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Asatryan B, Shah RA, Sharaf Dabbagh G, Landstrom AP, Darbar D, Khanji MY, Lopes LR, van Duijvenboden S, Muser D, Lee AM, Haggerty CM, Arora P, Semsarian C, Reichlin T, Somers VK, Owens AT, Petersen SE, Deo R, Munroe PB, Aung N, Chahal CAA. Predicted Deleterious Variants in Cardiomyopathy Genes Prognosticate Mortality and Composite Outcomes in UK Biobank. JACC Heart Fail 2023:S2213-1779(23)00492-4. [PMID: 37715771 DOI: 10.1016/j.jchf.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Inherited cardiomyopathies present with broad variation of phenotype. Data are limited regarding genetic screening strategies and outcomes associated with predicted deleterious variants in cardiomyopathy-associated genes in the general population. OBJECTIVES The authors aimed to determine the risk of mortality and composite cardiomyopathy-related outcomes associated with predicted deleterious variants in cardiomyopathy-associated genes in the UK Biobank. METHODS Using whole exome sequencing data, variants in dilated, hypertrophic, and arrhythmogenic right ventricular cardiomyopathy-associated genes with at least moderate evidence of disease causality according to ClinGen Expert Panel curations were annotated using REVEL (≥0.65) and ANNOVAR (predicted loss-of-function) considering gene-disease mechanisms. Genotype-positive and genotype-negative groups were compared using time-to-event analyses for the primary (all-cause mortality) and secondary outcomes (diagnosis of cardiomyopathy; composite outcome of diagnosis of cardiomyopathy, heart failure, arrhythmia, stroke, and death). RESULTS Among 200,619 participants (age at recruitment 56.46 ± 8.1 years), 5,292 (2.64%) were found to host ≥1 predicted deleterious variants in cardiomyopathy-associated genes (CMP-G+). After adjusting for age and sex, CMP-G+ individuals had higher risk for all-cause mortality (HR: 1.13 [95% CI: 1.01-1.25]; P = 0.027), increased risk for being diagnosed with cardiomyopathy later in life (HR: 5.75 [95% CI: 4.58-7.23]; P < 0.0001), and elevated risk for composite outcome (HR: 1.29 [95% CI: 1.20-1.39]; P < 0.0001) than CMP-G- individuals. The higher risk for being diagnosed with cardiomyopathy and composite outcomes in the genotype-positive subjects remained consistent across all cardiomyopathy subgroups. CONCLUSIONS Adults with predicted deleterious variants in cardiomyopathy-associated genes exhibited a slightly higher risk of mortality and a significantly increased risk of developing cardiomyopathy, and cardiomyopathy-related composite outcomes, in comparison with genotype-negative controls.
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Affiliation(s)
- Babken Asatryan
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ravi A Shah
- Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Ghaith Sharaf Dabbagh
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, Pennsylvania; University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, Michigan
| | - Andrew P Landstrom
- Departments of Pediatrics, Division of Cardiology, and Cell Biology, Duke University School of Medicine, Durham, North Carolina
| | | | - Mohammed Y Khanji
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, West Smithfield, UK; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK; Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Luis R Lopes
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, West Smithfield, UK; Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Stefan van Duijvenboden
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Daniele Muser
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Dipartimento Cardiotoracico, U.O.C. di Cardiologia, Presidio Ospedaliero Universitario "Santa Maria Della Misericordia," Udine, Italy
| | - Aaron Mark Lee
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, West Smithfield, UK; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, Pennsylvania
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Alabama
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anjali T Owens
- Center for Inherited Cardiovascular Disease, Cardiovascular Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Steffen E Petersen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, West Smithfield, UK; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Rajat Deo
- Center for Inherited Cardiovascular Disease, Cardiovascular Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Patricia B Munroe
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Nay Aung
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, West Smithfield, UK; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - C Anwar A Chahal
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, Pennsylvania; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, West Smithfield, UK; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Wang Y, Sun C, Ghadimi S, Auger DC, Croisille P, Viallon M, Mangion K, Berry C, Haggerty CM, Jing L, Fornwalt BK, Cao JJ, Cheng J, Scott AD, Ferreira PF, Oshinski JN, Ennis DB, Bilchick KC, Epstein FH. StrainNet: Improved Myocardial Strain Analysis of Cine MRI by Deep Learning from DENSE. Radiol Cardiothorac Imaging 2023; 5:e220196. [PMID: 37404792 PMCID: PMC10316292 DOI: 10.1148/ryct.220196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/16/2023] [Accepted: 03/15/2023] [Indexed: 07/06/2023]
Abstract
Purpose To develop a three-dimensional (two dimensions + time) convolutional neural network trained with displacement encoding with stimulated echoes (DENSE) data for displacement and strain analysis of cine MRI. Materials and Methods In this retrospective multicenter study, a deep learning model (StrainNet) was developed to predict intramyocardial displacement from contour motion. Patients with various heart diseases and healthy controls underwent cardiac MRI examinations with DENSE between August 2008 and January 2022. Network training inputs were a time series of myocardial contours from DENSE magnitude images, and ground truth data were DENSE displacement measurements. Model performance was evaluated using pixelwise end-point error (EPE). For testing, StrainNet was applied to contour motion from cine MRI. Global and segmental circumferential strain (Ecc) derived from commercial feature tracking (FT), StrainNet, and DENSE (reference) were compared using intraclass correlation coefficients (ICCs), Pearson correlations, Bland-Altman analyses, paired t tests, and linear mixed-effects models. Results The study included 161 patients (110 men; mean age, 61 years ± 14 [SD]), 99 healthy adults (44 men; mean age, 35 years ± 15), and 45 healthy children and adolescents (21 males; mean age, 12 years ± 3). StrainNet showed good agreement with DENSE for intramyocardial displacement, with an average EPE of 0.75 mm ± 0.35. The ICCs between StrainNet and DENSE and FT and DENSE were 0.87 and 0.72, respectively, for global Ecc and 0.75 and 0.48, respectively, for segmental Ecc. Bland-Altman analysis showed that StrainNet had better agreement than FT with DENSE for global and segmental Ecc. Conclusion StrainNet outperformed FT for global and segmental Ecc analysis of cine MRI.Keywords: Image Postprocessing, MR Imaging, Cardiac, Heart, Pediatrics, Technical Aspects, Technology Assessment, Strain, Deep Learning, DENSE Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Yu Wang
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Changyu Sun
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Sona Ghadimi
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Daniel C. Auger
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Pierre Croisille
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Magalie Viallon
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Kenneth Mangion
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Colin Berry
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Christopher M. Haggerty
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Linyuan Jing
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Brandon K. Fornwalt
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - J. Jane Cao
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Joshua Cheng
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Andrew D. Scott
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Pedro F. Ferreira
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - John N. Oshinski
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Daniel B. Ennis
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Kenneth C. Bilchick
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Frederick H. Epstein
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
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3
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Raghunath S, Pfeifer JM, Kelsey CR, Nemani A, Ruhl JA, Hartzel DN, Ulloa Cerna AE, Jing L, vanMaanen DP, Leader JB, Schneider G, Morland TB, Chen R, Zimmerman N, Fornwalt BK, Haggerty CM. An ECG-based machine learning model for predicting new-onset atrial fibrillation is superior to age and clinical features in identifying patients at high stroke risk. J Electrocardiol 2023; 76:61-65. [PMID: 36436476 DOI: 10.1016/j.jelectrocard.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/11/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Several large trials have employed age or clinical features to select patients for atrial fibrillation (AF) screening to reduce strokes. We hypothesized that a machine learning (ML) model trained to predict AF risk from 12‑lead electrocardiogram (ECG) would be more efficient than criteria based on clinical variables in indicating a population for AF screening to potentially prevent AF-related stroke. METHODS We retrospectively included all patients with clinical encounters in Geisinger without a prior history of AF. Incidence of AF within 1 year and AF-related strokes within 3 years of the encounter were identified. AF-related stroke was defined as a stroke where AF was diagnosed at the time of stroke or within a year after the stroke. The efficiency of five methods was evaluated for selecting a cohort for AF screening. The methods were selected from four clinical trials (mSToPS, GUARD-AF, SCREEN-AF and STROKESTOP) and the ECG-based ML model. We simulated patient selection for the five methods between the years 2011 and 2014 and evaluated outcomes for 1 year intervals between 2012 and 2015, resulting in a total of twenty 1-year periods. Patients were considered eligible if they met the criteria before the start of the given 1-year period or within that period. The primary outcomes were numbers needed to screen (NNS) for AF and AF-associated stroke. RESULTS The clinical trial models indicated large proportions of the population with a prior ECG for AF screening (up to 31%), coinciding with NNS ranging from 14 to 18 for AF and 249-359 for AF-associated stroke. At comparable sensitivity, the ECG ML model indicated a modest number of patients for screening (14%) and had the highest efficiency in NNS for AF (7.3; up to 60% reduction) and AF-associated stroke (223; up to 38% reduction). CONCLUSIONS An ECG-based ML risk prediction model is more efficient than contemporary AF-screening criteria based on age alone or age and clinical features at indicating a population for AF screening to potentially prevent AF-related strokes.
