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Yoshinaga M, Ninomiya Y, Tanaka Y, Fukuyama M, Kato K, Ohno S, Horie M, Ogata H. Holter Electrocardiographic Approach to Predicting Outcomes of Pediatric Patients With Long QT Syndrome. Circ J 2024; 88:1176-1184. [PMID: 38044147 DOI: 10.1253/circj.cj-23-0409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
BACKGROUND This study was performed to clarify the clinical findings of pediatric patients diagnosed with long QT syndrome (LQTS) through electrocardiographic screening programs and to predict their outcome using Holter electrocardiographic approaches.Methods and Results: This retrospective study included pediatric patients with a Schwartz score of ≥3.5 who visited the National Hospital Organization Kagoshima Medical Center between April 2005 and March 2019. Resting 12-lead and Holter electrocardiograms were recorded at every visit. The maximum resting QTc and maximum Holter QTc values among all recordings were used for statistical analyses. To test the prognostic value of QTc for the appearance of cardiac events after the first hospital visit, receiver operating characteristic curves were used to calculate the area under the curve (AUC). Among 207 patients, 181 (87%) were diagnosed through screening programs. The prevalence of cardiac events after the first hospital visit was 4% (8/207). Among QTc at diagnosis, maximum resting QTc, and maximum Holter QTc, only maximum Holter QTc value was a predictor (P=0.02) of cardiac events after the hospital visit in multivariate regression analysis. The AUC of the maximum Holter QTc was significantly superior to that of maximum resting QTc. CONCLUSIONS The maximum Holter QTc value can be used to predict the appearance of symptoms in pediatric patients with LQTS.
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Affiliation(s)
- Masao Yoshinaga
- Department of Pediatrics, National Hospital Organization Kagoshima Medical Center
- Orange Medical and Welfare Center for Severe Motor and Intellectual Disabilities
| | - Yumiko Ninomiya
- Department of Pediatrics, National Hospital Organization Kagoshima Medical Center
| | - Yuji Tanaka
- Department of Pediatrics, National Hospital Organization Kagoshima Medical Center
| | - Megumi Fukuyama
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Kato
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science
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Papadopoulou E, Bouzarelou D, Tsaousis G, Papathanasiou A, Vogiatzi G, Vlachopoulos C, Miliou A, Papachristou P, Prappa E, Servos G, Ritsatos K, Seretis A, Frogoudaki A, Nasioulas G. Application of next generation sequencing in cardiology: current and future precision medicine implications. Front Cardiovasc Med 2023; 10:1202381. [PMID: 37424920 PMCID: PMC10327645 DOI: 10.3389/fcvm.2023.1202381] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
Inherited cardiovascular diseases are highly heterogeneous conditions with multiple genetic loci involved. The application of advanced molecular tools, such as Next Generation Sequencing, has facilitated the genetic analysis of these disorders. Accurate analysis and variant identification are required to maximize the quality of the sequencing data. Therefore, the application of NGS for clinical purposes should be limited to laboratories with a high level of technological expertise and resources. In addition, appropriate gene selection and variant interpretation can result in the highest possible diagnostic yield. Implementation of genetics in cardiology is imperative for the accurate diagnosis, prognosis and management of several inherited disorders and could eventually lead to the realization of precision medicine in this field. However, genetic testing should also be accompanied by an appropriate genetic counseling procedure that clarifies the significance of the genetic analysis results for the proband and his family. In this regard, a multidisciplinary collaboration among physicians, geneticists, and bioinformaticians is imperative. In the present review, we address the current state of knowledge regarding genetic analysis strategies employed in the field of cardiogenetics. Variant interpretation and reporting guidelines are explored. Additionally, gene selection procedures are accessed, with a particular emphasis on information concerning gene-disease associations collected from international alliances such as the Gene Curation Coalition (GenCC). In this context, a novel approach to gene categorization is proposed. Moreover, a sub-analysis is conducted on the 1,502,769 variation records with submitted interpretations in the Clinical Variation (ClinVar) database, focusing on cardiology-related genes. Finally, the most recent information on genetic analysis's clinical utility is reviewed.
