1
|
Ylipää J, Andersson T. Genetic analysis and family screening for dilated cardiomyopathy: a retrospective analysis of the stepwise pedigree approach. SCAND CARDIOVASC J 2024; 58:2379356. [PMID: 39046218 DOI: 10.1080/14017431.2024.2379356] [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: 01/02/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
AIMS This study aimed to assess the practicality of using a stepwise pedigree-based approach to differentiate between familial and sporadic Dilated Cardiomyopathy (DCM), while also considering timing of the genetic analysis. The analysis includes an examination of the extent to which complete family investigations were conducted in real-world scenarios as well as the length of the investigation. METHODS The stepwise pedigree approach involved conducting a comprehensive family history spanning 3 to 4 generations, reviewing medical records of relatives, and conducting clinical screening using echocardiography and electrocardiogram on first-degree relatives. Familial DCM was diagnosed when at least 2 family members were found to have DCM, and genetic analysis was considered as an option. This study involved a manual review of all DCM investigations conducted at the Centre of Cardiovascular Genetics at Umeå University Hospital, where the stepwise pedigree approach has been employed since 2007. RESULTS The investigation process had a mean duration of 643 days (95% CI 560.5-724.9). Of the investigations preformed, 94 (68%) were complete, 12 (9%) were ongoing, and 33 (24%) were prematurely terminated and thus incomplete. At the conclusion of the investigations, 55 cases (43%) were classified as familial DCM, 50 (39%) as sporadic DCM, and 22 (18%) remained unassessed due to incomplete pedigrees. Among the familial cases, genetic verification was achieved in 40%. CONCLUSION The stepwise pedigree approach is time consuming, and the investigations are often incomplete which may suggest that a more direct approach to genetic analysis, may be warranted.
Collapse
Affiliation(s)
- Josef Ylipää
- Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden
| | - Therese Andersson
- Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
2
|
Myers MC, Wang S, Zhong Y, Maruyama S, Bueno C, Bastien A, Fazeli MS, Golchin N. Prevalence of Genetically Associated Dilated Cardiomyopathy: A Systematic Literature Review and Meta-Analysis. Cardiol Res 2024; 15:233-245. [PMID: 39205965 PMCID: PMC11349141 DOI: 10.14740/cr1680] [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: 06/14/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Background Dilated cardiomyopathy (DCM) is a leading cause of heart failure and cardiac transplantation globally. Disease-associated genetic variants play a significant role in the development of DCM. Accurately determining the prevalence of genetically associated DCM (genetic DCM) is important for developing targeted prevention strategies. This review synthesized published literature on the global prevalence of genetic DCM across various populations, focusing on two of the most common variants: titin (TTN) and myosin heavy chain 7 (MYH7). Methods MEDLINE® and Embase were searched from database inception to September 19, 2022 for English-language studies reporting the prevalence of genetic DCM within any population. Studies using family history as a proxy for genetic DCM were excluded. Results Of 2,736 abstracts, 57 studies were included. Among the global adult or mixed (mostly adults with few pediatric patients) DCM population, median prevalence was 20.2% (interquartile range (IQR): 16.3-36.0%) for overall genetic DCM, 11.4% (IQR: 8.2-17.8%) for TTN-associated DCM, and 3.2% (IQR: 1.8-5.2%) for MYH7-associated DCM. Global prevalence of overall pediatric genetic DCM within the DCM population was similar (weighted mean: 21.3%). Few studies reported data on the prevalence of genetic DCM within the general population. Conclusions Our study identified variable prevalence estimates of genetic DCM across different populations and geographic locations. The current evidence may underestimate the genetic contributions due to limited screening and detection of potential DCM patients. Epidemiological studies using long-read whole genome sequencing to identify structural variants or non-coding variants are needed, as well as large cohort datasets with genotype-phenotype correlation analyses.
Collapse
Affiliation(s)
| | - Su Wang
- Evidinno Outcomes Research Inc., Vancouver, BC, Canada
| | - Yue Zhong
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | | | | | | |
Collapse
|
3
|
Chao T, Ge Y, Sun J, Wang C. Research landscape of genetics in dilated cardiomyopathy: insight from a bibliometric analysis. Front Cardiovasc Med 2024; 11:1362551. [PMID: 39070560 PMCID: PMC11272475 DOI: 10.3389/fcvm.2024.1362551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/27/2024] [Indexed: 07/30/2024] Open
Abstract
Background Dilated cardiomyopathy (DCM) is a heterogeneous myocardial disorder with diverse genetic or acquired origins. Notable advances have been achieved in discovering and understanding the genetics of DCM. This study aimed to depict the distribution of the main research forces, hotspots, and frontiers in the genetics of DCM, thus shaping future research directions. Methods Based on the documents published in the Web of Science Core Collection database from 2013 to 2022, co-authorship of authors, institutions, and countries/regions, co-citation of references, and co-occurrence of keywords were conducted respectively to present the distribution of the leading research forces, research hotspots, and emerging trends in the genetics of DCM. Results 4,141 documents were included, and the annual publications have steadily increased. Seidman, Christine E, Meder, Benjamin, Sinagra, Gianfranco were the most productive authors, German Centre for Cardiovascular Research was the most productive institution, and the USA, China, and Germany were the most prolific countries. The co-occurrence of keywords has generated 8 clusters, including DCM, lamin a/c, heart failure, sudden cardiac death, hypertrophic cardiomyopathy, cardiac hypertrophy, arrhythmogenic cardiomyopathy, and next-generation sequencing. Frequent keywords with average publication time after 2019 mainly included arrhythmogenic cardiomyopathy, whole-exome sequencing, RBM 20, phenotype, risk stratification, precision medicine, genotype, and machine learning. Conclusion The research landscape of genetics in DCM is continuously evolving. Deciphering the genetic profiles by next-generation sequencing and illustrating pathogenic mechanisms of gene variants, establishing innovative treatments for heart failure and improved risk stratification for SCD, uncovering the genetic overlaps between DCM and other inherited cardiomyopathies, as well as identifying genotype-phenotype correlations are the main research hotspots and frontiers in this field.
Collapse
Affiliation(s)
- Tiantian Chao
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yaru Ge
- Community Medical Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jinghui Sun
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chenglong Wang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
4
|
Li Z, Chen X, He W, Chen H, Chen D. The causal effect of Alzheimer's disease and family history of Alzheimer's disease on non-ischemic cardiomyopathy and left ventricular structure and function: a Mendelian randomization study. Front Genet 2024; 15:1379865. [PMID: 38903751 PMCID: PMC11188370 DOI: 10.3389/fgene.2024.1379865] [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: 01/31/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Background Previous studies have shown that Alzheimer's disease (AD) can cause myocardial damage. However, whether there is a causal association between AD and non-ischemic cardiomyopathy (NICM) remains unclear. Using a comprehensive two-sample Mendelian randomization (MR) method, we aimed to determine whether AD and family history of AD (FHAD) affect left ventricular (LV) structure and function and lead to NICM, including hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). Methods The summary statistics for exposures [AD, paternal history of AD (PH-AD), and maternal history of AD (MH-AD)] and outcomes (NICM, HCM, DCM, and LV traits) were obtained from the large European genome-wide association studies. The causal effects were estimated using inverse variance weighted, MR-Egger, and weighted median methods. Sensitivity analyses were conducted, including Cochran's Q test, MR-Egger intercept test, MR pleiotropy residual sum and outlier, MR Steiger test, leave-one-out analysis, and the funnel plot. Results Genetically predicted AD was associated with a lower risk of NICM [odds ratio (OR) 0.9306, 95% confidence interval (CI) 0.8825-0.9813, p = 0.0078], DCM (OR 0.8666, 95% CI 0.7752-0.9689, p = 0.0119), and LV remodeling index (OR 0.9969, 95% CI 0.9940-0.9998, p = 0.0337). Moreover, genetically predicted PH-AD was associated with a decreased risk of NICM (OR 0.8924, 95% CI 0.8332-0.9557, p = 0.0011). MH-AD was also strongly associated with a decreased risk of NICM (OR 0.8958, 95% CI 0.8449-0.9498, p = 0.0002). Different methods of sensitivity analysis demonstrated the robustness of the results. Conclusion Our study revealed that AD and FHAD were associated with a decreased risk of NICM, providing a new genetic perspective on the pathogenesis of NICM.
