinning DCM, and suggests the potential implications for the genetic counseling and personalized treatment of the DCM patients.
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Affiliation(s)
- Jia-Hong Xu
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine
| | - Jian-Yun Gu
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine
| | - Yu-Han Guo
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine
| | - Hong Zhang
- Department of Pharmacy, Tongji Hospital, Tongji University School of Medicine
| | - Xing-Biao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Ruo-Gu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Hong-Yu Shi
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Hua Liu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Xiao-Xiao Yang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Ying-Jia Xu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Xin-Kai Qu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University.,Department of Cardiovascular Research Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University.,Department of Central Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University
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Gómez J, Lorca R, Reguero JR, Morís C, Martín M, Tranche S, Alonso B, Iglesias S, Alvarez V, Díaz-Molina B, Avanzas P, Coto E. Screening of the Filamin C Gene in a Large Cohort of Hypertrophic Cardiomyopathy Patients. ACTA ACUST UNITED AC 2017; 10:CIRCGENETICS.116.001584. [PMID: 28356264 DOI: 10.1161/circgenetics.116.001584] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 01/11/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Recent exome sequencing studies identified filamin C (FLNC) as a candidate gene for hypertrophic cardiomyopathy (HCM). Our aim was to determine the rate of FLNC candidate variants in a large cohort of HCM patients who were also sequenced for the main sarcomere genes. METHODS AND RESULTS A total of 448 HCM patients were next generation-sequenced (semiconductor chip technology) for the MYH7, MYBPC3, TNNT2, TNNI3, ACTC1, TNNC1, MYL2, MYL3, TPM1, and FLNC genes. We also sequenced 450 healthy controls from the same population. Based on the reported population frequencies, bioinformatic criteria, and familial segregation, we identified 20 FLNC candidate variants (13 new; 1 nonsense; and 19 missense) in 22 patients. Compared with the patients, only 1 of the control's missense variants was nonreported (P=0.007; Fisher exact probability test). Based on the familial segregation and the reported functional studies, 6 of the candidate variants (in 7 patients) were finally classified as likely pathogenic, 10 as variants of uncertain significance, and 4 as likely benign. CONCLUSIONS We provide a compelling evidence of the involvement of FLNC in the development of HCM. Most of the FLNC variants were associated with mild forms of HCM and a reduced penetrance, with few affected in the families to confirm the segregation. Our work, together with others who found FLNC variants among patients with dilated and restrictive cardiomyopathies, pointed to this gene as an important cause of structural cardiomyopathies.
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Affiliation(s)
- Juan Gómez
- From the Unidad de Referencia de Cardiopatías Familiares-HUCA, Genética Molecular y Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain (J.G., R.L., J.R.R., C.M., M.M., B.A., S.I., V.A., B.D.-M., P.A., E.C.); Fundación Asturcor, Spain (J.R.R., C.M.); Departamento de Medicina, Universidad de Oviedo, Spain (C.M., E.C.); Centro Salud El Cristo, Oviedo, Spain (S.T.); and Red de Investigación Renal (REDINREN), Madrid, Spain (E.C.)
| | - Rebeca Lorca
- From the Unidad de Referencia de Cardiopatías Familiares-HUCA, Genética Molecular y Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain (J.G., R.L., J.R.R., C.M., M.M., B.A., S.I., V.A., B.D.-M., P.A., E.C.); Fundación Asturcor, Spain (J.R.R., C.M.); Departamento de Medicina, Universidad de Oviedo, Spain (C.M., E.C.); Centro Salud El Cristo, Oviedo, Spain (S.T.); and Red de Investigación Renal (REDINREN), Madrid, Spain (E.C.)
| | - Julian R Reguero
- From the Unidad de Referencia de Cardiopatías Familiares-HUCA, Genética Molecular y Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain (J.G., R.L., J.R.R., C.M., M.M., B.A., S.I., V.A., B.D.-M., P.A., E.C.); Fundación Asturcor, Spain (J.R.R., C.M.); Departamento de Medicina, Universidad de Oviedo, Spain (C.M., E.C.); Centro Salud El Cristo, Oviedo, Spain (S.T.); and Red de Investigación Renal (REDINREN), Madrid, Spain (E.C.)
| | - César Morís
- From the Unidad de Referencia de Cardiopatías Familiares-HUCA, Genética Molecular y Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain (J.G., R.L., J.R.R., C.M., M.M., B.A., S.I., V.A., B.D.-M., P.A., E.C.); Fundación Asturcor, Spain (J.R.R., C.M.); Departamento de Medicina, Universidad de Oviedo, Spain (C.M., E.C.); Centro Salud El Cristo, Oviedo, Spain (S.T.); and Red de Investigación Renal (REDINREN), Madrid, Spain (E.C.)
