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Zafeiri M, Knott K, Lampejo T. Acute myocarditis: an overview of pathogenesis, diagnosis and management. Panminerva Med 2024; 66:174-187. [PMID: 38536007 DOI: 10.23736/s0031-0808.24.05042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Acute myocarditis encompasses a diverse presentation of inflammatory cardiomyopathies with infectious and non-infectious triggers. The clinical presentation is heterogeneous, from subtle symptoms like mild chest pain to life-threatening fulminant heart failure requiring urgent advanced hemodynamic support. This review provides a comprehensive overview of the current state of knowledge regarding the pathogenesis, diagnostic approach, management strategies, and directions for future research in acute myocarditis. The pathogenesis of myocarditis involves interplay between the inciting factors and the subsequent host immune response. Infectious causes, especially cardiotropic viruses, are the most frequently identified precipitants. However, autoimmune processes independent of microbial triggers, as well as toxic myocardial injury from drugs, chemicals or metabolic derangements also contribute to the development of myocarditis through diverse mechanisms. Furthermore, medications like immune checkpoint inhibitor therapies are increasingly recognized as causes of myocarditis. Elucidating the nuances of viral, autoimmune, hypersensitivity, and toxic subtypes of myocarditis is key to guiding appropriate therapy. The heterogeneous clinical presentation coupled with non-specific symptoms creates diagnostic challenges. A multifaceted approach is required, incorporating clinical evaluation, electrocardiography, biomarkers, imaging studies, and endomyocardial biopsy. Cardiovascular magnetic resonance imaging has become pivotal for non-invasive assessment of myocardial inflammation and fibrosis. However, biopsy remains the gold standard for histological classification and definitively establishing the underlying etiology. Management relies on supportive care, while disease-specific therapies are limited. Although some patients recover well with conservative measures, severe or fulminant myocarditis necessitates aggressive interventions such as mechanical circulatory support devices and transplantation. While immunosuppression is beneficial in certain histological subtypes, clear evidence supporting antiviral or immunomodulatory therapies for the majority of acute viral myocarditis cases remains insufficient. Substantial knowledge gaps persist regarding validated diagnostic biomarkers, optimal imaging surveillance strategies, evidence-based medical therapies, and risk stratification schema. A deeper understanding of the immunopathological mechanisms, rigorous clinical trials of targeted therapies, and longitudinal outcome studies are imperative to advance management and improve the prognosis across the myocarditis spectrum.
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Affiliation(s)
- Marina Zafeiri
- King's College Hospital NHS Foundation Trust, London, UK
- University Hospitals Dorset NHS Foundation Trust, London, UK
| | | | - Temi Lampejo
- King's College Hospital NHS Foundation Trust, London, UK -
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2
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Monda E, Bakalakos A, Cannie D, O'Mahony C, Syrris P, Kaski JP, Limongelli G, Elliott PM. Prevalence of Pathogenic Variants in Cardiomyopathy-Associated Genes in Acute Myocarditis: A Systematic Review and Meta-Analysis. JACC. HEART FAILURE 2024; 12:1101-1111. [PMID: 38573261 DOI: 10.1016/j.jchf.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Acute myocarditis is an inflammatory condition that may precede the development of dilated or arrhythmogenic cardiomyopathy. OBJECTIVES The aim of this study was to investigate the reported prevalence of pathogenic or likely pathogenic (P/LP) variants in cardiomyopathy-associated genes in patients with acute myocarditis. METHODS For this systematic review and meta-analysis, the PubMed and Embase databases were searched on March 4, 2023. Observational studies evaluating the prevalence of P/LP variants in cardiomyopathy-associated genes in patients with acute myocarditis were included. Studies were stratified into adult and pediatric age groups and for the following scenarios: 1) complicated myocarditis (ie, presenting with acute heart failure, reduced left ventricular ejection fraction, or life-threatening ventricular arrhythmias); and 2) uncomplicated myocarditis. The study was registered with the International Prospective Register of Systematic Reviews (CRD42023408668) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Of 732 studies identified, 8 met the inclusion criteria, providing data for 586 patients with acute myocarditis. A total of 89 P/LP variants in cardiomyopathy-associated genes were reported in 85 patients. For uncomplicated myocarditis, the pooled prevalence was 4.2% (95% CI: 1.8%-7.4%; I2 = 1.4%), whereas for complicated myocarditis, the pooled prevalence was 21.9% (95% CI: 14.3%-30.5%; I2 = 38.8%) and 44.5% (95% CI: 22.7%-67.4%; I2 = 52.8%) in adults and children, respectively. P/LP variants in desmosomal genes were predominant in uncomplicated myocarditis (64%), whereas sarcomeric gene variants were more prevalent in complicated myocarditis (58% in adults and 71% in children). CONCLUSIONS Genetic variants are present in a large proportion of patients with acute myocarditis. The prevalence of genetic variants and the genes involved vary according to age and clinical presentation.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy; Institute of Cardiovascular Science, University College London, London, United Kingdom.