Collapse
Affiliation(s)
| | | | | | | | - Dehai Chen
- Department of Cardiovascular Surgery, The First People’s Hospital of Zhaoqing, The First Affiliated Hospital of Zhaoqing Medical College, Zhaoqing, China
| |
Collapse
|
5
|
Mėlinytė-Ankudavičė K, Šukys M, Kasputytė G, Krikštolaitis R, Ereminienė E, Galnaitienė G, Mizarienė V, Šakalytė G, Krilavičius T, Jurkevičius R. Association of uncertain significance genetic variants with myocardial mechanics and morphometrics in patients with nonischemic dilated cardiomyopathy. BMC Cardiovasc Disord 2024; 24:224. [PMID: 38664609 PMCID: PMC11044472 DOI: 10.1186/s12872-024-03888-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Careful interpretation of the relation between phenotype changes of the heart and gene variants detected in dilated cardiomyopathy (DCM) is important for patient care and monitoring. OBJECTIVE We sought to assess the association between cardiac-related genes and whole-heart myocardial mechanics or morphometrics in nonischemic dilated cardiomyopathy (NIDCM). METHODS It was a prospective study consisting of patients with NIDCM. All patients were referred for genetic testing and a genetic analysis was performed using Illumina NextSeq 550 and a commercial gene capture panel of 233 genes (Systems Genomics, Cardiac-GeneSGKit®). It was analyzed whether there are significant differences in clinical, two-dimensional (2D) echocardiographic, and magnetic resonance imaging (MRI) parameters between patients with the genes variants and those without. 2D echocardiography and MRI were used to analyze myocardial mechanics and morphometrics. RESULTS The study group consisted of 95 patients with NIDCM and the average age was 49.7 ± 10.5. All echocardiographic and MRI parameters of myocardial mechanics (left ventricular ejection fraction 28.4 ± 8.7 and 30.7 ± 11.2, respectively) were reduced and all values of cardiac chambers were increased (left ventricular end-diastolic diameter 64.5 ± 5.9 mm and 69.5 ± 10.7 mm, respectively) in this group. It was noticed that most cases of whole-heart myocardial mechanics and morphometrics differences between patients with and without gene variants were in the genes GATAD1, LOX, RASA1, KRAS, and KRIT1. These genes have not been previously linked to DCM. It has emerged that KRAS and KRIT1 genes were associated with worse whole-heart mechanics and enlargement of all heart chambers. GATAD1, LOX, and RASA1 genes variants showed an association with better cardiac function and morphometrics parameters. It might be that these variants alone do not influence disease development enough to be selective in human evolution. CONCLUSIONS Combined variants in previously unreported genes related to DCM might play a significant role in affecting clinical, morphometrics, or myocardial mechanics parameters.
Collapse
Affiliation(s)
- Karolina Mėlinytė-Ankudavičė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LT-44307, Lithuania.
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, LT-50162, Lithuania.
| | - Marius Šukys
- Department of Genetics and Molecular Medicine, Lithuanian University of Health Sciences, Kaunas, LT-50161, Lithuania
| | - Gabrielė Kasputytė
- Faculty of Informatics, Vytautas Magnus University, Kaunas, LT-44248, Lithuania
| | | | - Eglė Ereminienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LT-44307, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, LT-50162, Lithuania
| | - Grytė Galnaitienė
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LT-44307, Lithuania
| | - Vaida Mizarienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LT-44307, Lithuania
| | - Gintarė Šakalytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LT-44307, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, LT-50162, Lithuania
| | - Tomas Krilavičius
- Faculty of Informatics, Vytautas Magnus University, Kaunas, LT-44248, Lithuania
| | - Renaldas Jurkevičius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LT-44307, Lithuania
| |
Collapse
|
6
|
Draper J, Bastiaenen R, Carr-White G, Bueser T, Webb J, Evans C, Nuthoo S, Sheikh N. Implementing a clinical scientist-led screening clinic for hypertrophic and dilated cardiomyopathies. Echo Res Pract 2024; 11:10. [PMID: 38627858 PMCID: PMC11022456 DOI: 10.1186/s44156-024-00045-0] [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: 01/08/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The burden of screening for inherited cardiac conditions on health services grows ever larger, with each new diagnosis necessitating screening of additional family members. Screening these usually asymptomatic, low-risk individuals is currently performed by consultant cardiologists, consuming vital clinic resources that could otherwise be diverted to sicker patients requiring specialist consultant input. Clinical scientists now constitute a highly skilled and often underutilised group of individuals with training in areas such as clinical evaluation, 12-lead electrocardiography (ECG) interpretation, and echocardiography. These skills place them in a unique position to offer a full screening evaluation in a single consultation. The aim of this study was to implement and evaluate a novel clinical scientist-led screening clinic for first-degree relatives of patients with hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). The clinical scientist-led screening clinic was established at a London tertiary centre to allow review of asymptomatic, first-degree relatives of patients with a confirmed diagnosis of HCM or DCM, independent of a cardiology consultant. Patients were evaluated with history, examination, ECG, and echocardiography, with further investigations if deemed necessary. A retrospective review was performed of the first 200 patients seen in the clinic. RESULTS Of the 200 individuals reviewed between September 2019 and July 2022, 99 had a proband with HCM and 101 a proband with DCM. Overall, 169 individuals (85%) revealed normal screenings and were discharged. Thirty-one individuals (15.5%), all asymptomatic, revealed ECG changes and/or significant echocardiographic findings. Of these, 21 individuals (10.5% of the total cohort) were subsequently diagnosed with a cardiomyopathy or early phenotypic changes consistent with a cardiomyopathy (11 with HCM and 10 with DCM). These individuals were referred on to an inherited cardiac conditions consultant clinic for regular follow-up. Overall, 179 consultant clinic appointments were saved which could instead be allocated to patients requiring specialist consultant input. CONCLUSIONS This is the first description of a clinical scientist-led screening clinic for first-degree relatives of patients with HCM and DCM. The findings demonstrate that implementation of such a service into routine clinical practice is feasible, effective, safe, and can free up capacity in consultant clinics for patients requiring specialist input.