| | - María Martín
- From the Unidad de Referencia de Cardiopatías Familiares-HUCA, Genética Molecular y Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain (J.G., R.L., J.R.R., C.M., M.M., B.A., S.I., V.A., B.D.-M., P.A., E.C.); Fundación Asturcor, Spain (J.R.R., C.M.); Departamento de Medicina, Universidad de Oviedo, Spain (C.M., E.C.); Centro Salud El Cristo, Oviedo, Spain (S.T.); and Red de Investigación Renal (REDINREN), Madrid, Spain (E.C.)
| | - Salvador Tranche
- From the Unidad de Referencia de Cardiopatías Familiares-HUCA, Genética Molecular y Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain (J.G., R.L., J.R.R., C.M., M.M., B.A., S.I., V.A., B.D.-M., P.A., E.C.); Fundación Asturcor, Spain (J.R.R., C.M.); Departamento de Medicina, Universidad de Oviedo, Spain (C.M., E.C.); Centro Salud El Cristo, Oviedo, Spain (S.T.); and Red de Investigación Renal (REDINREN), Madrid, Spain (E.C.)
| | - Belén Alonso
- From the Unidad de Referencia de Cardiopatías Familiares-HUCA, Genética Molecular y Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain (J.G., R.L., J.R.R., C.M., M.M., B.A., S.I., V.A., B.D.-M., P.A., E.C.); Fundación Asturcor, Spain (J.R.R., C.M.); Departamento de Medicina, Universidad de Oviedo, Spain (C.M., E.C.); Centro Salud El Cristo, Oviedo, Spain (S.T.); and Red de Investigación Renal (REDINREN), Madrid, Spain (E.C.)
| | - Sara Iglesias
- From the Unidad de Referencia de Cardiopatías Familiares-HUCA, Genética Molecular y Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain (J.G., R.L., J.R.R., C.M., M.M., B.A., S.I., V.A., B.D.-M., P.A., E.C.); Fundación Asturcor, Spain (J.R.R., C.M.); Departamento de Medicina, Universidad de Oviedo, Spain (C.M., E.C.); Centro Salud El Cristo, Oviedo, Spain (S.T.); and Red de Investigación Renal (REDINREN), Madrid, Spain (E.C.)
| | - Victoria Alvarez
- From the Unidad de Referencia de Cardiopatías Familiares-HUCA, Genética Molecular y Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain (J.G., R.L., J.R.R., C.M., M.M., B.A., S.I., V.A., B.D.-M., P.A., E.C.); Fundación Asturcor, Spain (J.R.R., C.M.); Departamento de Medicina, Universidad de Oviedo, Spain (C.M., E.C.); Centro Salud El Cristo, Oviedo, Spain (S.T.); and Red de Investigación Renal (REDINREN), Madrid, Spain (E.C.)
| | - Beatriz Díaz-Molina
- From the Unidad de Referencia de Cardiopatías Familiares-HUCA, Genética Molecular y Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain (J.G., R.L., J.R.R., C.M., M.M., B.A., S.I., V.A., B.D.-M., P.A., E.C.); Fundación Asturcor, Spain (J.R.R., C.M.); Departamento de Medicina, Universidad de Oviedo, Spain (C.M., E.C.); Centro Salud El Cristo, Oviedo, Spain (S.T.); and Red de Investigación Renal (REDINREN), Madrid, Spain (E.C.)
| | - Pablo Avanzas
- From the Unidad de Referencia de Cardiopatías Familiares-HUCA, Genética Molecular y Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain (J.G., R.L., J.R.R., C.M., M.M., B.A., S.I., V.A., B.D.-M., P.A., E.C.); Fundación Asturcor, Spain (J.R.R., C.M.); Departamento de Medicina, Universidad de Oviedo, Spain (C.M., E.C.); Centro Salud El Cristo, Oviedo, Spain (S.T.); and Red de Investigación Renal (REDINREN), Madrid, Spain (E.C.)
| | - Eliecer Coto
- From the Unidad de Referencia de Cardiopatías Familiares-HUCA, Genética Molecular y Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain (J.G., R.L., J.R.R., C.M., M.M., B.A., S.I., V.A., B.D.-M., P.A., E.C.); Fundación Asturcor, Spain (J.R.R., C.M.); Departamento de Medicina, Universidad de Oviedo, Spain (C.M., E.C.); Centro Salud El Cristo, Oviedo, Spain (S.T.); and Red de Investigación Renal (REDINREN), Madrid, Spain (E.C.).