| | - Athanasios Bakalakos
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Douglas Cannie
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Constantinos O'Mahony
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Petros Syrris
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Juan Pablo Kaski
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital, London, United Kingdom
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Perry Mark Elliott
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
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Selgrade DF, Fullenkamp DE, Chychula IA, Li B, Dellefave-Castillo L, Dubash AD, Ohiri J, Monroe TO, Blancard M, Tomar G, Holgren C, Burridge PW, George AL, Demonbreun AR, Puckelwartz MJ, George SA, Efimov IR, Green KJ, McNally EM. Susceptibility to innate immune activation in genetically mediated myocarditis. J Clin Invest 2024; 134:e180254. [PMID: 38768074 PMCID: PMC11213508 DOI: 10.1172/jci180254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
Myocarditis is clinically characterized by chest pain, arrhythmias, and heart failure, and treatment is often supportive. Mutations in DSP, a gene encoding the desmosomal protein desmoplakin, have been increasingly implicated in myocarditis. To model DSP-associated myocarditis and assess the role of innate immunity, we generated engineered heart tissues (EHTs) using human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) from patients with heterozygous DSP truncating variants (DSPtvs) and a gene-edited homozygous deletion cell line (DSP-/-). At baseline, DSP-/- EHTs displayed a transcriptomic signature of innate immune activation, which was mirrored by cytokine release. Importantly, DSP-/- EHTs were hypersensitive to Toll-like receptor (TLR) stimulation, demonstrating more contractile dysfunction compared with isogenic controls. Relative to DSP-/- EHTs, heterozygous DSPtv EHTs had less functional impairment. DSPtv EHTs displayed heightened sensitivity to TLR stimulation, and when subjected to strain, DSPtv EHTs developed functional deficits, indicating reduced contractile reserve compared with healthy controls. Colchicine or NF-κB inhibitors improved strain-induced force deficits in DSPtv EHTs. Genomic correction of DSP p.R1951X using adenine base editing reduced inflammatory biomarker release from EHTs. Thus, EHTs replicate electrical and contractile phenotypes seen in human myocarditis, implicating cytokine release as a key part of the myogenic susceptibility to inflammation. The heightened innate immune activation and sensitivity are targets for clinical intervention.