Collapse
Affiliation(s)
- Jane Draper
- Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Rachel Bastiaenen
- Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- King's College London, Faculty of Life Sciences and Medicine, St. Thomas' Hospital, St. Thomas' Campus, Westminster Bridge Road, London, SE1 7EH, UK
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Gerald Carr-White
- Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- King's College London, Faculty of Life Sciences and Medicine, St. Thomas' Hospital, St. Thomas' Campus, Westminster Bridge Road, London, SE1 7EH, UK
| | - Teofila Bueser
- Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- King's College London, Faculty of Life Sciences and Medicine, St. Thomas' Hospital, St. Thomas' Campus, Westminster Bridge Road, London, SE1 7EH, UK
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Jessica Webb
- Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Colin Evans
- Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Soraya Nuthoo
- Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Nabeel Sheikh
- Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
- King's College London, Faculty of Life Sciences and Medicine, St. Thomas' Hospital, St. Thomas' Campus, Westminster Bridge Road, London, SE1 7EH, UK.
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| |
Collapse
|
7
|
Santoro F, Vitale E, Ragnatela I, Cetera R, Leopzzi A, Mallardi A, Matera A, Mele M, Correale M, Brunetti ND. Multidisciplinary approach in cardiomyopathies: From genetics to advanced imaging. Heart Fail Rev 2024; 29:445-462. [PMID: 38041702 DOI: 10.1007/s10741-023-10373-8] [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] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Cardiomyopathies are myocardial diseases characterized by mechanical and electrical dysfunction of the heart muscle which could lead to heart failure and life-threatening arrhythmias. Certainly, an accurate anamnesis, a meticulous physical examination, and an ECG are cornerstones in raising the diagnostic suspicion. However, cardiovascular imaging techniques are indispensable to diagnose a specific cardiomyopathy, to stratify the risk related to the disease and even to track the response to the therapy. Echocardiography is often the first exam that the patient undergoes, because of its non-invasiveness, wide availability, and cost-effectiveness. Cardiac magnetic resonance imaging allows to integrate and implement the information obtained with the echography. Furthermore, cardiomyopathies' genetic basis has been investigated over the years and the list of genetic mutations deemed potentially pathogenic is expected to grow further. The aim of this review is to show echocardiographic, cardiac magnetic resonance imaging, and genetic features of several cardiomyopathies: dilated cardiomyopathy (DMC), hypertrophic cardiomyopathy (HCM), arrhythmogenic cardiomyopathy (ACM), left ventricular noncompaction cardiomyopathy (LVNC), myocarditis, and takotsubo cardiomyopathy.
Collapse
Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy.
| | - Enrica Vitale
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Ilaria Ragnatela
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Rosa Cetera
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | | | | | - Annalisa Matera
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Marco Mele
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Michele Correale
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| |
Collapse
|
8
|
Owen R, Buchan R, Frenneaux M, Jarman JWE, Baruah R, Lota AS, Halliday BP, Roberts AM, Izgi C, Van Spall HGC, Michos ED, McMurray JJV, Januzzi JL, Pennell DJ, Cook SA, Ware JS, Barton PJ, Gregson J, Prasad SK, Tayal U. Sex Differences in the Clinical Presentation and Natural History of Dilated Cardiomyopathy. JACC. HEART FAILURE 2024; 12:352-363. [PMID: 38032570 PMCID: PMC10857810 DOI: 10.1016/j.jchf.2023.10.009] [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: 05/05/2023] [Revised: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Biological sex has a diverse impact on the cardiovascular system. Its influence on dilated cardiomyopathy (DCM) remains unresolved. OBJECTIVES This study aims to investigate sex-specific differences in DCM presentation, natural history, and prognostic factors. METHODS The authors conducted a prospective observational cohort study of DCM patients assessing baseline characteristics, cardiac magnetic resonance imaging, biomarkers, and genotype. The composite outcome was cardiovascular mortality or major heart failure (HF) events. RESULTS Overall, 206 females and 398 males with DCM were followed for a median of 3.9 years. At baseline, female patients had higher left ventricular ejection fraction, smaller left ventricular volumes, less prevalent mid-wall myocardial fibrosis (23% vs 42%), and lower high-sensitivity cardiac troponin I than males (all P < 0.05) with no difference in time from diagnosis, age at enrollment, N-terminal pro-B-type natriuretic peptide levels, pathogenic DCM genetic variants, myocardial fibrosis extent, or medications used for HF. Despite a more favorable profile, the risk of the primary outcome at 2 years was higher in females than males (8.6% vs 4.4%, adjusted HR: 3.14; 95% CI: 1.55-6.35; P = 0.001). Between 2 and 5 years, the effect of sex as a prognostic modifier attenuated. Age, mid-wall myocardial fibrosis, left ventricular ejection fraction, left atrial volume, N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin I, left bundle branch block, and NYHA functional class were not sex-specific prognostic factors. CONCLUSIONS The authors identified a novel paradox in prognosis for females with DCM. Female DCM patients have a paradoxical early increase in major HF events despite less prevalent myocardial fibrosis and a milder phenotype at presentation. Future studies should interrogate the mechanistic basis for these sex differences.
Collapse
Affiliation(s)
- Ruth Owen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rachel Buchan
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael Frenneaux
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Julian W E Jarman
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Resham Baruah
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Amrit S Lota
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Brian P Halliday
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Angharad M Roberts
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Cemil Izgi
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Harriette G C Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Cardiology Division, Massachusetts General Hospital, Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Dudley J Pennell
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Stuart A Cook
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - James S Ware
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; MRC London Institute of Medical Sciences, London, United Kingdom
| | - Paul J Barton
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sanjay K Prasad
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Upasana Tayal
- National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
9
|
Cannie DE, Syrris P, Protonotarios A, Bakalakos A, Pruny JF, Ditaranto R, Martinez-Veira C, Larrañaga-Moreira JM, Medo K, Bermúdez-Jiménez FJ, Ben Yaou R, Leturcq F, Mezcua AR, Marini-Bettolo C, Cabrera E, Reuter C, Limeres Freire J, Rodríguez-Palomares JF, Mestroni L, Taylor MRG, Parikh VN, Ashley EA, Barriales-Villa R, Jiménez-Jáimez J, Garcia-Pavia P, Charron P, Biagini E, García Pinilla JM, Bourke J, Savvatis K, Wahbi K, Elliott PM. Emery-Dreifuss muscular dystrophy Type 1 is associated with a high risk of malignant ventricular arrhythmias and end-stage heart failure. Eur Heart J 2023; 44:5064-5073. [PMID: 37639473 PMCID: PMC10733739 DOI: 10.1093/eurheartj/ehad561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND AND AIMS Emery-Dreifuss muscular dystrophy (EDMD) is caused by variants in EMD (EDMD1) and LMNA (EDMD2). Cardiac conduction defects and atrial arrhythmia are common to both, but LMNA variants also cause end-stage heart failure (ESHF) and malignant ventricular arrhythmia (MVA). This study aimed to better characterize the cardiac complications of EMD variants. METHODS Consecutively referred EMD variant-carriers were retrospectively recruited from 12 international cardiomyopathy units. MVA and ESHF incidences in male and female variant-carriers were determined. Male EMD variant-carriers with a cardiac phenotype at baseline (EMDCARDIAC) were compared with consecutively recruited male LMNA variant-carriers with a cardiac phenotype at baseline (LMNACARDIAC). RESULTS Longitudinal follow-up data were available for 38 male and 21 female EMD variant-carriers [mean (SD) ages 33.4 (13.3) and 43.3 (16.8) years, respectively]. Nine (23.7%) males developed MVA and five (13.2%) developed ESHF during a median (inter-quartile range) follow-up of 65.0 (24.3-109.5) months. No female EMD variant-carrier had MVA or ESHF, but nine (42.8%) developed a cardiac phenotype at a median (inter-quartile range) age of 58.6 (53.2-60.4) years. Incidence rates for MVA were similar for EMDCARDIAC and LMNACARDIAC (4.8 and 6.6 per 100 person-years, respectively; log-rank P = .49). Incidence rates for ESHF were 2.4 and 5.9 per 100 person-years for EMDCARDIAC and LMNACARDIAC, respectively (log-rank P = .09). CONCLUSIONS Male EMD variant-carriers have a risk of progressive heart failure and ventricular arrhythmias similar to that of male LMNA variant-carriers. Early implantable cardioverter defibrillator implantation and heart failure drug therapy should be considered in male EMD variant-carriers with cardiac disease.