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Affiliation(s)
| | | | | | | | - Georgia Vogiatzi
- Third Department of Cardiology, Sotiria Hospital, Athens, Greece
| | - Charalambos Vlachopoulos
- Unit of Inherited Cardiac Conditions and Sports Cardiology, First Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Antigoni Miliou
- Unit of Inherited Cardiac Conditions and Sports Cardiology, First Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Efstathia Prappa
- Second Department of Cardiology, Arrhythmia Unit, Evangelismos General Hospital of Athens, Athens, Greece
| | - Georgios Servos
- Pediatric Cardiology Unit, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
| | - Konstantinos Ritsatos
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Aristeidis Seretis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Alexandra Frogoudaki
- Second Department of Cardiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Imanishi R, Nakau K, Shimada S, Oka H, Takeguchi R, Tanaka R, Sugiyama T, Nii M, Okamoto T, Nagaya K, Makita Y, Yanagi K, Kaname T, Takahashi S. A novel HECW2 variant in an infant with congenital long QT syndrome. Hum Genome Var 2023; 10:17. [PMID: 37280227 PMCID: PMC10244414 DOI: 10.1038/s41439-023-00245-w] [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: 04/14/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023] Open
Abstract
Pathogenic variants of HECW2 have been reported in cases of neurodevelopmental disorder with hypotonia, seizures, and absent language (NDHSAL; OMIM #617268). A novel HECW2 variant (NM_001348768.2:c.4343 T > C,p.Leu1448Ser) was identified in an NDHSAL infant with severe cardiac comorbidities. The patient presented with fetal tachyarrhythmia and hydrops and was postnatally diagnosed with long QT syndrome. This study provides evidence that HECW2 pathogenic variants can cause long QT syndrome along with neurodevelopmental disorders.
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Affiliation(s)
- Rina Imanishi
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Kouichi Nakau
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Sorachi Shimada
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Hideharu Oka
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Ryo Takeguchi
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Ryosuke Tanaka
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Tatsutoshi Sugiyama
- Division of Neonatology, Center for Maternity and Infant Care, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Mitsumaro Nii
- Division of Neonatology, Center for Maternity and Infant Care, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Toshio Okamoto
- Division of Neonatology, Center for Maternity and Infant Care, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Ken Nagaya
- Division of Neonatology, Center for Maternity and Infant Care, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Yoshio Makita
- Department of Genetic Counseling, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Kumiko Yanagi
- Department of Genome Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tadashi Kaname
- Department of Genome Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Satoru Takahashi
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan.
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Karlova M, Abramochkin DV, Pustovit KB, Nesterova T, Novoseletsky V, Loussouarn G, Zaklyazminskaya E, Sokolova OS. Disruption of a Conservative Motif in the C-Terminal Loop of the KCNQ1 Channel Causes LQT Syndrome. Int J Mol Sci 2022; 23:ijms23147953. [PMID: 35887302 PMCID: PMC9316142 DOI: 10.3390/ijms23147953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023] Open
Abstract
We identified a single nucleotide variation (SNV) (c.1264A > G) in the KCNQ1 gene in a 5-year-old boy who presented with a prolonged QT interval. His elder brother and mother, but not sister and father, also had this mutation. This missense mutation leads to a p.Lys422Glu (K422E) substitution in the Kv7.1 protein that has never been mentioned before. We inserted this substitution in an expression plasmid containing Kv7.1 cDNA and studied the electrophysiological characteristics of the mutated channel expressed in CHO-K1, using the whole-cell configuration of the patch-clamp technique. Expression of the mutant Kv7.1 channel in both homo- and heterozygous conditions in the presence of auxiliary subunit KCNE1 results in a significant decrease in tail current densities compared to the expression of wild-type (WT) Kv7.1 and KCNE1. This study also indicates that K422E point mutation causes a dominant negative effect. The mutation was not associated with a trafficking defect; the mutant channel protein was confirmed to localize at the cell membrane. This mutation disrupts the poly-Lys strip in the proximal part of the highly conserved cytoplasmic A−B linker of Kv7.1 that was not shown before to be crucial for channel functioning.