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Affiliation(s)
| | - Dominic E. Fullenkamp
- Center for Genetic Medicine and
- Bluhm Cardiovascular Institute, Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Binjie Li
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
| | - Lisa Dellefave-Castillo
- Center for Genetic Medicine and
- Bluhm Cardiovascular Institute, Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Adi D. Dubash
- Department of Biology, Furman University, Greenville, South Carolina, USA
- Department of Pathology
| | | | | | | | | | | | | | | | | | | | - Sharon A. George
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
| | - Igor R. Efimov
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
| | - Kathleen J. Green
- Department of Pathology
- Department of Dermatology, and
- R.H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elizabeth M. McNally
- Center for Genetic Medicine and
- Bluhm Cardiovascular Institute, Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Scheel PJ, Cartella I, Murray B, Gilotra NA, Ammirati E. Role of genetics in inflammatory cardiomyopathy. Int J Cardiol 2024; 400:131777. [PMID: 38218248 DOI: 10.1016/j.ijcard.2024.131777] [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: 10/27/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
Traditional cardiomyopathy paradigms segregate inflammatory etiologies from those caused by genetic variants. An identified or presumed trigger is implicated in acute myocarditis or chronic inflammatory cardiomyopathy but growing evidence suggests a significant proportion of patients have an underlying cardiomyopathy-associated genetic variant often even when a clear inflammatory trigger is identified. Recognizing a possible genetic contribution to inflammatory cardiomyopathy may have major downstream implications for both the patient and family. The presenting features of myocarditis (i.e. chest pain, arrhythmia, and/or heart failure) may provide insight into diagnostic considerations. One example is isolated cardiac sarcoidosis, a distinct inflammatory cardiomyopathy that carries diagnostic challenges and clinical overlap; genetic testing has increasingly reclassified cases of isolated cardiac sarcoidosis as genetic cardiomyopathy, notably altering management. On the other side, inflammatory presentations of genetic cardiomyopathies are likewise underappreciated and a growing area of investigation. Inflammation plays an important role in the pathogenesis of several familial cardiomyopathies, especially arrhythmogenic phenotypes. Given these clinical scenarios, and the implications on clinical decision making such as initiation of immunosuppression, sudden cardiac death prevention, and family screening, it is important to recognize when genetics may be playing a role.
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Affiliation(s)
- Paul J Scheel
- Division of Cardiology, Department of Medicine, Johns Hopkins University, USA.
| | - Iside Cartella
- De Gasperis Cardio Center, Transplant Center, Niguarda Hospital, Milano, Italy; Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, USA
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University, USA
| | - Enrico Ammirati
- De Gasperis Cardio Center, Transplant Center, Niguarda Hospital, Milano, Italy; Department of Health Sciences, University of Milano-Bicocca, Monza, Italy.
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Vrettos A, Demetriades P, Ortiz M, Domínguez F, García-Pavía P, Suárez-Mier MP, Gossios T, Savvatis K. Pathogenic truncating filamin C mutations presenting as acute myocarditis: a case series with insights from cardiac magnetic resonance and histological analysis. Eur Heart J Case Rep 2024; 8:ytae111. [PMID: 38476289 PMCID: PMC10928485 DOI: 10.1093/ehjcr/ytae111] [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: 06/15/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
Background The exact mechanisms underlying the pathogenesis of myocarditis are not always understood, but there is emerging evidence to suggest that genetic factors may play a significant role. Case summary Herein, we present six cases in which clinical, biochemical, and cardiovascular magnetic resonance data were consistent with myocarditis, and genetic testing subsequently revealed pathogenic filamin C (FLNC) mutations. Three patients presented with ventricular arrhythmias, two with severe biventricular dysfunction, and two suffered sudden cardiac arrest. Three received an implantable cardioverter defibrillator, and one underwent heart transplantation. Cascade testing was useful in identifying other relatives with FLNC mutation. We also present relevant histology results of myocardial specimens showing the presence of lymphocytic infiltration and inflammation, further supporting the potential association between FLNC mutations and a myocarditis phenotype. Discussion Genetic testing of affected individuals for FLNC mutations and cascade screening in the setting of acute myocarditis may be considered in selected clinical context, such as in acute myocarditis accompanied by severe left ventricular systolic dysfunction, biventricular failure, significant ventricular arrhythmias, or right ventricular involvement.