Collapse
Affiliation(s)
- Douglas E Cannie
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Petros Syrris
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Alexandros Protonotarios
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Athanasios Bakalakos
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Jean-François Pruny
- APHP, Sorbonne Université, Centre de Référence pour les Maladies Cardiaques Héréditaires ou rares, ICAN Institute, Hôpital Pitié-Salpêtrière, Paris, France
| | - Raffaello Ditaranto
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
| | - Cristina Martinez-Veira
- Unidad de Cardiopatías Familiares, Complexo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC/CIBERCV), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Jose M Larrañaga-Moreira
- Unidad de Cardiopatías Familiares, Complexo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC/CIBERCV), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Kristen Medo
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Francisco José Bermúdez-Jiménez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria IBS Granada, Granada, Spain
| | - Rabah Ben Yaou
- APHP-Sorbonne Universite, Centre de Référence des Maladies Neuromusculaires, Inserm, Centre de Recherche en Myologie, Institut de Myologie, Hopital Pitie-Salpetriere, Paris, France
| | - France Leturcq
- APHP, Cochin Hospital, Department of Genomic Medicine and Systemic Diseases, University of Paris, Paris, France
| | - Ainhoa Robles Mezcua
- Heart Failure and Familial Cardiomyopathies Unit, Department of Cardiology, IBIMA, Málaga. Spain
- Ciber-Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Chiara Marini-Bettolo
- Department of Cardiology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Eva Cabrera
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
| | - Chloe Reuter
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Javier Limeres Freire
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
- 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
| | - José F Rodríguez-Palomares
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
- 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
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew R G Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Victoria N Parikh
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Euan A Ashley
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Complexo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC/CIBERCV), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Juan Jiménez-Jáimez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria IBS Granada, Granada, Spain
| | - Pablo Garcia-Pavia
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Philippe Charron
- APHP, Sorbonne Université, Centre de Référence pour les Maladies Cardiaques Héréditaires ou rares, ICAN Institute, Hôpital Pitié-Salpêtrière, Paris, France
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
| | - Elena Biagini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
| | - José M García Pinilla
- Heart Failure and Familial Cardiomyopathies Unit, Department of Cardiology, IBIMA, Málaga. Spain
- Ciber-Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Medicina y Dermatología, Universidad de Malaga, Malaga, Spain
| | - John Bourke
- Department of Cardiology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Konstantinos Savvatis
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
- William Harvey Institute, Queen Mary University London, London, United Kingdom
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Karim Wahbi
- AP-HP, Pitié-Salpêtrière Hospital, Reference Center for Muscle Diseases Paris-Est, Myology Institute, Paris, France
- AP-HP, Cochin Hospital, Cardiology Department, Paris Cedex, France
- Université de Paris, Paris, France; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France
| | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| |
Collapse
|
10
|
Akinrinade O, Lesurf R, Lougheed J, Mondal T, Smythe J, Altamirano-Diaz L, Oechslin E, Mital S. Age and Sex Differences in the Genetics of Cardiomyopathy. J Cardiovasc Transl Res 2023; 16:1287-1302. [PMID: 37477868 PMCID: PMC10721711 DOI: 10.1007/s12265-023-10411-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023]
Abstract
Cardiomyopathy has variable penetrance. We analyzed age and sex-related genetic differences in 1,397 cardiomyopathy patients (Ontario, UK) with whole genome sequencing. Pediatric cases (n = 471) harbored more deleterious protein-coding variants in Tier 1 cardiomyopathy genes compared to adults (n = 926) (34.6% vs 25.9% respectively, p = 0.0015), with variant enrichment in constrained coding regions. Pediatric patients had a higher burden of sarcomere and lower burden of channelopathy gene variants compared to adults. Specifically, pediatric patients had more MYH7 and MYL3 variants in hypertrophic cardiomyopathy, and fewer TTN truncating variants in dilated cardiomyopathy. MYH7 variants clustered in the myosin head and neck domains in children. OBSCN was a top mutated gene in adults, enriched for protein-truncating variants. In dilated cardiomyopathy, female patients had a higher burden of z-disc gene variants compared to males. Genetic differences may explain age and sex-related variability in cardiomyopathy penetrance. Genotype-guided predictions of age of onset can inform pre-test genetic counseling. Pediatric cardiomyopathy patients were more likely to be genotype-positive than adults with a higher burden of variants in MYH7, MYL3, TNNT2, VCL. Adults had a higher burden of OBSCN and TTN variants. Females with dilated cardiomyopathy (DCM) had a higher burden of z-disc gene variants compared to males.
Collapse
Affiliation(s)
- Oyediran Akinrinade
- Genetics and Genome Biology Program, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- St. George's University School of Medicine, St. George's, West Indies, Grenada
| | - Robert Lesurf
- Genetics and Genome Biology Program, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Jane Lougheed
- Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Tapas Mondal
- Division of Cardiology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | - John Smythe
- Division of Cardiology, Department of Pediatrics, Kingston General Hospital, Kingston, ON, Canada
| | - Luis Altamirano-Diaz
- Division of Cardiology, Department of Pediatrics, London Health Sciences Centre, London, ON, Canada
| | - Erwin Oechslin
- Division of Cardiology, Toronto Adult Congenital Heart Disease Program at Peter Munk Cardiac Centre, Department of Medicine, University Health Network, and University of Toronto, Toronto, ON, Canada
| | - Seema Mital
- Genetics and Genome Biology Program, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Ted Rogers Centre for Heart Research, Toronto, ON, Canada.