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Affiliation(s)
| | - John M Pfeifer
- Geisinger, Danville, PA, USA; Tempus Labs Inc., Chicago, IL, USA
| | | | | | | | | | | | | | | | - Joseph B Leader
- Geisinger, Danville, PA, USA; Tempus Labs Inc., Chicago, IL, USA
| | | | | | - Ruijun Chen
- Geisinger, Danville, PA, USA; Tempus Labs Inc., Chicago, IL, USA
| | | | | | | |
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4
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Levin MG, Tsao NL, Singhal P, Liu C, Vy HMT, Paranjpe I, Backman JD, Bellomo TR, Bone WP, Biddinger KJ, Hui Q, Dikilitas O, Satterfield BA, Yang Y, Morley MP, Bradford Y, Burke M, Reza N, Charest B, Judy RL, Puckelwartz MJ, Hakonarson H, Khan A, Kottyan LC, Kullo I, Luo Y, McNally EM, Rasmussen-Torvik LJ, Day SM, Do R, Phillips LS, Ellinor PT, Nadkarni GN, Ritchie MD, Arany Z, Cappola TP, Margulies KB, Aragam KG, Haggerty CM, Joseph J, Sun YV, Voight BF, Damrauer SM. Genome-wide association and multi-trait analyses characterize the common genetic architecture of heart failure. Nat Commun 2022; 13:6914. [PMID: 36376295 PMCID: PMC9663424 DOI: 10.1038/s41467-022-34216-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Heart failure is a leading cause of cardiovascular morbidity and mortality. However, the contribution of common genetic variation to heart failure risk has not been fully elucidated, particularly in comparison to other common cardiometabolic traits. We report a multi-ancestry genome-wide association study meta-analysis of all-cause heart failure including up to 115,150 cases and 1,550,331 controls of diverse genetic ancestry, identifying 47 risk loci. We also perform multivariate genome-wide association studies that integrate heart failure with related cardiac magnetic resonance imaging endophenotypes, identifying 61 risk loci. Gene-prioritization analyses including colocalization and transcriptome-wide association studies identify known and previously unreported candidate cardiomyopathy genes and cellular processes, which we validate in gene-expression profiling of failing and healthy human hearts. Colocalization, gene expression profiling, and Mendelian randomization provide convergent evidence for the roles of BCKDHA and circulating branch-chain amino acids in heart failure and cardiac structure. Finally, proteome-wide Mendelian randomization identifies 9 circulating proteins associated with heart failure or quantitative imaging traits. These analyses highlight similarities and differences among heart failure and associated cardiovascular imaging endophenotypes, implicate common genetic variation in the pathogenesis of heart failure, and identify circulating proteins that may represent cardiomyopathy treatment targets.
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Affiliation(s)
- Michael G Levin
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Noah L Tsao
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Pankhuri Singhal
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Chang Liu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ha My T Vy
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ishan Paranjpe
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Tiffany R Bellomo
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William P Bone
- Genomics and Computational Biology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kiran J Biddinger
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Qin Hui
- Emory University School of Public Health, Atlanta, GA, USA
- Atlanta VA Health Care System, Decatur, GA, USA
| | - Ozan Dikilitas
- Departments of Internal Medicine and Cardiovascular Medicine, and Mayo Clinician-Investigator Training Program, Mayo Clinic, Rochester, MN, USA
| | | | - Yifan Yang
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael P Morley
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuki Bradford
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Megan Burke
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Charest
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
| | - Renae L Judy
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Megan J Puckelwartz
- Department of Pharmacology, Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Atlas Khan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Leah C Kottyan
- Department of Pediatrics, Division of Human Genetics and Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Iftikhar Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yuan Luo
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elizabeth M McNally
- Center for Genetic Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sharlene M Day
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, BioMe Phenomics Center, and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lawrence S Phillips
- Atlanta VA Health Care System, Decatur, GA, USA
- Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA
| | - Patrick T Ellinor
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marylyn D Ritchie
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Zoltan Arany
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas P Cappola
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth B Margulies
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Krishna G Aragam
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics and Heart Institute, Geisinger, Danville, PA, USA
| | - Jacob Joseph
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yan V Sun
- Emory University School of Public Health, Atlanta, GA, USA
- Atlanta VA Health Care System, Decatur, GA, USA
| | - Benjamin F Voight
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Scott M Damrauer
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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5
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Halford JL, Morrill VN, Choi SH, Jurgens SJ, Melloni G, Marston NA, Weng LC, Nauffal V, Hall AW, Gunn S, Austin-Tse CA, Pirruccello JP, Khurshid S, Rehm HL, Benjamin EJ, Boerwinkle E, Brody JA, Correa A, Fornwalt BK, Gupta N, Haggerty CM, Harris S, Heckbert SR, Hong CC, Kooperberg C, Lin HJ, Loos RJF, Mitchell BD, Morrison AC, Post W, Psaty BM, Redline S, Rice KM, Rich SS, Rotter JI, Schnatz PF, Soliman EZ, Sotoodehnia N, Wong EK, Sabatine MS, Ruff CT, Lunetta KL, Ellinor PT, Lubitz SA. Publisher Correction: Endophenotype effect sizes support variant pathogenicity in monogenic disease susceptibility genes. Nat Commun 2022; 13:5767. [PMID: 36180445 PMCID: PMC9525665 DOI: 10.1038/s41467-022-33534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jennifer L Halford
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Valerie N Morrill
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sean J Jurgens
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Experimental Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Giorgio Melloni
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nicholas A Marston
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lu-Chen Weng
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Victor Nauffal
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Amelia W Hall
- Gene Regulation Observatory and Epigenomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sophia Gunn
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Christina A Austin-Tse
- Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - James P Pirruccello
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Shaan Khurshid
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.,Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA
| | - Heidi L Rehm
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Emelia J Benjamin
- NHLBI and Boston University's Framingham Heart Study, Framingham, MA, USA.,Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Adolfo Correa
- Departments of Medicine, Pediatrics and Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,Heart Institute, Geisinger, Danville, PA, USA.,Department of Radiology, Geisinger, Danville, PA, USA
| | - Namrata Gupta
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,Heart Institute, Geisinger, Danville, PA, USA
| | - Stephanie Harris
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Charles C Hong
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Henry J Lin
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, 10029, New York, NY, USA.,The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, 10029, New York, NY, USA
| | - Braxton D Mitchell
- University of Maryland School of Medicine, Baltimore, MD, USA.,Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Wendy Post
- Division of Cardiology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kenneth M Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Stephen S Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peter F Schnatz
- Department of ObGyn, The Reading Hospital of Tower Health, Reading, PA, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA.,Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Eugene K Wong
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian T Ruff
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kathryn L Lunetta
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.,Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA
| | - Steven A Lubitz
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA. .,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA. .,Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA.