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Affiliation(s)
- Maria Karlova
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia; (M.K.); (D.V.A.); (K.B.P.); (V.N.)
| | - Denis V. Abramochkin
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia; (M.K.); (D.V.A.); (K.B.P.); (V.N.)
| | - Ksenia B. Pustovit
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia; (M.K.); (D.V.A.); (K.B.P.); (V.N.)
| | - Tatiana Nesterova
- Institute of Immunology and Physiology, Ural Branch of Russian Academy of Sciences, 620049 Ekaterinburg, Russia;
- Institute of Natural Sciences and Mathematics, Ural Federal University, 620075 Ekaterinburg, Russia
| | - Valery Novoseletsky
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia; (M.K.); (D.V.A.); (K.B.P.); (V.N.)
- Biology Department, Shenzhen MSU-BIT University, Shenzhen 517182, China
| | - Gildas Loussouarn
- Nantes Université, CNRS, INSERM, l’institut du Thorax, F-44000 Nantes, France;
| | | | - Olga S. Sokolova
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia; (M.K.); (D.V.A.); (K.B.P.); (V.N.)
- Biology Department, Shenzhen MSU-BIT University, Shenzhen 517182, China
- Correspondence: or
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Fukuyama M, Horie M, Aoki H, Ozawa J, Kato K, Sawayama Y, Tanaka-Mizuno S, Makiyama T, Yoshinaga M, Nakagawa Y, Ohno S. School-based routine screenings of electrocardiograms for the diagnosis of long QT syndrome. Europace 2022; 24:1496-1503. [DOI: 10.1093/europace/euab320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
School-based routine screenings of electrocardiograms (ECGs) have been performed upon admission to primary school (PS), junior high school (JHS), and high school (HS) in Japan. Though ECGs with prolonged QT intervals are occasionally found, the role of regular ECG screening tests in identifying long QT syndrome (LQTS) remains to be determined. We investigated the usefulness of the ECG screenings by comparing the results of genetic tests between students who showed QT-prolongation in the screenings and patients with LQTS.
Methods and results
We genetically screened 341 students (106 PS, 173 JHS, and 62 HS). Of these, 230 subjects showed QT-prolongation during regular screenings (S-S group), and the other 111 patients were clinically consulted with suspected LQTS by paediatricians (C-C group). Genotype–phenotype relationships were compared between the two groups. The positive rates in the genetic tests were comparable among the two groups; however, symptomatic subjects were significantly fewer in the S-S group than the C-C group (3% vs. 70%). Compared to the genotype-negative subjects, the positive subjects showed significantly longer QTc (P < 0.0001) and more frequently presented LQTS risk scores with ≥3.5 points (P < 0.0001). Lethal arrhythmic events (LAE) occurred only in the C-C group; 18 subjects experienced LAE and 83% of them were found to carry variant(s) in the LQTS-related genes.
Conclusion
The school-based ECG screenings are effective in identifying young patients with LQTS who require genetic analysis. If individuals are screened at a younger age, we can identify patients at risk earlier and provide preventative treatments.