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
11
|
Polovina M, Tschöpe C, Rosano G, Metra M, Crea F, Mullens W, Bauersachs J, Sliwa K, de Boer RA, Farmakis D, Thum T, Corrado D, Bayes-Genis A, Bozkurt B, Filippatos G, Keren A, Skouri H, Moura B, Volterrani M, Abdelhamid M, Ašanin M, Krljanac G, Tomić M, Savarese G, Adamo M, Lopatin Y, Chioncel O, Coats AJS, Seferović PM. Incidence, risk assessment and prevention of sudden cardiac death in cardiomyopathies. Eur J Heart Fail 2023; 25:2144-2163. [PMID: 37905371 DOI: 10.1002/ejhf.3076] [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] [Received: 08/18/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023] Open
Abstract
Cardiomyopathies are a significant contributor to cardiovascular morbidity and mortality, mainly due to the development of heart failure and increased risk of sudden cardiac death (SCD). Despite improvement in survival with contemporary treatment, SCD remains an important cause of mortality in cardiomyopathies. It occurs at a rate ranging between 0.15% and 0.7% per year (depending on the cardiomyopathy), which significantly surpasses SCD incidence in the age- and sex-matched general population. The risk of SCD is affected by multiple factors including the aetiology, genetic basis, age, sex, physical exertion, the extent of myocardial disease severity, conduction system abnormalities, and electrical instability, as measured by various metrics. Over the past decades, the knowledge on the mechanisms and risk factors for SCD has substantially improved, allowing for a better-informed risk stratification. However, unresolved issues still challenge the guidance of SCD prevention in patients with cardiomyopathies. In this review, we aim to provide an in-depth discussion of the contemporary concepts pertinent to understanding the burden, risk assessment and prevention of SCD in cardiomyopathies (dilated, non-dilated left ventricular, hypertrophic, arrhythmogenic right ventricular, and restrictive). The review first focuses on SCD incidence in cardiomyopathies and then summarizes established and emerging risk factors for life-threatening arrhythmias/SCD. Finally, it discusses validated approaches to the risk assessment and evidence-based measures for SCD prevention in cardiomyopathies, pointing to the gaps in evidence and areas of uncertainties that merit future clarification.
Collapse
Affiliation(s)
- Marija Polovina
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Wilfried Mullens
- Hasselt University, Hasselt, Belgium
- Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Karen Sliwa
- Cape Heart Institute. Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Domenico Corrado
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antoni Bayes-Genis
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, CIBERCV, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Biykem Bozkurt
- Section of Cardiology, Winters Center for Heart Failure, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Andre Keren
- Hadassah-Hebrew University Medical Center Jerusalem, Clalit Services District of Jerusalem, Jerusalem, Israel
| | - Hadi Skouri
- Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Brenda Moura
- Armed Forces Hospital, Porto, & Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maurizio Volterrani
- IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University of Rome, Rome, Italy
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University, Giza, Egypt
| | - Milika Ašanin
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Milenko Tomić
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Yuri Lopatin
- Volgograd Medical University, Cardiology Centre, Volgograd, Russian Federation
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania
- University for Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | | | - Petar M Seferović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| |
Collapse
|
12
|
Kasiakogias A, Ragavan A, Halliday BP. Your Heart Function Has Normalized-What Next After TRED-HF? Curr Heart Fail Rep 2023; 20:542-554. [PMID: 37999902 PMCID: PMC10746577 DOI: 10.1007/s11897-023-00636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW With the widespread implementation of contemporary disease-modifying heart failure therapy, the rates of normalization of ejection fraction are continuously increasing. The TRED-HF trial confirmed that heart failure remission rather than complete recovery is typical in patients with dilated cardiomyopathy who respond to therapy. The present review outlines key points related to the management and knowledge gaps of this growing patient group, focusing on patients with non-ischaemic dilated cardiomyopathy. RECENT FINDINGS There is substantial heterogeneity among patients with normalized ejection fraction. The specific etiology is likely to affect the outcome, although a multiple-hit phenotype is frequent and may not be identified without comprehensive characterization. A monogenic or polygenic genetic susceptibility is common. Ongoing pathophysiological processes may be unraveled with advanced cardiac imaging, biomarkers, multi-omics, and machine learning technologies. There are limited studies that have investigated the withdrawal of specific heart failure therapies in these patients. Diuretics may be safely withdrawn if there is no evidence of congestion, while continued therapy with at least some disease-modifying therapy is likely to be required to reduce myocardial workload and sustain remission for the vast majority. Understanding the underlying disease mechanisms of patients with normalized ejection fraction is crucial in identifying markers of myocardial relapse and guiding individualized therapy in the future. Ongoing clinical trials should inform personalized approaches to therapy.
Collapse
Affiliation(s)
- Alexandros Kasiakogias
- Inherited Cardiac Conditions Care Group, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aaraby Ragavan
- Inherited Cardiac Conditions Care Group, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Brian P Halliday
- Inherited Cardiac Conditions Care Group, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK.
- National Heart and Lung Institute, Imperial College London, London, UK.
| |
Collapse
|
13
|
Tong X, Shen L, Zhou X, Wang Y, Chang S, Lu S. Comparative Efficacy of Different Drugs for the Treatment of Dilated Cardiomyopathy: A Systematic Review and Network Meta-analysis. Drugs R D 2023; 23:197-210. [PMID: 37556093 PMCID: PMC10439079 DOI: 10.1007/s40268-023-00435-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVE At present, the therapies of dilated cardiomyopathy concentrated on the symptoms of heart failure and related complications. The study is to evaluate the clinical efficacy of a combination of various conventional and adjuvant drugs in treating dilated cardiomyopathy via network meta-analysis. METHODS The study was reported according to the PRISMA 2020 statement. From inception through 27 June 2022, the PubMed, Embase, Cochrane library, and Web of Science databases were searched for randomized controlled trials on medicines for treating dilated cardiomyopathy. The quality of the included studies was evaluated according to the Cochrane risk of bias assessment. R4.1.3 and Revman5.3 software were used for analysis. RESULTS There were 52 randomized controlled trials in this study, with a total of 25 medications and a sample size of 3048 cases. The network meta-analysis found that carvedilol, verapamil, and trimetazidine were the top three medicines for improving left ventricular ejection fraction (LVEF). Ivabradine, bucindolol, and verapamil were the top 3 drugs for improving left ventricular end-diastolic dimension (LVEDD). Ivabradine, L-thyroxine, and atorvastatin were the top 3 drugs for improving left ventricular end-systolic dimension (LVESD). Trimetazidine, pentoxifylline, and bucindolol were the top 3 drugs for improving the New York Heart Association classification (NYHA) cardiac function score. Ivabradine, carvedilol, and bucindolol were the top 3 drugs for reducing heart rate (HR). CONCLUSION A combination of different medications and conventional therapy may increase the clinical effectiveness of treating dilated cardiomyopathy. Beta-blockers, especially carvedilol, can improve ventricular remodeling, cardiac function, and clinical efficacy in patients with dilated cardiomyopathy (DCM). Hence, they can be used if patients tolerate them. If LVEF and HR do not meet the standard, ivabradine can also be used in combination with other treatments. However, since the quality and number of studies in our research were limited, large sample size, multi-center, and high-quality randomized controlled trials are required to corroborate our findings.
Collapse
Affiliation(s)
- Xinyu Tong
- Wuxi Traditional Chinese Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lijuan Shen
- Wuxi Traditional Chinese Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaomin Zhou
- Wuxi Traditional Chinese Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yudan Wang
- Wuxi Traditional Chinese Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Sheng Chang
- Wuxi Traditional Chinese Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shu Lu
- Wuxi Traditional Chinese Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
14
|
Duryagina R, Richter S, Ebert M. Legal aspects of genetic testing in the evaluation of ventricular tachycardias. Herzschrittmacherther Elektrophysiol 2023; 34:205-211. [PMID: 37524841 DOI: 10.1007/s00399-023-00948-1] [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: 04/28/2023] [Accepted: 06/06/2023] [Indexed: 08/02/2023]
Abstract
There is increasing knowledge of the genetic basis of distinct cardiac pathologies that are related to ventricular tachyarrhythmias (VT) and sudden cardiac death (SCD). The identification of genes responsible for inherited cardiac diseases has led to the organization of cardiogenetic consultations in many countries worldwide. The 2022 European Society of Cardiology (ESC) guidelines for the management of patients with ventricular arrhythmias and the prevention of SCD and the international 2022 Expert Consensus Statement on the state of genetic testing for cardiac diseases emphasize the importance of genetic testing in cardiology practice along with appropriate information provision to affected individuals and their relatives. However, the context of genetic examination raises particular ethical, practical (including economic or financial), and legal challenges. This review aims to elucidate practical considerations related to legal aspects relevant for the evaluation of patients presenting with VT in Germany.