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6
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Halford JL, Morrill VN, Choi SH, Jurgens SJ, Melloni G, Marston NA, Weng LC, Nauffal V, Hall AW, Gunn S, Austin-Tse CA, Pirruccello JP, Khurshid S, Rehm HL, Benjamin EJ, Boerwinkle E, Brody JA, Correa A, Fornwalt BK, Gupta N, Haggerty CM, Harris S, Heckbert SR, Hong CC, Kooperberg C, Lin HJ, Loos RJF, Mitchell BD, Morrison AC, Post W, Psaty BM, Redline S, Rice KM, Rich SS, Rotter JI, Schnatz PF, Soliman EZ, Sotoodehnia N, Wong EK, Sabatine MS, Ruff CT, Lunetta KL, Ellinor PT, Lubitz SA. Endophenotype effect sizes support variant pathogenicity in monogenic disease susceptibility genes. Nat Commun 2022; 13:5106. [PMID: 36042188 PMCID: PMC9427940 DOI: 10.1038/s41467-022-32009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 07/12/2022] [Indexed: 11/09/2022] Open
Abstract
Accurate and efficient classification of variant pathogenicity is critical for research and clinical care. Using data from three large studies, we demonstrate that population-based associations between rare variants and quantitative endophenotypes for three monogenic diseases (low-density-lipoprotein cholesterol for familial hypercholesterolemia, electrocardiographic QTc interval for long QT syndrome, and glycosylated hemoglobin for maturity-onset diabetes of the young) provide evidence for variant pathogenicity. Effect sizes are associated with pathogenic ClinVar assertions (P < 0.001 for each trait) and discriminate pathogenic from non-pathogenic variants (area under the curve 0.82-0.84 across endophenotypes). An effect size threshold of ≥ 0.5 times the endophenotype standard deviation nominates up to 35% of rare variants of uncertain significance or not in ClinVar in disease susceptibility genes with pathogenic potential. We propose that variant associations with quantitative endophenotypes for monogenic diseases can provide evidence supporting pathogenicity.
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Affiliation(s)
- Jennifer L Halford
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Valerie N Morrill
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sean J Jurgens
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Experimental Cardiology, Amsterdam UMC, Amsterdam, Netherlands
| | - Giorgio Melloni
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nicholas A Marston
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lu-Chen Weng
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Victor Nauffal
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Amelia W Hall
- Gene Regulation Observatory and Epigenomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sophia Gunn
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Christina A Austin-Tse
- Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - James P Pirruccello
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Shaan Khurshid
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA
| | - Heidi L Rehm
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Emelia J Benjamin
- NHLBI and Boston University's Framingham Heart Study, Framingham, MA, USA
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Adolfo Correa
- Departments of Medicine, Pediatrics and Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
- Heart Institute, Geisinger, Danville, PA, USA
- Department of Radiology, Geisinger, Danville, PA, USA
| | - Namrata Gupta
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
- Heart Institute, Geisinger, Danville, PA, USA
| | - Stephanie Harris
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Charles C Hong
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Henry J Lin
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, 10029, New York, NY, USA
- The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, 10029, New York, NY, USA
| | - Braxton D Mitchell
- University of Maryland School of Medicine, Baltimore, Maryland, USA
- Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, Maryland, USA
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Wendy Post
- Division of Cardiology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kenneth M Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Stephen S Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peter F Schnatz
- Department of ObGyn, The Reading Hospital of Tower Health, Reading, PA, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Eugene K Wong
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian T Ruff
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kathryn L Lunetta
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA
| | - Steven A Lubitz
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA.
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7
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Zhang X, Cerna AEU, Stough JV, Chen Y, Carry BJ, Alsaid A, Raghunath S, vanMaanen DP, Fornwalt BK, Haggerty CM. Generalizability and quality control of deep learning-based 2D echocardiography segmentation models in a large clinical dataset. Int J Cardiovasc Imaging 2022; 38:1685-1697. [PMID: 35201510 DOI: 10.1007/s10554-022-02554-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/04/2022] [Indexed: 11/26/2022]
Abstract
Use of machine learning (ML) for automated annotation of heart structures from echocardiographic videos is an active research area, but understanding of comparative, generalizable performance among models is lacking. This study aimed to (1) assess the generalizability of five state-of-the-art ML-based echocardiography segmentation models within a large Geisinger clinical dataset, and (2) test the hypothesis that a quality control (QC) method based on segmentation uncertainty can further improve segmentation results. Five models were applied to 47,431 echocardiography studies that were independent from any training samples. Chamber volume and mass from model segmentations were compared to clinically-reported values. The median absolute errors (MAE) in left ventricular (LV) volumes and ejection fraction exhibited by all five models were comparable to reported inter-observer errors (IOE). MAE for left atrial volume and LV mass were similarly favorable to respective IOE for models trained for those tasks. A single model consistently exhibited the lowest MAE in all five clinically-reported measures. We leveraged the tenfold cross-validation training scheme of this best-performing model to quantify segmentation uncertainty. We observed that removing segmentations with high uncertainty from 14 to 71% studies reduced volume/mass MAE by 6-10%. The addition of convexity filters improved specificity, efficiently removing < 10% studies with large MAE (16-40%). In conclusion, five previously published echocardiography segmentation models generalized to a large, independent clinical dataset-segmenting one or multiple cardiac structures with overall accuracy comparable to manual analyses-with variable performance. Convexity-reinforced uncertainty QC efficiently improved segmentation performance and may further facilitate the translation of such models.
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Affiliation(s)
- Xiaoyan Zhang
- Department of Translational Data Science and Informatics, Geisinger, 100 North Academy Avenue, Danville, PA, 17822, USA
| | - Alvaro E Ulloa Cerna
- Department of Translational Data Science and Informatics, Geisinger, 100 North Academy Avenue, Danville, PA, 17822, USA
| | | | - Yida Chen
- Computer Science, Bucknell University, Lewisburg, PA, USA
| | | | - Amro Alsaid
- Heart Institute, Geisinger, Danville, PA, USA
| | - Sushravya Raghunath
- Department of Translational Data Science and Informatics, Geisinger, 100 North Academy Avenue, Danville, PA, 17822, USA
| | - David P vanMaanen
- Department of Translational Data Science and Informatics, Geisinger, 100 North Academy Avenue, Danville, PA, 17822, USA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics, Geisinger, 100 North Academy Avenue, Danville, PA, 17822, USA
- Heart Institute, Geisinger, Danville, PA, USA
- Department of Radiology, Geisinger, Danville, PA, USA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, 100 North Academy Avenue, Danville, PA, 17822, USA.
- Heart Institute, Geisinger, Danville, PA, USA.