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Affiliation(s)
- Apostolos Vrettos
- Barts Heart Centre, Barts Health NHS Trust, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Polyvios Demetriades
- Barts Heart Centre, Barts Health NHS Trust, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Martín Ortiz
- Departamento Científico/Scientific Department, Health in Code, Edificio O Fortín, Hospital Marítimo de Oza, As Xubias s/n, 15006 A Coruña, Spain
| | - Fernando Domínguez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
- Centro Nacional de investigaciones Cardiovasculares (CNIC), Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo García-Pavía
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
- Centro Nacional de investigaciones Cardiovasculares (CNIC), Instituto de Salud Carlos III, Madrid, Spain
| | - M Paz Suárez-Mier
- Histopathology Service, National Institute of Toxicology and Forensic Sciences, Madrid, Spain
| | - Thomas Gossios
- Laboratory of Cardiomyopathies and Inherited Cardiac Diseases, Aristotle University of Thessaloniki 1st Cardiology Department, AHEPA University Hospital, 546 21 Thessaloniki, Greece
| | - Konstantinos Savvatis
- Inherited Cardiomyopathies Unit, St Bartholomew’s Hospital, W Smithfield, London EC1A 7BE, UK
- Institute for Cardiovascular Science, University College London, 62 Huntley St, London WC1E 6DD, UK
- NIHR University College London Hospitals Biomedical Research Centre, 170 Tottenham Ct Rd, London W1T 7HA, UK
- William Harvey Research Institute, Queen Mary University London, John Vane Science Centre, Charterhouse Square, London EC1M 6BQ, UK
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6
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Sanford CB, Fan J, Hua Y, Nikolaidis L, Edmister W, Payne S, Dandapantula H, Veer M, Nguyen V. Case Illustration of the Natural History of Left Dominant Arrhythmogenic Cardiomyopathy. Ochsner J 2024; 24:62-66. [PMID: 38510230 PMCID: PMC10949047 DOI: 10.31486/toj.23.0057] [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] [Indexed: 03/22/2024] Open
Abstract
Background: Arrhythmogenic left ventricular cardiomyopathy is an increasingly recognized cause of recurrent myocarditis, a mimicker of acute coronary syndrome, and an important cause of malignant ventricular arrythmias and heart failure. Desmoplakin is a protein that is critical to maintaining the structural integrity of the myocardium. Disruption of desmoplakin leads to fibrofatty infiltration of the myocardium which leads to congestive heart failure, cardiac arrhythmias, and sudden cardiac death. However, desmoplakin cardiomyopathy is often misdiagnosed, resulting in significant morbidity and mortality. We report 2 contrasting cases illustrating the natural history-hot and cold phases-of arrhythmogenic left ventricular cardiomyopathy. Case Series: The first case demonstrates a common phenotypic presentation of desmoplakin cardiomyopathy manifested as recurrent myocarditis and myocardial injury representing the hot phase. The second case is an undulating course of chronic systolic heart failure and ventricular arrhythmias representing the cold phase. Conclusion: Arrhythmogenic cardiomyopathy manifests as a spectrum of disease processes that involve the right, left, or both ventricles. Mutations in the desmoplakin gene are often associated with a left dominant ventricular cardiomyopathy. Diagnosis remains difficult as the condition has no signature clinical presentation, and imaging findings are variable.
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Affiliation(s)
- Corry B. Sanford
- Department of Internal Medicine, Baylor Scott & White Medical Center, Temple, TX
| | - Jerry Fan
- Division of Cardiology, Baylor Scott & White Medical Center, Temple, TX
| | - Yinan Hua
- Department of Pathology, Baylor Scott & White Medical Center, Temple, TX
| | | | - Whitney Edmister
- Department of Radiology, Baylor Scott & White Medical Center, Temple, TX
| | - Sarah Payne
- Division of Cardiology, Baylor Scott & White Medical Center, Temple, TX
| | - Hari Dandapantula
- Division of Cardiology, Baylor Scott & White Medical Center, Temple, TX
| | - Manik Veer
- Department of Cardiology, MercyOne Iowa Heart Center, Des Moines, IA
| | - Vinh Nguyen
- Division of Cardiology, Baylor Scott & White Medical Center, Temple, TX
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Santos LD, Walker AL. The Role of Autoantibodies in Companion Animal Cardiac Disease. Vet Clin North Am Small Anim Pract 2023; 53:1367-1377. [PMID: 37423843 DOI: 10.1016/j.cvsm.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Clinical studies exploring the role of autoimmune diseases in cardiac dysfunction have become increasingly common in both human and veterinary literature. Autoantibodies (AABs) specific to cardiac receptors have been found in human and canine dilated cardiomyopathy, and circulating autoantibodies have been suggested as a sensitive biomarker for arrhythmogenic right ventricular cardiomyopathy in people and Boxer dogs. In this article, we will summarize recent literature on AABs and their role in cardiac diseases of small animals. Despite the potential for new discoveries in veterinary cardiology, current data in veterinary medicine are limited and further studies are needed.