Collapse
Affiliation(s)
- Regina Duryagina
- Division of Electrophysiology, Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Sergio Richter
- Division of Electrophysiology, Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Micaela Ebert
- Division of Electrophysiology, Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany.
| |
Collapse
|
15
|
Crotti L, Brugada P, Calkins H, Chevalier P, Conte G, Finocchiaro G, Postema PG, Probst V, Schwartz PJ, Behr ER. From gene-discovery to gene-tailored clinical management: 25 years of research in channelopathies and cardiomyopathies. Europace 2023; 25:euad180. [PMID: 37622577 PMCID: PMC10450790 DOI: 10.1093/europace/euad180] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 08/26/2023] Open
Abstract
In the early nineties, few years before the birth of Europace, the clinical and scientific world of familial arrhythmogenic conditions was revolutionized by the identification of the first disease-causing genes. The explosion of genetic studies over a 15-year period led to the discovery of major disease-causing genes in practically all channelopathies and cardiomyopathies, bringing insight into the pathophysiological mechanisms of these conditions. The birth of next generation sequencing allowed a further step forward and other significant genes, as CALM1-3 in channelopathies and FLN C and TTN in cardiomyopathies were identified. Genotype-phenotype studies allowed the implementation of the genetic results in diagnosis, risk stratification, and therapeutic management with a different level of evidence in different arrhythmogenic conditions. The influence of common genetic variants, i.e. SNPs, on disease manifestation was proved in mid-twenties, and in the last 10 years with the advent of genome-wide association studies performed in familial arrhythmogenic diseases, the concept of polygenic risk score has been consolidated. Now, we are at the start of another amazing phase, i.e. the initiation of first gene therapy clinical trials.
Collapse
Affiliation(s)
- Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy
- IRCCS Istituto Auxologico Italiano, Department of Cardiology, Cardiomyopathy Unit, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Piazzale Brescia, 20, 20149 Milan, Italy
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philippe Chevalier
- Neuromyogene Institute, Claude Bernard University, Lyon 1, Lyon, France
- Service de Rythmologie, Hospices Civils de Lyon, Lyon, France
| | - Giulio Conte
- Division of Cardiology, Istituto Cardiocentro Ticino, Ente Cantonale Ospedaliero, Lugano, Switzerland
| | - Gherardo Finocchiaro
- Cardiovascular Sciences Research Centre, St. George’s, University of London, London, UK
| | - Pieter G Postema
- Department of Cardiology, Amsterdam University Medical Centers, location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - Vincent Probst
- Centre Hospitalier Universitaire Nantes, Nantes Université, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Peter J Schwartz
- IRCCS Istituto Auxologico Italiano, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Elijah R Behr
- Cardiology Section, Institute of Molecular and Clinical Sciences, St. George's, University of London, London SW17 0RE, UK
- Department of Cardiology, Mayo Clinic Healthcare, 15 Portland Pl, London W1B 1PT, UK
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT
| |
Collapse
|
16
|
Jordan E, Kinnamon DD, Haas GJ, Hofmeyer M, 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, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Mead JO, Hurst N, Cao J, Huggins GS, Cowan J, Ni H, Rehm HL, Jarvik GP, Vatta M, Burke W, Hershberger RE. Genetic Architecture of Dilated Cardiomyopathy in Individuals of African and European Ancestry. JAMA 2023; 330:432-441. [PMID: 37526719 PMCID: PMC10394581 DOI: 10.1001/jama.2023.11970] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/13/2023] [Indexed: 08/02/2023]
Abstract
Importance Black patients with dilated cardiomyopathy (DCM) have increased familial risk and worse outcomes than White patients, but most DCM genetic data are from White patients. Objective To compare the rare variant genetic architecture of DCM by genomic ancestry within a diverse population of patients with DCM. Design Cross-sectional study enrolling patients with DCM who self-identified as non-Hispanic Black, Hispanic, or non-Hispanic White from June 7, 2016, to March 15, 2020, at 25 US advanced heart failure programs. Variants in 36 DCM genes were adjudicated as pathogenic, likely pathogenic, or of uncertain significance. Exposure Presence of DCM. Main Outcomes and Measures Variants in DCM genes classified as pathogenic/likely pathogenic/uncertain significance and clinically actionable (pathogenic/likely pathogenic). Results A total of 505, 667, and 26 patients with DCM of predominantly African, European, or Native American genomic ancestry, respectively, were included. Compared with patients of European ancestry, a lower percentage of patients of African ancestry had clinically actionable variants (8.2% [95% CI, 5.2%-11.1%] vs 25.5% [95% CI, 21.3%-29.6%]), reflecting the lower odds of a clinically actionable variant for those with any pathogenic variant/likely pathogenic variant/variant of uncertain significance (odds ratio, 0.25 [95% CI, 0.17-0.37]). On average, patients of African ancestry had fewer clinically actionable variants in TTN (difference, -0.09 [95% CI, -0.14 to -0.05]) and other genes with predicted loss of function as a disease-causing mechanism (difference, -0.06 [95% CI, -0.11 to -0.02]). However, the number of pathogenic variants/likely pathogenic variants/variants of uncertain significance was more comparable between ancestry groups (difference, -0.07 [95% CI, -0.22 to 0.09]) due to a larger number of non-TTN non-predicted loss of function variants of uncertain significance, mostly missense, in patients of African ancestry (difference, 0.15 [95% CI, 0.00-0.30]). Published clinical case-based evidence supporting pathogenicity was less available for variants found only in patients of African ancestry (P < .001). Conclusion and Relevance Patients of African ancestry with DCM were less likely to have clinically actionable variants in DCM genes than those of European ancestry due to differences in genetic architecture and a lack of representation of African ancestry in clinical data sets.