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8
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Carruth ED, Qureshi M, Alsaid A, Kelly MA, Calkins H, Murray B, Tichnell C, Sturm AC, Baras A, Kirchner HL, Fornwalt BK, James CA, Haggerty CM. Loss-of-Function FLNC Variants Are Associated With Arrhythmogenic Cardiomyopathy Phenotypes When Identified Through Exome Sequencing of a General Clinical Population. Circ Genom Precis Med 2022; 15:e003645. [PMID: 35699965 PMCID: PMC9388603 DOI: 10.1161/circgen.121.003645] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The FLNC gene has recently garnered attention as a likely cause of arrhythmogenic cardiomyopathy, which is considered an actionable genetic condition. However, the association with disease in an unselected clinical population is unknown. We hypothesized that individuals with loss-of-function variants in FLNC (FLNCLOF) would have increased odds for arrhythmogenic cardiomyopathy-associated phenotypes versus variant-negative controls in the Geisinger MyCode cohort. METHODS We identified rare, putative FLNCLOF among 171 948 individuals with exome sequencing linked to health records. Associations with arrhythmogenic cardiomyopathy phenotypes from available diagnoses and cardiac evaluations were investigated. RESULTS Sixty individuals (0.03%; median age 58 years [47-70 interquartile range], 43% male) harbored 27 unique FLNCLOF. These individuals had significantly increased odds ratios for dilated cardiomyopathy (odds ratio, 4.9 [95% CI, 2.6-7.6]; P<0.001), supraventricular tachycardia (odds ratio, 3.2 [95% CI, 1.1-5.6]; P=0.048), and left-dominant arrhythmogenic cardiomyopathy (odds ratio, 4.2 [95% CI, 1.4-7.9]; P=0.03). Echocardiography revealed reduced left ventricular ejection fraction (52±13% versus 57±9%; P=0.001) associated with FLNCLOF. Overall, at least 9% of FLNCLOF patients demonstrated evidence of penetrant disease. CONCLUSIONS FLNCLOF variants are associated with increased odds of ventricular arrhythmia and dysfunction in an unselected clinical population. These findings support genomic screening of FLNC for actionable secondary findings.
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Affiliation(s)
- Eric D. Carruth
- Dept of Translational Data Science and Informatics, Geisinger, Danville, PA
| | | | - Amro Alsaid
- The Heart Institute, Geisinger, Danville, PA
| | | | - Hugh Calkins
- Dept of Medicine, Division of Cardiology, Johns Hopkins Medical Center, Baltimore, MD
| | - Brittney Murray
- Dept of Medicine, Division of Cardiology, Johns Hopkins Medical Center, Baltimore, MD
| | - Crystal Tichnell
- Dept of Medicine, Division of Cardiology, Johns Hopkins Medical Center, Baltimore, MD
| | - Amy C. Sturm
- The Heart Institute, Geisinger, Danville, PA,Genomic Medicine Institute, Geisinger, Danville, PA
| | - Aris Baras
- Regeneron Genetics Center, Tarrytown, NY
| | - H. Lester Kirchner
- Dept of Translational Data Science and Informatics, Geisinger, Danville, PA,Dept of Population Health Sciences, Geisinger, Danville, PA
| | - Brandon K. Fornwalt
- Dept of Translational Data Science and Informatics, Geisinger, Danville, PA,The Heart Institute, Geisinger, Danville, PA,Dept of Radiology, Geisinger, Danville, PA
| | - Cynthia A. James
- Dept of Medicine, Division of Cardiology, Johns Hopkins Medical Center, Baltimore, MD
| | - Christopher M. Haggerty
- Dept of Translational Data Science and Informatics, Geisinger, Danville, PA,The Heart Institute, Geisinger, Danville, PA
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9
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Nauffal V, Morrill VN, Jurgens SJ, Choi SH, Hall AW, Weng LC, Halford JL, Austin-Tse C, Haggerty CM, Harris SL, Wong EK, Alonso A, Arking DE, Benjamin EJ, Boerwinkle E, Min YI, Correa A, Fornwalt BK, Heckbert SR, Kooperberg C, Lin HJ, J F Loos R, Rice KM, Gupta N, Blackwell TW, Mitchell BD, Morrison AC, Psaty BM, Post WS, Redline S, Rehm HL, Rich SS, Rotter JI, Soliman EZ, Sotoodehnia N, Lunetta KL, Ellinor PT, Lubitz SA. Monogenic and Polygenic Contributions to QTc Prolongation in the Population. Circulation 2022; 145:1524-1533. [PMID: 35389749 PMCID: PMC9117504 DOI: 10.1161/circulationaha.121.057261] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rare sequence variation in genes underlying cardiac repolarization and common polygenic variation influence QT interval duration. However, current clinical genetic testing of individuals with unexplained QT prolongation is restricted to examination of monogenic rare variants. The recent emergence of large-scale biorepositories with sequence data enables examination of the joint contribution of rare and common variations to the QT interval in the population. METHODS We performed a genome-wide association study of the QTc in 84 630 UK Biobank participants and created a polygenic risk score (PRS). Among 26 976 participants with whole-genome sequencing and ECG data in the TOPMed (Trans-Omics for Precision Medicine) program, we identified 160 carriers of putative pathogenic rare variants in 10 genes known to be associated with the QT interval. We examined QTc associations with the PRS and with rare variants in TOPMed. RESULTS Fifty-four independent loci were identified by genome-wide association study in the UK Biobank. Twenty-one loci were novel, of which 12 were replicated in TOPMed. The PRS composed of 1 110 494 common variants was significantly associated with the QTc in TOPMed (ΔQTc/decile of PRS=1.4 ms [95% CI, 1.3 to 1.5]; P=1.1×10-196). Carriers of putative pathogenic rare variants had longer QTc than noncarriers (ΔQTc=10.9 ms [95% CI, 7.4 to 14.4]). Of individuals with QTc>480 ms, 23.7% carried either a monogenic rare variant or had a PRS in the top decile (3.4% monogenic, 21% top decile of PRS). CONCLUSIONS QTc duration in the population is influenced by both rare variants in genes underlying cardiac repolarization and polygenic risk, with a sizeable contribution from polygenic risk. Comprehensive assessment of the genetic determinants of QTc prolongation includes incorporation of both polygenic and monogenic risk.
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Affiliation(s)
- Victor Nauffal
- Division of Cardiovascular Medicine (V.N.), Brigham and Women's Hospital, Boston, MA
- Cardiovascular Disease Initiative (V.N., V.N.M., S.J.J., S.H.C., L.-C.W., J.L.H., P.T.E., S.A.L.), Broad Institute, Cambridge, MA
| | - Valerie N Morrill
- Cardiovascular Disease Initiative (V.N., V.N.M., S.J.J., S.H.C., L.-C.W., J.L.H., P.T.E., S.A.L.), Broad Institute, Cambridge, MA
| | - Sean J Jurgens
- Cardiovascular Disease Initiative (V.N., V.N.M., S.J.J., S.H.C., L.-C.W., J.L.H., P.T.E., S.A.L.), Broad Institute, Cambridge, MA
- Department of Experimental Cardiology, Amsterdam University Medical Centers, The Netherlands (S.J.J.)
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (N.G., S.J.J., S.H.C., L.C.W., J.L.H., C.A.T., H.L.R., P.T.E., S.A.L.)
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative (V.N., V.N.M., S.J.J., S.H.C., L.-C.W., J.L.H., P.T.E., S.A.L.), Broad Institute, Cambridge, MA
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (N.G., S.J.J., S.H.C., L.C.W., J.L.H., C.A.T., H.L.R., P.T.E., S.A.L.)
| | - Amelia W Hall
- Gene Regulation Observatory (A.W.H.), Broad Institute, Cambridge, MA
| | - Lu-Chen Weng
- Cardiovascular Disease Initiative (V.N., V.N.M., S.J.J., S.H.C., L.-C.W., J.L.H., P.T.E., S.A.L.), Broad Institute, Cambridge, MA
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (N.G., S.J.J., S.H.C., L.C.W., J.L.H., C.A.T., H.L.R., P.T.E., S.A.L.)
| | - Jennifer L Halford
- Cardiovascular Disease Initiative (V.N., V.N.M., S.J.J., S.H.C., L.-C.W., J.L.H., P.T.E., S.A.L.), Broad Institute, Cambridge, MA
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (N.G., S.J.J., S.H.C., L.C.W., J.L.H., C.A.T., H.L.R., P.T.E., S.A.L.)
| | - Christina Austin-Tse
- Center for Genomic Medicine (C.A.-T., H.L.R.), Massachusetts General Hospital, Boston
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (N.G., S.J.J., S.H.C., L.C.W., J.L.H., C.A.T., H.L.R., P.T.E., S.A.L.)