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Manolis AS. Sudden death risk stratification in non-ischemic dilated cardiomyopathy using old and new tools: a clinical challenge. Expert Rev Cardiovasc Ther 2017; 15:315-325. [PMID: 28292197 DOI: 10.1080/14779072.2017.1307735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Risk stratification for sudden cardiac death in non-ischemic dilated cardiomyopathy (NIDCM) remains a clinical challenge. Areas covered: Currently, left ventricular ejection fraction (LVEF), severity of heart failure symptoms according to NYHA classification, and morphology and duration of the QRS complex guide device management in these patients with implantation of a cardioverter defibrillator (ICD) and/or cardiac resynchronization therapy (CRT) devices. Recently, the results of a randomized trial stirred some controversy regarding the utility of ICD in NIDCM patients, however, a subsequent meta-analysis confirmed prior findings of the survival-prolonging benefit of device therapy. Newer risk markers, like late gadolinium enhancement in cardiac magnetic resonance imaging (CMR) detecting myocardial fibrosis, are encouraging in improving risk stratification in these patients. Furthermore, resurgence of an old tool, the electrophysiology study (EPS), and technical advances in genetics in identifying high-risk familial NIDCM, appear promising in this direction. Expert commentary: Based on old and new tools, a more individualized approach may be applied in NIDCM patients, whereby CMR, EPS and genetics may provide further guidance, particularly in patients with LVEF>35%. These issues are herein reviewed and a practical algorithm is proposed for risk stratification and device implantation in NIDCM patients with LVEF below and above 35%.
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Affiliation(s)
- Antonis S Manolis
- a Third Department of Cardiology , Athens University School of Medicine , Athens , Greece
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van Opbergen CJM, Delmar M, van Veen TAB. Potential new mechanisms of pro-arrhythmia in arrhythmogenic cardiomyopathy: focus on calcium sensitive pathways. Neth Heart J 2017; 25:157-169. [PMID: 28102477 PMCID: PMC5313453 DOI: 10.1007/s12471-017-0946-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Arrhythmogenic cardiomyopathy, or its most well-known subform arrhythmogenic right ventricular cardiomyopathy (ARVC), is a cardiac disease mainly characterised by a gradual replacement of the myocardial mass by fibrous and fatty tissue, leading to dilatation of the ventricular wall, arrhythmias and progression towards heart failure. ARVC is commonly regarded as a disease of the intercalated disk in which mutations in desmosomal proteins are an important causative factor. Interestingly, the Dutch founder mutation PLN R14Del has been identified to play an additional, and major, role in ARVC patients within the Netherlands. This is remarkable since the phospholamban (PLN) protein plays a leading role in regulation of the sarcoplasmic reticulum calcium load rather than in the establishment of intercellular integrity. In this review we outline the intracellular cardiac calcium dynamics and relate pathophysiological signalling, induced by disturbed calcium handling, with activation of calmodulin dependent kinase II (CaMKII) and calcineurin A (CnA). We postulate a thus far unrecognised role for Ca2+ sensitive signalling proteins in maladaptive remodelling of the macromolecular protein complex that forms the intercalated disk, during pro-arrhythmic remodelling of the heart.
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Affiliation(s)
- C J M van Opbergen
- Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Delmar
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, USA
| | - T A B van Veen
- Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
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50
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Usefulness of Genetic Testing in Hypertrophic Cardiomyopathy: an Analysis Using Real-World Data. J Cardiovasc Transl Res 2017; 10:35-46. [PMID: 28138913 DOI: 10.1007/s12265-017-9730-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/15/2017] [Indexed: 10/20/2022]
Abstract
This study sought to determine the usefulness of genetic testing to predict evolution in hypertrophic cardiomyopathy (HCM) and to assess the role of genetic testing in clinical practice. Genetic results of 100 HCM patients tested for mutations in ≥10 HCM-causing genes were evaluated. Patients were classified as with poor (group A) or favourable (group B) clinical course. Forty-five pathogenic mutations (PM) were identified in 28 patients (56 %) from group A and in 23 (46 %) from group B (p = 0.317). Only 40 patients (40 %) exhibited PM that had been previously reported and only 15 (15 %) had PM reported in ≥10 individuals. PM associated with poor prognosis were identified in just five patients from group A (10 %). Genetic findings are not useful to predict prognosis in most HCM patients. By contrast, real-world data reinforce the usefulness of genetic testing to provide genetic counselling and to enable cascade genetic screening.
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