Collapse
Affiliation(s)
- Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Garrie J. Haas
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
| | - Mark Hofmeyer
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, DC
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha
| | | | | | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J. C. Walter Jr Transplant Center, Houston, Texas
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson
- Now with Washington University, St Louis, Missouri
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stuart Katz
- New York University Langone Medical Center, New York, New York
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla
| | - Javier Jimenez
- Miami Cardiac and Vascular Institute, Baptist Health South, Miami, Florida
| | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles
| | | | | | | | - Jonathan O. Mead
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Natalie Hurst
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Jinwen Cao
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Jason Cowan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Heidi L. Rehm
- Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | - Gail P. Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle
- Department of Genome Sciences, University of Washington, Seattle
| | - Matteo Vatta
- Departments of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
| |
Collapse
|
17
|
Wilcox JE, Beussink-Nelson L, Cao J, Kumar R, Jordan E, Ni H, Shah SJ, Hershberger RE, Kinnamon DD. Differences in Cardiac Mechanics among Genetically At-Risk First-Degree Relatives: The DCM Precision Medicine Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.30.23290123. [PMID: 37398079 PMCID: PMC10312893 DOI: 10.1101/2023.05.30.23290123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Aims Among genetically at-risk first-degree relatives (FDRs) of probands with dilated cardiomyopathy (DCM), the ability to detect changes in left ventricular (LV) mechanics with normal LV size and ejection fraction (LVEF) remains incompletely explored. We sought to define a pre-DCM phenotype among at-risk FDRs, including those with variants of uncertain significance (VUSs), using echocardiographic measures of cardiac mechanics. Methods and Results LV structure and function, including speckle-tracking analysis for LV global longitudinal strain (GLS), were evaluated in 124 FDRs (65% female; median age 44.9 [IQR: 30.6-60.3] years) of 66 DCM probands of European ancestry sequenced for rare variants in 35 DCM genes. FDRs had normal LV size and LVEF. Negative FDRs of probands with pathogenic or likely pathogenic (P/LP) variants (n=28) were a reference group to which negative FDRs of probands without P/LP variants (n=30), FDRs with only VUSs (n=27), and FDRs with P/LP variants (n=39) were compared. In an analysis accounting for age-dependent penetrance, FDRs below the median age showed minimal differences in LV GLS across groups while those above it with P/LP variants or VUSs had lower absolute values than the reference group (-3.9 [95% CI: -5.7, -2.1] or -3.1 [-4.8, -1.4] %-units) and negative FDRs of probands without P/LP variants (-2.6 [-4.0, -1.2] or -1.8 [-3.1, -0.6]). Conclusions Older FDRs with normal LV size and LVEF who harbored P/LP variants or VUSs had lower absolute LV GLS values, indicating that some DCM-related VUSs are clinically relevant. LV GLS may have utility for defining a pre-DCM phenotype. Clinical Trial Registration clinicaltrials.gov, NCT03037632.
Collapse
Affiliation(s)
- Jane E. Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Beussink-Nelson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jinwen Cao
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Ritika Kumar
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Sanjiv J. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- 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
| | - Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| |
Collapse
|
18
|
Cho JY, Cho DH, Youn JC, Kim D, Park SM, Jung MH, Hyun J, Choi J, Cho HJ, Park SM, Choi JO, Chung WJ, Yoo BS, Kang SM. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Definition and Diagnosis. Korean Circ J 2023; 53:195-216. [PMID: 37161680 PMCID: PMC10172202 DOI: 10.4070/kcj.2023.0046] [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: 02/09/2023] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 05/11/2023] Open
Abstract
The Korean Society of Heart Failure guidelines aim to provide physicians with evidence-based recommendations for diagnosing and managing patients with heart failure (HF). In Korea, the prevalence of HF has been rapidly increasing in the last 10 years. HF has recently been classified into HF with reduced ejection fraction (EF), HF with mildly reduced EF, and HF with preserved EF (HFpEF). Moreover, the availability of newer therapeutic agents has led to an increased emphasis on the appropriate diagnosis of HFpEF. Accordingly, this part of the guidelines will mainly cover the definition, epidemiology, and diagnosis of HF.
Collapse
Affiliation(s)
- Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Catholic Research Institute for Intractable Cardiovascular Disease, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Min Park
- Department of Cardiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Catholic Research Institute for Intractable Cardiovascular Disease, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jimi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
19
|
Cho JY, Cho DH, Youn JC, Kim D, Park SM, Jung MH, Hyun J, Choi J, Cho HJ, Park SM, Choi JO, Chung WJ, Yoo BS, Kang SM. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Definition and Diagnosis. INTERNATIONAL JOURNAL OF HEART FAILURE 2023; 5:51-65. [PMID: 37180563 PMCID: PMC10172081 DOI: 10.36628/ijhf.2023.0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023]
Abstract
The Korean Society of Heart Failure guidelines aim to provide physicians with evidence-based recommendations for diagnosing and managing patients with heart failure (HF). In Korea, the prevalence of HF has been rapidly increasing in the last 10 years. HF has recently been classified into HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (EF), and HF with preserved EF (HFpEF). Moreover, the availability of newer therapeutic agents has led to an increased emphasis on the appropriate diagnosis of HFpEF. Accordingly, this part of the guidelines will mainly cover the definition, epidemiology, and diagnosis of HF.
Collapse
Affiliation(s)
- Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Min Park
- Department of Cardiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jimi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | |
Collapse
|
20
|
The genetic basis for adult-onset idiopathic dilated cardiomyopathy in people of African descent. Heart Fail Rev 2023:10.1007/s10741-023-10302-9. [PMID: 36917398 PMCID: PMC10011790 DOI: 10.1007/s10741-023-10302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/16/2023]
Abstract
Cardiomyopathies are a heterogeneous group of cardiac muscle disorders that result in dilated, hypertrophic, or restrictive pathophysiological entities. Dilated cardiomyopathy (DCM) is the most common form in sub-Saharan Africa (SSA). However, population-specific research studies reporting the actual burden of DCM in this region are still lacking. Also, little is known about the genetic basis of DCM in this population, and genetic testing is still not readily accessible. This review describes the common pathogenic genes implicated in DCM globally and discusses the evidence-based management of patients with DCM. We also present a summary of studies describing genes implicated or associated with DCM in patients residing in SSA.
Collapse
|
21
|
El Hadi H, Freund A, Desch S, Thiele H, Majunke N. Hypertrophic, Dilated, and Arrhythmogenic Cardiomyopathy: Where Are We? Biomedicines 2023; 11:biomedicines11020524. [PMID: 36831060 PMCID: PMC9953324 DOI: 10.3390/biomedicines11020524] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Cardiomyopathies are a heterogeneous group of structural, mechanical, and electrical heart muscle disorders which often correlate with life-threatening arrhythmias and progressive heart failure accounting for significant cardiovascular morbidity and mortality. Currently, cardiomyopathies still represent a leading reason for heart transplantation worldwide. The last years have brought remarkable advances in the field of cardiomyopathies especially in terms of understanding the molecular basis as well as the diagnostic evaluation and management. Although most cardiomyopathy treatments had long focused on symptom management, much of the current research efforts aim to identify and act on the disease-driving mechanisms. Regarding risk assessment and primary prevention of sudden cardiac death, additional data are still pending in order to pave the way for a more refined and early patient selection for defibrillator implantation. This review summarizes the current knowledge of hypertrophic, dilated and arrhythmogenic cardiomyopathy with a particular emphasis on their pathophysiology, clinical features, and diagnostic approach. Furthermore, the relevant ongoing studies investigating novel management approaches and main gaps in knowledge are highlighted.