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA (C.M.H., B.K.F.)
| | - Stephanie L Harris
- Cardiovascular Genetics Program (S.L.H., E.K.W.), Massachusetts General Hospital, Boston
| | - Eugene K Wong
- Cardiovascular Genetics Program (S.L.H., E.K.W.), Massachusetts General Hospital, Boston
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Dan E Arking
- McKusick-Nathans Institute, Department of Genetic Medicine (D.E.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emelia J Benjamin
- Boston University School of Public Health, MA (E.J.B., K.L.L.)
- Boston University School of Medicine, MA (E.J.B.)
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston (E.B., A.C.M.)
| | - Yuan-I Min
- Department of Medicine, University of Mississippi Medical Center, Jackson (Y.-I.M., A.C.)
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson (Y.-I.M., A.C.)
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA (C.M.H., B.K.F.)
| | - Susan R Heckbert
- Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.)
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA (C.K.)
| | - Henry J Lin
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California-Los Angeles Medical Center, Torrance (H.J.L., J.I.R.)
| | - Ruth J F Loos
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York (R.J.F.L.)
| | | | - Namrata Gupta
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (N.G., S.J.J., S.H.C., L.C.W., J.L.H., C.A.T., H.L.R., P.T.E., S.A.L.)
| | - Thomas W Blackwell
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor (T.W.B.)
| | - Braxton D Mitchell
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore (B.D.M.)
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston (E.B., A.C.M.)
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Systems and Population Health, University of Washington, Seattle, WA (B.M.P.)
| | - Wendy S Post
- Division of Cardiology, Department of Medicine (W.S.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Susan Redline
- Harvard Medical School (S.R.), Brigham and Women's Hospital, Boston, MA
| | - Heidi L Rehm
- Center for Genomic Medicine (C.A.-T., H.L.R.), Massachusetts General Hospital, Boston
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (N.G., S.J.J., S.H.C., L.C.W., J.L.H., C.A.T., H.L.R., P.T.E., S.A.L.)
| | - Stephen S Rich
- Center for Public Health Genomics and Department of Public Health Sciences, University of Virginia, Charlottesville (S.S.R.)
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California-Los Angeles Medical Center, Torrance (H.J.L., J.I.R.)
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.)
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, Cardiology, University of Washington, Seattle, WA (N.S.)
| | | | - Patrick T Ellinor
- Cardiovascular Disease Initiative (V.N., V.N.M., S.J.J., S.H.C., L.-C.W., J.L.H., P.T.E., S.A.L.), Broad Institute, Cambridge, MA
- Cardiac Arrhythmia Service and Cardiovascular Research Center (P.T.E., S.A.L.), Massachusetts General Hospital, Boston
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (N.G., S.J.J., S.H.C., L.C.W., J.L.H., C.A.T., H.L.R., P.T.E., S.A.L.)
| | - Steven A Lubitz
- Cardiovascular Disease Initiative (V.N., V.N.M., S.J.J., S.H.C., L.-C.W., J.L.H., P.T.E., S.A.L.), Broad Institute, Cambridge, MA
- Cardiac Arrhythmia Service and Cardiovascular Research Center (P.T.E., S.A.L.), Massachusetts General Hospital, Boston
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (N.G., S.J.J., S.H.C., L.C.W., J.L.H., C.A.T., H.L.R., P.T.E., S.A.L.)
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10
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Ulloa-Cerna AE, Jing L, Pfeifer JM, Raghunath S, Ruhl JA, Rocha DB, Leader JB, Zimmerman N, Lee G, Steinhubl SR, Good CW, Haggerty CM, Fornwalt BK, Chen R. rECHOmmend: An ECG-based Machine-learning Approach for Identifying Patients at High-risk of Undiagnosed Structural Heart Disease Detectable by Echocardiography. Circulation 2022; 146:36-47. [PMID: 35533093 PMCID: PMC9241668 DOI: 10.1161/circulationaha.121.057869] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Timely diagnosis of structural heart disease improves patient outcomes, yet many remain underdiagnosed. While population screening with echocardiography is impractical, ECG-based prediction models can help target high-risk patients. We developed a novel ECG-based machine learning approach to predict multiple structural heart conditions, hypothesizing that a composite model would yield higher prevalence and positive predictive values to facilitate meaningful recommendations for echocardiography. Methods: Using 2 232 130 ECGs linked to electronic health records and echocardiography reports from 484 765 adults between 1984 to 2021, we trained machine learning models to predict the presence or absence of any of 7 echocardiography-confirmed diseases within 1 year. This composite label included the following: moderate or severe valvular disease (aortic/mitral stenosis or regurgitation, tricuspid regurgitation), reduced ejection fraction <50%, or interventricular septal thickness >15 mm. We tested various combinations of input features (demographics, laboratory values, structured ECG data, ECG traces) and evaluated model performance using 5-fold cross-validation, multisite validation trained on 1 site and tested on 10 independent sites, and simulated retrospective deployment trained on pre-2010 data and deployed in 2010. Results: Our composite rECHOmmend model used age, sex, and ECG traces and had a 0.91 area under the receiver operating characteristic curve and a 42% positive predictive value at 90% sensitivity, with a composite label prevalence of 17.9%. Individual disease models had area under the receiver operating characteristic curves from 0.86 to 0.93 and lower positive predictive values from 1% to 31%. Area under the receiver operating characteristic curves for models using different input features ranged from 0.80 to 0.93, increasing with additional features. Multisite validation showed similar results to cross-validation, with an aggregate area under the receiver operating characteristic curve of 0.91 across our independent test set of 10 clinical sites after training on a separate site. Our simulated retrospective deployment showed that for ECGs acquired in patients without preexisting structural heart disease in the year 2010, 11% were classified as high risk and 41% (4.5% of total patients) developed true echocardiography-confirmed disease within 1 year. Conclusions: An ECG-based machine learning model using a composite end point can identify a high-risk population for having undiagnosed, clinically significant structural heart disease while outperforming single-disease models and improving practical utility with higher positive predictive values. This approach can facilitate targeted screening with echocardiography to improve underdiagnosis of structural heart disease.
