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Titin-Related Dilated Cardiomyopathy: The Clinical Trajectory and the Role of Circulating Biomarkers in the Clinical Assessment. Diagnostics (Basel) 2021; 12:diagnostics12010013. [PMID: 35054181 PMCID: PMC8775078 DOI: 10.3390/diagnostics12010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 12/21/2022] Open
Abstract
Titin truncating variants (TTNtv) are known as the leading cause of inherited dilated cardiomyopathy (DCM). Nevertheless, it is unclear whether circulating cardiac biomarkers are helpful in detection and risk assessment. We sought to assess 1) early indicators of cardiotitinopathy including the serum biomarkers high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in clinically stable patients, and 2) predictors of outcome among TTNtv carriers. Our single-center cohort consisted of 108 TTNtv carriers (including 70 DCM patients) from 43 families. Clinical, laboratory and follow-up data were analyzed. The earliest abnormality was left ventricular dysfunction, present in 8, 26 and 47% of patients in the second, third and fourth decade of life, respectively. It was followed by symptoms of heart failure, linked to NT-proBNP elevation and severe left ventricular systolic dysfunction, and later by arrhythmias. Hs-cTnT serum levels were increased in the late stage of the disease only. During the median follow-up of 5.2 years, both malignant ventricular arrhythmia (MVA) and end-stage heart failure (esHF) occurred in 12% of TTNtv carriers. In multivariable analysis, NT-proBNP level ≥650 pg/mL was the best predictor of both composite endpoints (MVA and esHF) and of MVA alone. In conclusion, echocardiographic abnormalities are the first detectable anomalies in the course of cardiotitinopathies. The assessment of circulating cardiac biomarkers is not useful in the detection of the disease onset but may be helpful in risk assessment.
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Franaszczyk M, Bilinska ZT, Sobieszczańska-Małek M, Michalak E, Sleszycka J, Sioma A, Małek ŁA, Kaczmarska D, Walczak E, Włodarski P, Hutnik Ł, Milanowska B, Dzielinska Z, Religa G, Grzybowski J, Zieliński T, Ploski R. The BAG3 gene variants in Polish patients with dilated cardiomyopathy: four novel mutations and a genotype-phenotype correlation. J Transl Med 2014; 12:192. [PMID: 25008357 PMCID: PMC4105391 DOI: 10.1186/1479-5876-12-192] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/25/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND BAG3 gene mutations have been recently implicated as a novel cause of dilated cardiomyopathy (DCM). Our aim was to evaluate the prevalence of BAG3 mutations in Polish patients with DCM and to search for genotype-phenotype correlations. METHODS We studied 90 unrelated probands by direct sequencing of BAG3 exons and splice sites. Large deletions/insertions were screened for by quantitative real time polymerase chain reaction (qPCR). RESULTS We found 5 different mutations in 6 probands and a total of 21 mutations among their relatives: the known p.Glu455Lys mutation (2 families), 4 novel mutations: p.Gln353ArgfsX10 (c.1055delC), p.Gly379AlafsX45 (c.1135delG), p.Tyr451X (c.1353C>A) and a large deletion of 17,990 bp removing BAG3 exons 3-4. Analysis of mutation positive relatives of the probands from this study pooled with those previously reported showed higher DCM prevalence among those with missense vs. truncating mutations (OR = 8.33, P = 0.0058) as well as a difference in age at disease onset between the former and the latter in Kaplan-Meier survival analysis (P = 0.006). Clinical data from our study suggested that in BAG3 mutation carriers acute onset DCM with hemodynamic compromise may be triggered by infection. CONCLUSIONS BAG3 point mutations and large deletions are relatively frequent cause of DCM. Delayed DCM onset associated with truncating vs. non-truncating mutations may be important for genetic counseling.
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Affiliation(s)
- Maria Franaszczyk
- Laboratory of Molecular Biology, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Zofia T Bilinska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | | | - Ewa Michalak
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Justyna Sleszycka
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Agnieszka Sioma
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Łukasz A Małek
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Dorota Kaczmarska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Ewa Walczak
- Department of Pathology, Institute of Rheumatology, Warsaw, Spartańska 1 02-637, Poland
| | - Paweł Włodarski
- The Department of Histology and Embryology, Centre of Biostructure, Medical University of Warsaw, Warsaw, Chałubińskiego 5 02-004, Poland
| | - Łukasz Hutnik
- The Department of Histology and Embryology, Centre of Biostructure, Medical University of Warsaw, Warsaw, Chałubińskiego 5 02-004, Poland
| | - Blanka Milanowska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Zofia Dzielinska
- Department of Structural Heart Diseases, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Grzegorz Religa
- Department of Cardiac Surgery, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Tomasz Zieliński
- Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Rafal Ploski
- Department of Medical Genetics, Centre of Biostructure, Medical University of Warsaw, Warsaw, Pawinskiego 3C 02-106, Poland
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Bilinska ZT, Caforio AL, Kuśmierczyk-Droszcz BK, Michalak E, Grzybowski J, Goldman JH, Haven AJ, Rydlewska-Sadowska W, McKenna WJ, Ruzyøøo W. Increased frequency of organ-specific cardiac antibodies in healthy relatives of patients with dilated cardiomyopathy: evidence for autoimmunity in Polish families. Clin Cardiol 1996; 19:794-8. [PMID: 8896912 DOI: 10.1002/clc.4960191008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS Autoantibodies represent markers of autoimmune involvement and are found with increased frequency in patients and their symptom-free relatives at risk compared with normal controls. Cardiac-specific autoantibodies, detected by immunofluorescence, were found in 20% of symptom-free relative of patients with dilated cardiomyopathy (DCM) from England and Italy. The role of autoimmunity may vary in DCM patients from Poland due to ethnic differences in genetic susceptibility to autoimmune disease. METHODS We assessed the frequency of the organ-specific cardiac autoantibodies in 162 symptom-free relatives of DCM patients [85 male, mean (SD) age 27 (18) years] and 80 control subjects from Poland. Familial DCM (> 1 affected member) was present in 4 families, nonfamilial DCM in the remaining 24 pedigrees. We performed antibody screening and noninvasive cardiological assessment in the whole group. RESULTS The frequency of cardiac-specific autoantibodies was higher among patients with documented DCM (probands and relatives) (50%) and their symptom-free relatives (38%) than in unrelated normal subjects (10%; p = 0.0001). In 24 (86%) of the pedigrees studied, autoantibodies were found in the proband and/or in at least one family member and tended to be more common in familial than in nonfamilial DCM (50 vs. 35%, p = NS). Echocardiographic indices of left ventricular size and function were similar in relatives with and without detectable antibodies. CONCLUSIONS The presence of cardiac-specific autoantibodies in symptom-free relatives of DCM patients provides evidence for autoimmunity in the majority (86%) of our pedigrees, including both familial and nonfamilial forms of DCM.
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Affiliation(s)
- Z T Bilinska
- National Institute of Cardiology, Warsaw, Poland
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