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Affiliation(s)
- Megumi Fukuyama
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hisaaki Aoki
- Department of Pediatric Cardiology, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Junichi Ozawa
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Koichi Kato
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Yuichi Sawayama
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | | | - Takeru Makiyama
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Yoshinaga
- Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
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Akgun-Dogan O, Ağaoğlu NB, K Demirkol Y, Doğanay L, Ergül Y, Karacan M. Mutational spectrum of congenital long QT syndrome in Turkey; identification of 12 novel mutations across KCNQ1, KCNH2, SCN5A, KCNJ2, CACNA1C, and CALM1. J Cardiovasc Electrophysiol 2021; 33:262-273. [PMID: 34860437 DOI: 10.1111/jce.15306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/10/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Long QT syndrome (LQTS) is of great importance as it is the most common cause of sudden cardiac death in childhood. The diagnosis is made by the prolongation of the QTc interval on the electrocardiography. However, clinical heterogeneity and nondiagnostic QTc intervals may cause a delay in the diagnosis. In such cases, genetic tests such as next-generation sequencing (NGS) panel analysis enable a definitive diagnosis. We present the first study that aimed to expand the LQTS's mutational spectrum by NGS panel analysis from Turkey. METHODS Fifty-seven unrelated patients with clinically diagnosed LQTS were investigated using an NGS panel that includes six LQTS-related genes. Clinical aspects, outcome, and molecular analysis results were reviewed. RESULTS Pathogenic (53%)/likely pathogenic (23%)/variant of unknown significance (4%) variants were detected in any of the genes examined in 79% of the patients. Among all detected variants, KCNQ1(71%) was the most common gene, followed by SCN5A (11%), KCNH2 (10%), CALM1 (5%), and CACNA1C (3%). Twelve novel variants were detected. Among the variants in KCNQ1, the c.1097G>A variant was present in 42% of patients. This variant also composed 31% of the variants detected in all of the genes. CONCLUSION Our study expands the spectrum of the variations associated with LQTS with twelve novel variants in five genes. And also it draws attention to the frequency of the KCNQ1 c.1097G>A variant and forms the basis for new studies to determine the possible founder effect in the Turkish population. Furthermore, identifying new variants and clinical findings has importance in elaborating the roles of related genes in pathophysiology and determining the variable expression and incomplete penetration rates in this syndrome.
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Affiliation(s)
- Ozlem Akgun-Dogan
- Division of Pediatric Genetics, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Nihat B Ağaoğlu
- Department of Medical Genetics, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Yasemin K Demirkol
- Division of Pediatric Genetics, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Levent Doğanay
- Department of Internal Medicine, Genomic Laboratory (GLAB), Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Yakup Ergül
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Istanbul, Turkey
| | - Mehmet Karacan
- Department of Pediatric Cardiology, Umraniye Training and Research Hospital, Istanbul, Turkey
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Kashiwa A, Hosaka Y, Takahashi K, Ohno S, Wada Y, Makiyama T, Oda H, Horie M. Pueraria mirifica, an estrogenic tropical herb, unveiled the severity of Type 1 LQTS caused by KCNQ1-T587M. J Arrhythm 2021; 37:1114-1116. [PMID: 34386142 PMCID: PMC8339079 DOI: 10.1002/joa3.12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/07/2021] [Accepted: 05/22/2021] [Indexed: 11/09/2022] Open
Abstract
After taking an estrogen-containing supplement derived from a tropical plant Pueraria mirifica, a 24-year-old woman presented marked QT prolongation and repetitive torsade de pointes. The patient was found to carry a heterozygous KCNQ1-T587M mutation. This is the first report on Pueraria mirifica-related acquired long QT syndrome.
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Affiliation(s)
- Asami Kashiwa
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
- Department of Cardiovascular MedicineNiigata City General HospitalNiigataJapan
| | - Yukio Hosaka
- Department of Cardiovascular MedicineNiigata City General HospitalNiigataJapan
| | - Kazuyoshi Takahashi
- Department of Cardiovascular MedicineNiigata City General HospitalNiigataJapan
| | - Seiko Ohno
- Department of Bioscience and GeneticsNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Yuko Wada
- Vanderbilt Center for Arrhythmia Research and TherapeuticsDivision of Clinical PharmacologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTNUSA
- Department of Cardiovascular MedicineShiga University of Medical ScienceShigaJapan
| | - Takeru Makiyama
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Hirotaka Oda
- Department of Cardiovascular MedicineNiigata City General HospitalNiigataJapan
| | - Minoru Horie
- Department of Cardiovascular MedicineShiga University of Medical ScienceShigaJapan
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