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Affiliation(s)
- Alvaro E Ulloa-Cerna
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA
| | - Linyuan Jing
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA
| | - John M Pfeifer
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA; Heart and Vascular Center, Evangelical Hospital, Lewisburg, PA; Tempus Labs Inc, Chicago, IL
| | - Sushravya Raghunath
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA; Tempus Labs Inc, Chicago, IL
| | - Jeffrey A Ruhl
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA
| | - Daniel B Rocha
- Phenomic Analytics and Clinical Data Core, Geisinger, Danville, PA
| | - Joseph B Leader
- Phenomic Analytics and Clinical Data Core, Geisinger, Danville, PA; Tempus Labs Inc, Chicago, IL
| | | | | | - Steven R Steinhubl
- Tempus Labs Inc, Chicago, IL; Scripps Research Translational Institute, La Jolla, CA
| | - Christopher W Good
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA; UPMC Heart and Vascular Institute at UPMC, Hamot, PA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA; Heart Institute, Geisinger, Danville, PA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA; Tempus Labs Inc, Chicago, IL; Heart Institute, Geisinger, Danville, PA; Department of Radiology, Geisinger, Danville, PA
| | - RuiJun Chen
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA; Tempus Labs Inc, Chicago, IL; Department of Medicine, Geisinger, Danville, PA
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11
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Carruth E, Alsaid A, Murray B, Tichnell C, Sturm AC, James CA, Haggerty CM. HF-566-02 PREDICTED RISK OF VENTRICULAR ARRHYTHMIA IN INDIVIDUALS WITH DESMOSOME GENE VARIANTS IDENTIFIED VIA POPULATION GENOMIC SCREENING. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Jurgens SJ, Choi SH, Morrill VN, Chaffin M, Pirruccello JP, Halford JL, Weng LC, Nauffal V, Roselli C, Hall AW, Oetjens MT, Lagerman B, vanMaanen DP, Aragam KG, Lunetta KL, Haggerty CM, Lubitz SA, Ellinor PT. Analysis of rare genetic variation underlying cardiometabolic diseases and traits among 200,000 individuals in the UK Biobank. Nat Genet 2022; 54:240-250. [PMID: 35177841 PMCID: PMC8930703 DOI: 10.1038/s41588-021-01011-w] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/22/2021] [Indexed: 12/30/2022]
Abstract
Cardiometabolic diseases are the leading cause of death worldwide. Despite a known genetic component, our understanding of these diseases remains incomplete. Here, we analyzed the contribution of rare variants to 57 diseases and 26 cardiometabolic traits, using data from 200,337 UK Biobank participants with whole-exome sequencing. We identified 57 gene-based associations, with broad replication of novel signals in Geisinger MyCode. There was a striking risk associated with mutations in known Mendelian disease genes, including MYBPC3, LDLR, GCK, PKD1 and TTN. Many genes showed independent convergence of rare and common variant evidence, including an association between GIGYF1 and type 2 diabetes. We identified several large effect associations for height and 18 unique genes associated with blood lipid or glucose levels. Finally, we found that between 1.0% and 2.4% of participants carried rare potentially pathogenic variants for cardiometabolic disorders. These findings may facilitate studies aimed at therapeutics and screening of these common disorders.
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Affiliation(s)
- Sean J. Jurgens
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Valerie N. Morrill
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Mark Chaffin
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - James P. Pirruccello
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer L. Halford
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lu-Chen Weng
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Victor Nauffal
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Carolina Roselli
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Amelia W. Hall
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Braxton Lagerman
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - David P. vanMaanen
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | | | - Krishna G. Aragam
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kathryn L. Lunetta
- NHLBI and Boston University’s Framingham Heart Study, Framingham, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Christopher M. Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,Heart Institute, Geisinger, Danville, PA, USA
| | - Steven A. Lubitz
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.,Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick T. Ellinor
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.,Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA.,
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13
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Carry BJ, Young K, Fielden S, Kelly MA, Sturm AC, Avila JD, Martin CL, Kirchner HL, Fornwalt BK, Haggerty CM. Genomic Screening for Pathogenic Transthyretin Variants Finds Evidence of Underdiagnosed Amyloid Cardiomyopathy From Health Records. JACC CardioOncol 2021; 3:550-561. [PMID: 34746851 PMCID: PMC8543083 DOI: 10.1016/j.jaccao.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND New treatments for transthyretin amyloidosis improve survival, but diagnosis remains challenging. Pathogenic or likely pathogenic (P/LP) variants in the transthyretin (TTR) gene are one cause of transthyretin amyloidosis, and genomic screening has been proposed to identify at-risk individuals. However, data on disease features and penetrance are lacking to inform the utility of such population-based genomic screening for TTR. OBJECTIVES This study characterized the prevalence of P/LP variants in TTR identified through exome sequencing and the burden of associated disease from electronic health records for individuals with these variants from a large (N = 134,753), primarily European-ancestry cohort. METHODS We compared frequencies of common disease features and cardiac imaging findings between individuals with and without P/LP TTR variants. RESULTS We identified 157 of 134,753 (0.12%) individuals with P/LP TTR variants (43% male, median age 52 [Q1-Q3: 37-61] years). Seven P/LP variants accounted for all observations, the majority being V122I (p.V142I; 113, 0.08%). Approximately 60% (n = 91) of individuals with P/LP TTR variants (all V122I) had African ancestry. Diagnoses of amyloidosis were limited (2 of 157 patients), although related heart disease diagnoses, including cardiomyopathy and heart failure, were significantly increased in individuals with P/LP TTR variants who were aged >60 years. Fourteen percent (7 of 49) of individuals aged ≥60 or older with a P/LP TTR variant had heart disease and ventricular septal thickness >1.2 cm, only one of whom was diagnosed with amyloidosis. CONCLUSIONS Individuals with P/LP TTR variants identified by genomic screening have increased odds of heart disease after age 60 years, although amyloidosis is likely underdiagnosed without knowledge of the genetic variant.
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Key Words
- ATTR, transthyretin amyloidosis
- CI, confidence interval
- EHR, electronic health record
- HCC, hierarchical condition categories
- LP, likely pathogenic
- LV, left ventricle/ventricular
- OR, odds ratio
- P, pathogenic
- TTR, transthyretin
- amyloidosis
- cardiomyopathy
- electronic health records
- genomics
- hATTR, hereditary transthyretin amyloidosis
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Affiliation(s)
- Brendan J. Carry
- Heart Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Katelyn Young
- Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Samuel Fielden
- Department of Translational Data Science and Informatics, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Melissa A. Kelly
- Genomic Medicine Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Amy C. Sturm
- Heart Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
- Genomic Medicine Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - J. David Avila
- Department of Neurology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Christa L. Martin
- Genomic Medicine Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
- Autism & Developmental Medicine Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - H. Lester Kirchner
- Department of Population Health Sciences, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Brandon K. Fornwalt
- Heart Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
- Department of Translational Data Science and Informatics, Geisinger Medical Center, Danville, Pennsylvania, USA
- Department of Radiology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Christopher M. Haggerty
- Heart Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
- Department of Translational Data Science and Informatics, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Regeneron Genetics Center, Tarrytown, New York, USA
- Heart Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
- Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
- Department of Translational Data Science and Informatics, Geisinger Medical Center, Danville, Pennsylvania, USA
- Genomic Medicine Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
- Department of Neurology, Geisinger Medical Center, Danville, Pennsylvania, USA
- Autism & Developmental Medicine Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
- Department of Population Health Sciences, Geisinger Medical Center, Danville, Pennsylvania, USA
- Department of Radiology, Geisinger Medical Center, Danville, Pennsylvania, USA
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14
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Khurshid S, Mars N, Haggerty CM, Huang Q, Weng LC, Hartzel DN, Lunetta KL, Ashburner JM, Anderson CD, Benjamin EJ, Salomaa V, Ellinor PT, Fornwalt BK, Ripatti S, Trinquart L, Lubitz SA. Predictive Accuracy of a Clinical and Genetic Risk Model for Atrial Fibrillation. Circ Genom Precis Med 2021; 14:e003355. [PMID: 34463125 PMCID: PMC8530935 DOI: 10.1161/circgen.121.003355] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) risk estimation using clinical factors with or without genetic information may identify AF screening candidates more accurately than the guideline-based age threshold of ≥65 years. METHODS We analyzed 4 samples across the United States and Europe (derivation: UK Biobank; validation: FINRISK, Geisinger MyCode Initiative, and Framingham Heart Study). We estimated AF risk using the CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology AF) score and a combination of CHARGE-AF and a 1168-variant polygenic score (Predict-AF). We compared the utility of age, CHARGE-AF, and Predict-AF for predicting 5-year AF by quantifying discrimination and calibration. RESULTS Among 543 093 individuals, 8940 developed AF within 5 years. In the validation sets, CHARGE-AF (C index range, 0.720-0.824) and Predict-AF (0.749-0.831) had largely comparable discrimination, both favorable to continuous age (0.675-0.801). Calibration was similar using CHARGE-AF (slope range, 0.67-0.87) and Predict-AF (0.65-0.83). Net reclassification improvement using Predict-AF versus CHARGE-AF was modest (net reclassification improvement range, 0.024-0.057) but more favorable among individuals aged <65 years (0.062-0.11). Using Predict-AF among 99 530 individuals aged ≥65 years across each sample, 70 849 had AF risk <5%, of whom 69 067 (97.5%) did not develop AF, whereas 28 681 had AF risk ≥5%, of whom 2264 (7.9%) developed AF. Of 11 379 individuals aged <65 years with AF risk ≥5%, 435 (3.8%) developed AF before age 65 years, with roughly half (46.9%) meeting anticoagulation criteria. CONCLUSIONS AF risk estimation using clinical factors may prioritize individuals for AF screening more precisely than the age threshold endorsed in current guidelines. The additional value of genetic predisposition is modest but greatest among younger individuals.