Collapse
Affiliation(s)
- Hamza El Hadi
- Correspondence: (H.E.H.); (N.M.); Tel.: +49-341-865-142 (H.E.H. & N.M.); Fax: +49-341-865-1461 (N.M.)
| | | | | | | | - Nicolas Majunke
- Correspondence: (H.E.H.); (N.M.); Tel.: +49-341-865-142 (H.E.H. & N.M.); Fax: +49-341-865-1461 (N.M.)
| |
Collapse
|
22
|
Crea F. Management of atrial fibrillation: role of population screening, biomarkers, and polygenic risk scores. Eur Heart J 2023; 44:167-170. [PMID: 36638838 DOI: 10.1093/eurheartj/ehac802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
23
|
Gu JN, Yang CX, Ding YY, Qiao Q, Di RM, Sun YM, Wang J, Yang L, Xu YJ, Yang YQ. Identification of BMP10 as a Novel Gene Contributing to Dilated Cardiomyopathy. Diagnostics (Basel) 2023; 13:diagnostics13020242. [PMID: 36673052 PMCID: PMC9857772 DOI: 10.3390/diagnostics13020242] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/20/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Dilated cardiomyopathy (DCM), characterized by left ventricular or biventricular enlargement with systolic dysfunction, is the most common type of cardiac muscle disease. It is a major cause of congestive heart failure and the most frequent indication for heart transplantation. Aggregating evidence has convincingly demonstrated that DCM has an underlying genetic basis, though the genetic defects responsible for DCM in a larger proportion of cases remain elusive, motivating the ongoing research for new DCM-causative genes. In the current investigation, a multigenerational family affected with autosomal-dominant DCM was recruited from the Chinese Han population. By whole-exome sequencing and Sanger sequencing analyses of the DNAs from the family members, a new BMP10 variation, NM_014482.3:c.166C > T;p.(Gln56*), was discovered and verified to be in co-segregation with the DCM phenotype in the entire family. The heterozygous BMP10 variant was not detected in 268 healthy volunteers enrolled as control subjects. The functional measurement via dual-luciferase reporter assay revealed that Gln56*-mutant BMP10 lost the ability to transactivate its target genes NKX2.5 and TBX20, two genes that had been causally linked to DCM. The findings strongly indicate BMP10 as a new gene contributing to DCM in humans and support BMP10 haploinsufficiency as an alternative pathogenic mechanism underpinning DCM, implying potential implications for the early genetic diagnosis and precision prophylaxis of DCM.
Collapse
Affiliation(s)
- Jia-Ning Gu
- Department of Cardiology, Shanghai Fifth People′s Hospital, Fudan University, Shanghai 200240, China
| | - Chen-Xi Yang
- Department of Cardiology, Shanghai Fifth People′s Hospital, Fudan University, Shanghai 200240, China
| | - Yuan-Yuan Ding
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai 200031, China
| | - Qi Qiao
- Department of Cardiology, Shanghai Fifth People′s Hospital, Fudan University, Shanghai 200240, China
| | - Ruo-Min Di
- Department of Cardiology, Shanghai Fifth People′s Hospital, Fudan University, Shanghai 200240, China
| | - Yu-Min Sun
- Department of Cardiology, Shanghai Jing’an District Central Hospital, Fudan University, Shanghai 200040, China
| | - Jun Wang
- Department of Cardiology, Shanghai Jing’an District Central Hospital, Fudan University, Shanghai 200040, China
| | - Ling Yang
- Department of Ultrasound, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Ying-Jia Xu
- Department of Cardiology, Shanghai Fifth People′s Hospital, Fudan University, Shanghai 200240, China
- Correspondence: (Y.-J.X.); (Y.-Q.Y.)
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Fifth People′s Hospital, Fudan University, Shanghai 200240, China
- Department of Cardiovascular Research Laboratory, Shanghai Fifth People′s Hospital, Fudan University, Shanghai 200240, China
- Department of Central Laboratory, Shanghai Fifth People′s Hospital, Fudan University, Shanghai 200240, China
- Correspondence: (Y.-J.X.); (Y.-Q.Y.)
| |
Collapse
|
24
|
Crea F. New avenues in the prevention of sudden cardiac death. Eur Heart J 2022; 43:2083-2086. [PMID: 35667660 DOI: 10.1093/eurheartj/ehac277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
25
|
Crea F. Challenges in heart failure: from actionability of genetic variants in cardiopmyopathies to new therapeutic targets. Eur Heart J 2022; 43:1887-1890. [PMID: 35596264 DOI: 10.1093/eurheartj/ehac243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
26
|
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.
Collapse
|
27
|
Cannatà A, Merlo M, Dal Ferro M, Barbati G, Manca P, Paldino A, Graw S, Gigli M, Stolfo D, Johnson R, Roy D, Tharratt K, Bromage DI, Jirikowic J, Abbate A, Goodwin A, Rao K, Marawan A, Carr-White G, Robert L, Parikh V, Ashley E, McDonagh T, Lakdawala NK, Fatkin D, Taylor MRG, Mestroni L, Sinagra G. Association of Titin Variations With Late-Onset Dilated Cardiomyopathy. JAMA Cardiol 2022; 7:371-377. [PMID: 35138330 PMCID: PMC8829739 DOI: 10.1001/jamacardio.2021.5890] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/09/2021] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Dilated cardiomyopathy (DCM) is frequently caused by genetic factors. Studies identifying deleterious rare variants have predominantly focused on early-onset cases, and little is known about the genetic underpinnings of the growing numbers of patients with DCM who are diagnosed when they are older than 60 years (ie, late-onset DCM). OBJECTIVE To investigate the prevalence, type, and prognostic impact of disease-associated rare variants in patients with late-onset DCM. DESIGN, SETTING, AND PARTICIPANTS A population of patients with late-onset DCM who had undergone genetic testing in 7 international tertiary referral centers worldwide were enrolled from March 1990 to August 2020. A positive genotype was defined as the presence of pathogenic or likely pathogenic (P/LP) variants. MAIN OUTCOMES AND MEASURES The study outcome was all-cause mortality. RESULTS A total of 184 patients older than 60 years (103 female [56%]; mean [SD] age, 67 [6] years; mean [SD] left ventricular ejection fraction, 32% [10%]) were studied. Sixty-six patients (36%) were carriers of a P/LP variant. Titin-truncating variants were the most prevalent (present in 46 [25%] of the total population and accounting for 46 [69%] of all genotype-positive patients). During a median (interquartile range) follow-up of 42 (10-115) months, 23 patients (13%) died; 17 (25%) of these were carriers of P/LP variants, while 6 patients (5.1%) were genotype-negative. CONCLUSIONS AND RELEVANCE Late-onset DCM might represent a distinct subgroup characterized by and a high genetic variation burden, largely due to titin-truncating variants. Patients with a positive genetic test had higher mortality than genotype-negative patients. These findings support the extended use of genetic testing also in older patients.
Collapse
Affiliation(s)
- Antonio Cannatà
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Matteo Dal Ferro
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Paolo Manca
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Alessia Paldino
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Sharon Graw
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Marta Gigli
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Renee Johnson
- Molecular Cardiology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - Darius Roy
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin Tharratt
- Center for Inherited Heart Disease, Stanford University, Stanford, California
| | - Daniel I. Bromage
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Jean Jirikowic
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Allison Goodwin
- VCU Medical Center, Clinical Genetics Services, Richmond, Virginia
| | - Krishnasree Rao
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Amr Marawan
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Gerry Carr-White
- Department of Cardiology, Guys and St Thomas’ NHS Trust, London, United Kingdom
| | - Leema Robert
- Department of Clinical Genetics, Guys and St Thomas' NHS Trust, London, United Kingdom
| | - Victoria Parikh
- Center for Inherited Heart Disease, Stanford University, Stanford, California
| | - Euan Ashley
- Center for Inherited Heart Disease, Stanford University, Stanford, California
| | - Theresa McDonagh
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Neal K. Lakdawala
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Diane Fatkin
- Molecular Cardiology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - Matthew R. G. Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| |
Collapse
|