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Haggerty CM, Damrauer SM, Levin MG, Birtwell D, Carey DJ, Golden AM, Hartzel DN, Hu Y, Judy R, Kelly MA, Kember RL, Lester Kirchner H, Leader JB, Liang L, McDermott-Roe C, Babu A, Morley M, Nealy Z, Person TN, Pulenthiran A, Small A, Smelser DT, Stahl RC, Sturm AC, Williams H, Baras A, Margulies KB, Cappola TP, Dewey FE, Verma A, Zhang X, Correa A, Hall ME, Wilson JG, Ritchie MD, Rader DJ, Murray MF, Fornwalt BK, Arany Z. Genomics-First Evaluation of Heart Disease Associated With Titin-Truncating Variants. Circulation 2019; 140:42-54. [PMID: 31216868 DOI: 10.1161/circulationaha.119.039573] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Truncating variants in the Titin gene (TTNtvs) are common in individuals with idiopathic dilated cardiomyopathy (DCM). However, a comprehensive genomics-first evaluation of the impact of TTNtvs in different clinical contexts, and the evaluation of modifiers such as genetic ancestry, has not been performed. METHODS We reviewed whole exome sequence data for >71 000 individuals (61 040 from the Geisinger MyCode Community Health Initiative (2007 to present) and 10 273 from the PennMedicine BioBank (2013 to present) to identify anyone with TTNtvs. We further selected individuals with TTNtvs in exons highly expressed in the heart (proportion spliced in [PSI] >0.9). Using linked electronic health records, we evaluated associations of TTNtvs with diagnoses and quantitative echocardiographic measures, including subanalyses for individuals with and without DCM diagnoses. We also reviewed data from the Jackson Heart Study to validate specific analyses for individuals of African ancestry. RESULTS Identified with a TTNtv in a highly expressed exon (hiPSI) were 1.2% individuals in PennMedicine BioBank and 0.6% at Geisinger. The presence of a hiPSI TTNtv was associated with increased odds of DCM in individuals of European ancestry (odds ratio [95% CI]: 18.7 [9.1-39.4] {PennMedicine BioBank} and 10.8 [7.0-16.0] {Geisinger}). hiPSI TTNtvs were not associated with DCM in individuals of African ancestry, despite a high DCM prevalence (odds ratio, 1.8 [0.2-13.7]; P=0.57). Among 244 individuals of European ancestry with DCM in PennMedicine BioBank, hiPSI TTNtv carriers had lower left ventricular ejection fraction (β=-12%, P=3×10-7), and increased left ventricular diameter (β=0.65 cm, P=9×10-3). In the Geisinger cohort, hiPSI TTNtv carriers without a cardiomyopathy diagnosis had more atrial fibrillation (odds ratio, 2.4 [1.6-3.6]) and heart failure (odds ratio, 3.8 [2.4-6.0]), and lower left ventricular ejection fraction (β=-3.4%, P=1×10-7). CONCLUSIONS Individuals of European ancestry with hiPSI TTNtv have an abnormal cardiac phenotype characterized by lower left ventricular ejection fraction, irrespective of the clinical manifestation of cardiomyopathy. Associations with arrhythmias, including atrial fibrillation, were observed even when controlling for cardiomyopathy diagnosis. In contrast, no association between hiPSI TTNtvs and DCM was discerned among individuals of African ancestry. Given these findings, clinical identification of hiPSI TTNtv carriers may alter clinical management strategies.
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Affiliation(s)
- Christopher M Haggerty
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Scott M Damrauer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.).,Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (S.M.D.)
| | - Michael G Levin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - David Birtwell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - David J Carey
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Alicia M Golden
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Dustin N Hartzel
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Yirui Hu
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Renae Judy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - Melissa A Kelly
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Rachel L Kember
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - H Lester Kirchner
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Joseph B Leader
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Lusha Liang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - Chris McDermott-Roe
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - Apoorva Babu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - Michael Morley
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - Zachariah Nealy
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Thomas N Person
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Arichanah Pulenthiran
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Aeron Small
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - Diane T Smelser
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Richard C Stahl
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Amy C Sturm
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Heather Williams
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - Aris Baras
- Regeneron Genetics Center, Tarrytown, NY (A. Baras, F.E.D.)
| | - Kenneth B Margulies
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - Thomas P Cappola
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | | | - Anurag Verma
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - Xinyuang Zhang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - Adolfo Correa
- Department of Medicine (A.C., M.E.H.), University of Mississippi Medical Center, Jackson
| | - Michael E Hall
- Department of Medicine (A.C., M.E.H.), University of Mississippi Medical Center, Jackson.,Department of Physiology and Biophysics (M.E.H., J.G.W.), University of Mississippi Medical Center, Jackson
| | - James G Wilson
- Department of Physiology and Biophysics (M.E.H., J.G.W.), University of Mississippi Medical Center, Jackson
| | - Marylyn D Ritchie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - Daniel J Rader
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
| | - Michael F Murray
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Brandon K Fornwalt
- Geisinger, Danville, PA (C.M.H., D.J.C., A.M.G., D.N.H., Y.H., M.A.K., H.L.K., J.B.L., Z.N., T.N.P., A.P., D.T.S., R.C.S., A.C.S., M.F.M., B.K.F.)
| | - Zoltan Arany
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D., M.G.L., D.B., R.J., R.L.K., L.L., C.M.-R., A. Babu, M.M., A.S., H.W., K.B.M., T.P.C., A.V., X.Z., M.D.R., D.J.R., Z.A.)
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