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Affiliation(s)
- Shaan Khurshid
- Division of Cardiology, Massachusetts General Hospital, Boston
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Cardiovascular Disease Initiative, Broad Institute of Harvard & Massachusetts Institute of Technology, Cambridge, MA
| | - Nina Mars
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Christopher M. Haggerty
- Heart Institute, Geisinger, Danville, PA
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA
| | - Qiuxi Huang
- Department of Biostatistics, Boston University School of Public Health, Boston
- Boston University and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA
| | - Lu-Chen Weng
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Cardiovascular Disease Initiative, Broad Institute of Harvard & Massachusetts Institute of Technology, Cambridge, MA
| | - Dustin N. Hartzel
- Phenomic Analytics and Clinical Data Core, Geisinger Health, Danville, PA
| | | | - Kathryn L. Lunetta
- Department of Biostatistics, Boston University School of Public Health, Boston
- Boston University and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA
| | | | - Christopher D. Anderson
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston
- Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Cardiovascular Disease Initiative, Broad Institute of Harvard & Massachusetts Institute of Technology, Cambridge, MA
| | - Emelia J. Benjamin
- Sections of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Department of Epidemiology, Boston University School of Public Health, Boston
- Boston University and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Patrick T. Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston
- Cardiovascular Disease Initiative, Broad Institute of Harvard & Massachusetts Institute of Technology, Cambridge, MA
| | - Brandon K. Fornwalt
- Heart Institute, Geisinger, Danville, PA
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Broad Institute of Harvard & Massachusetts Institute of Technology, Cambridge, MA
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston
- Boston University and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA
| | - Steven A. Lubitz
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston
- Cardiovascular Disease Initiative, Broad Institute of Harvard & Massachusetts Institute of Technology, Cambridge, MA
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15
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Lumbers RT, Shah S, Lin H, Czuba T, Henry A, Swerdlow DI, Mälarstig A, Andersson C, Verweij N, Holmes MV, Ärnlöv J, Svensson P, Hemingway H, Sallah N, Almgren P, Aragam KG, Asselin G, Backman JD, Biggs ML, Bloom HL, Boersma E, Brandimarto J, Brown MR, Brunner-La Rocca HP, Carey DJ, Chaffin MD, Chasman DI, Chazara O, Chen X, Chen X, Chung JH, Chutkow W, Cleland JGF, Cook JP, de Denus S, Dehghan A, Delgado GE, Denaxas S, Doney AS, Dörr M, Dudley SC, Engström G, Esko T, Fatemifar G, Felix SB, Finan C, Ford I, Fougerousse F, Fouodjio R, Ghanbari M, Ghasemi S, Giedraitis V, Giulianini F, Gottdiener JS, Gross S, Guðbjartsson DF, Gui H, Gutmann R, Haggerty CM, van der Harst P, Hedman ÅK, Helgadottir A, Hillege H, Hyde CL, Jacob J, Jukema JW, Kamanu F, Kardys I, Kavousi M, Khaw KT, Kleber ME, Køber L, Koekemoer A, Kraus B, Kuchenbaecker K, Langenberg C, Lind L, Lindgren CM, London B, Lotta LA, Lovering RC, Luan J, Magnusson P, Mahajan A, Mann D, Margulies KB, Marston NA, März W, McMurray JJV, Melander O, Melloni G, Mordi IR, Morley MP, Morris AD, Morris AP, Morrison AC, Nagle MW, Nelson CP, Newton-Cheh C, Niessner A, Niiranen T, Nowak C, O'Donoghue ML, Owens AT, Palmer CNA, Paré G, Perola M, Perreault LPL, Portilla-Fernandez E, Psaty BM, Rice KM, Ridker PM, Romaine SPR, Roselli C, Rotter JI, Ruff CT, Sabatine MS, Salo P, Salomaa V, van Setten J, Shalaby AA, Smelser DT, Smith NL, Stefansson K, Stender S, Stott DJ, Sveinbjörnsson G, Tammesoo ML, Tardif JC, Taylor KD, Teder-Laving M, Teumer A, Thorgeirsson G, Thorsteinsdottir U, Torp-Pedersen C, Trompet S, Tuckwell D, Tyl B, Uitterlinden AG, Vaura F, Veluchamy A, Visscher PM, Völker U, Voors AA, Wang X, Wareham NJ, Weeke PE, Weiss R, White HD, Wiggins KL, Xing H, Yang J, Yang Y, Yerges-Armstrong LM, Yu B, Zannad F, Zhao F, Wilk JB, Holm H, Sattar N, Lubitz SA, Lanfear DE, Shah S, Dunn ME, Wells QS, Asselbergs FW, Hingorani AD, Dubé MP, Samani NJ, Lang CC, Cappola TP, Ellinor PT, Vasan RS, Smith JG. The genomics of heart failure: design and rationale of the HERMES consortium. ESC Heart Fail 2021; 8:5531-5541. [PMID: 34480422 PMCID: PMC8712846 DOI: 10.1002/ehf2.13517] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/09/2021] [Accepted: 07/05/2021] [Indexed: 12/28/2022] Open
Abstract
Aims The HERMES (HEart failure Molecular Epidemiology for Therapeutic targetS) consortium aims to identify the genomic and molecular basis of heart failure. Methods and results The consortium currently includes 51 studies from 11 countries, including 68 157 heart failure cases and 949 888 controls, with data on heart failure events and prognosis. All studies collected biological samples and performed genome‐wide genotyping of common genetic variants. The enrolment of subjects into participating studies ranged from 1948 to the present day, and the median follow‐up following heart failure diagnosis ranged from 2 to 116 months. Forty‐nine of 51 individual studies enrolled participants of both sexes; in these studies, participants with heart failure were predominantly male (34–90%). The mean age at diagnosis or ascertainment across all studies ranged from 54 to 84 years. Based on the aggregate sample, we estimated 80% power to genetic variant associations with risk of heart failure with an odds ratio of ≥1.10 for common variants (allele frequency ≥ 0.05) and ≥1.20 for low‐frequency variants (allele frequency 0.01–0.05) at P < 5 × 10−8 under an additive genetic model. Conclusions HERMES is a global collaboration aiming to (i) identify the genetic determinants of heart failure; (ii) generate insights into the causal pathways leading to heart failure and enable genetic approaches to target prioritization; and (iii) develop genomic tools for disease stratification and risk prediction.