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Affiliation(s)
- Luís Dos Santos
- Department of Veterinary Clinical Sciences, Purdue University, College of Veterinary Medicine, 625 Harrison Street, West Lafayette, IN 47907, USA.
| | - Ashley L Walker
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, 1 Garrod Drive, Davis, CA 9561, USA
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Tadros HJ, Miyake CY, Kearney DL, Kim JJ, Denfield SW. The Many Faces of Arrhythmogenic Cardiomyopathy: An Overview. Appl Clin Genet 2023; 16:181-203. [PMID: 37933265 PMCID: PMC10625769 DOI: 10.2147/tacg.s383446] [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: 06/29/2023] [Accepted: 10/10/2023] [Indexed: 11/08/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (AC) is a disease that involves electromechanical uncoupling of cardiomyocytes. This leads to characteristic histologic changes that ultimately lead to the arrhythmogenic clinical features of the disease. Initially thought to affect the right ventricle predominantly, more recent data show that it can affect both the ventricles or the left ventricle alone. Throughout the recent era, diagnostic modalities and criteria for AC have continued to evolve and our understanding of its clinical features in different age groups as well as the genotype to the phenotype correlations have improved. In this review, we set out to detail the epidemiology, etiologies, presentations, evaluation, and management of AC across the age continuum.
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Affiliation(s)
- Hanna J Tadros
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Christina Y Miyake
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Debra L Kearney
- Department of Pathology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey J Kim
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Susan W Denfield
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
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Azimi A, Pourirahim M, Houshmand G, Adimi S, Maleki M, Kalayinia S. Arrhythmogenic left ventricular cardiomyopathy caused by a novel likely pathogenic DSP mutation, p.K1165Rfs*8, in a family with sudden cardiac death. BMC Med Genomics 2023; 16:266. [PMID: 37885024 PMCID: PMC10601356 DOI: 10.1186/s12920-023-01701-w] [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: 07/22/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE We conducted an investigation into the clinical and molecular characteristics of Arrhythmogenic left ventricular cardiomyopathy (ALVC) caused by a novel likely pathogenic mutation in an Iranian pedigree with sudden cardiac death (SCD). BACKGROUND ALVC is a genetically inherited myocardial disease characterized by the substitution of fibro-fatty tissue in the left ventricular myocardium, predominantly inherited in an autosomal dominant pattern and is commonly associated with genes involved in encoding desmosomal proteins, specifically Desmoplakin (DSP). METHODS The patient and available family members underwent a comprehensive clinical assessment, including Cardiac magnetic resonance (CMR) imaging, along with Whole-exome sequencing (WES). The identified variant was confirmed and segregated by Polymerase chain reaction (PCR) and Sanger sequencing in the family members. RESULTS A novel likely pathogenic heterozygous variant, DSP (NM_004415.4), c.3492_3498del, p.K1165Rfs*8 was discovered in the proband. This variant is likely to be the primary reason for ALVC in this specific family. This variant was confirmed by Sanger sequencing and segregated in other affected members of the family. CONCLUSION We identified a novel likely pathogenic variant in the DSP gene, which has been identified as the cause of ALVC in an Iranian family. Our investigation underscores the importance of genetic testing, specifically WES, for individuals suspected of ALVC and have a family history of SCD.
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Affiliation(s)
- Amir Azimi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Pourirahim
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Golnaz Houshmand
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Adimi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Kalayinia
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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