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Affiliation(s)
- R Thomas Lumbers
- Institute of Health Informatics, University College London, Gower St, London, WC1E 7HB, UK.,Health Data Research UK London, University College London, London, UK.,BHF Research Accelerator, University College London, London, UK
| | - Sonia Shah
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia.,Institute of Cardiovascular Science, University College London, London, UK
| | - Honghuang Lin
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA
| | - Tomasz Czuba
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Albert Henry
- Institute of Health Informatics, University College London, Gower St, London, WC1E 7HB, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Daniel I Swerdlow
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Medicine, Imperial College London, London, UK
| | - Anders Mälarstig
- Pfizer Worldwide Research & Development, Cambridge, MA, USA.,Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Charlotte Andersson
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA.,Department of Cardiology, Herlev Gentofte Hospital, Herlev, Denmark
| | - Niek Verweij
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michael V Holmes
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK.,Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, UK
| | - Johan Ärnlöv
- Department of Neurobiology, Care Sciences and Society/Section of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.,School of Health and Social Sciences, Dalarna University, Falun, Sweden
| | - Per Svensson
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Harry Hemingway
- Institute of Health Informatics, University College London, Gower St, London, WC1E 7HB, UK.,Health Data Research UK London, University College London, London, UK.,The National Institute for Health Research, University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - Neneh Sallah
- Institute of Health Informatics, University College London, Gower St, London, WC1E 7HB, UK.,Health Data Research UK London, University College London, London, UK.,UCL Genetics Institute, University College London, London, UK
| | - Peter Almgren
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Krishna G Aragam
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Mary L Biggs
- Department of Biostatistics, University of Washington, Seattle, WA, USA.,Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA, USA
| | - Heather L Bloom
- Division of Cardiology, Department of Medicine, Emory University Medical Center, Atlanta, GA, USA
| | - Eric Boersma
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeffrey Brandimarto
- Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael R Brown
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - David J Carey
- Department of Molecular and Functional Genomics, Geisinger, Danville, PA, USA
| | - Mark D Chaffin
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Olympe Chazara
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Xing Chen
- Pfizer Worldwide Research & Development, Cambridge, MA, USA
| | - Xu Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - William Chutkow
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - John G F Cleland
- Robertson Centre for Biostatistics & Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - James P Cook
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Simon de Denus
- Montreal Heart Institute, Montreal, Quebec, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Abbas Dehghan
- Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, London, UK.,MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, London, UK
| | - Graciela E Delgado
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, Gower St, London, WC1E 7HB, UK.,Health Data Research UK London, University College London, London, UK.,The National Institute for Health Research, University College London Hospitals Biomedical Research Centre, University College London, London, UK.,The Alan Turing Institute, British Library, London, UK
| | - Alexander S Doney
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Samuel C Dudley
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Tõnu Esko
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Ghazaleh Fatemifar
- Institute of Health Informatics, University College London, Gower St, London, WC1E 7HB, UK.,Health Data Research UK London, University College London, London, UK
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Chris Finan
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ian Ford
- Robertson Centre for Biostatistics & Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Francoise Fougerousse
- Translational and Clinical Research, Servier Cardiovascular Center for Therapeutic Innovation, Suresnes, France
| | | | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sahar Ghasemi
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Franco Giulianini
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John S Gottdiener
- Department of Medicine, Division of Cardiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stefan Gross
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Daníel F Guðbjartsson
- deCODE genetics/Amgen Inc., Reykjavik, Iceland.,School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Hongsheng Gui
- Center for Individualized and Genomic Medicine Research, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Rebecca Gutmann
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | | | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
| | - Åsa K Hedman
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | | | - Hans Hillege
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Craig L Hyde
- Pfizer Worldwide Research & Development, Cambridge, MA, USA
| | - Jaison Jacob
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Frederick Kamanu
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Isabella Kardys
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marcus E Kleber
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andrea Koekemoer
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Bill Kraus
- Duke Molecular Physiology Institute, Durham, NC, USA
| | - Karoline Kuchenbaecker
- UCL Genetics Institute, University College London, London, UK.,Division of Psychiatry, University College of London, London, UK
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Cecilia M Lindgren
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Barry London
- Division of Cardiovascular Medicine and Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA, USA
| | - Luca A Lotta
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ruth C Lovering
- Institute of Cardiovascular Science, University College London, London, UK
| | - Jian'an Luan
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Patrik Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Douglas Mann
- Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Kenneth B Margulies
- Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicholas A Marston
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Winfried März
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Heidelberg, Germany.,Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Olle Melander
- Department of Internal Medicine, Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Giorgio Melloni
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Michael P Morley
- Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew D Morris
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Andrew P Morris
- Department of Biostatistics, University of Liverpool, Liverpool, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Christopher Newton-Cheh
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.,Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Teemu Niiranen
- Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Christoph Nowak
- Department of Neurobiology, Care Sciences and Society/Section of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Michelle L O'Donoghue
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anjali T Owens
- Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Colin N A Palmer
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Guillaume Paré
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Eliana Portilla-Fernandez
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA, USA.,Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Kenneth M Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Simon P R Romaine
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Carolina Roselli
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Christian T Ruff
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Perttu Salo
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jessica van Setten
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Alaa A Shalaby
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center and VA Pittsburgh HCS, Pittsburgh, PA, USA
| | - Diane T Smelser
- Department of Molecular and Functional Genomics, Geisinger, Danville, PA, USA
| | - Nicholas L Smith
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Veterans Affairs Office of Research and Development, Seattle Epidemiologic Research and Information Center, Seattle, WA, USA
| | - Kari Stefansson
- deCODE genetics/Amgen Inc., Reykjavik, Iceland.,Faculty of Medicine, Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - Steen Stender
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Mari-Liis Tammesoo
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Maris Teder-Laving
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Alexander Teumer
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Guðmundur Thorgeirsson
- deCODE genetics/Amgen Inc., Reykjavik, Iceland.,Faculty of Medicine, Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - Unnur Thorsteinsdottir
- deCODE genetics/Amgen Inc., Reykjavik, Iceland.,Faculty of Medicine, Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - Christian Torp-Pedersen
- Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.,Department of Health, Science and Technology, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Danny Tuckwell
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Benoit Tyl
- Translational and Clinical Research, Servier Cardiovascular Center for Therapeutic Innovation, Suresnes, France
| | - Andre G Uitterlinden
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Felix Vaura
- Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Abirami Veluchamy
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Peter M Visscher
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Uwe Völker
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.,Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Xiaosong Wang
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Peter E Weeke
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Raul Weiss
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Kerri L Wiggins
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Heming Xing
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Jian Yang
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Yifan Yang
- Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Bing Yu
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Faiez Zannad
- CHU de Nancy, Inserm and INI-CRCT (F-CRIN), Institut Lorrain du Coeur et des Vaisseaux, Université de Lorraine, Nancy, France
| | - Faye Zhao
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | -
- Regeneron Genetics Center, Tarrytown, NY, USA
| | - Jemma B Wilk
- Pfizer Worldwide Research & Development, Cambridge, MA, USA
| | - Hilma Holm
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
| | - Naveed Sattar
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Steven A Lubitz
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - David E Lanfear
- Center for Individualized and Genomic Medicine Research, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.,Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Svati Shah
- Duke Molecular Physiology Institute, Durham, NC, USA.,Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Michael E Dunn
- Regeneron Pharmaceuticals, Cardiovascular Research, Tarrytown, NY, USA
| | - Quinn S Wells
- Division of Cardiovascular Medicine and the Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN, USA
| | - Folkert W Asselbergs
- Health Data Research UK London, University College London, London, UK.,BHF Research Accelerator, University College London, London, UK.,Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Aroon D Hingorani
- BHF Research Accelerator, University College London, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Thomas P Cappola
- Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA.,Sections of Cardiology, Preventive Medicine and Epidemiology, Department of Medicine, Boston University Schools of Medicine and Public Health, Boston, MA, USA
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.,Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden.,The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University and the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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16
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Dries AM, Kirillova A, Reuter CM, Garcia J, Zouk H, Hawley M, Murray B, Tichnell C, Pilichou K, Protonotarios A, Medeiros-Domingo A, Kelly MA, Baras A, Ingles J, Semsarian C, Bauce B, Celeghin R, Basso C, Jongbloed JDH, Nussbaum RL, Funke B, Cerrone M, Mestroni L, Taylor MRG, Sinagra G, Merlo M, Saguner AM, Elliott PM, Syrris P, van Tintelen JP, James CA, Haggerty CM, Parikh VN. Correction to: The genetic architecture of Plakophilin 2 cardiomyopathy. Genet Med 2021; 23:2014. [PMID: 34408292 PMCID: PMC8486651 DOI: 10.1038/s41436-021-01298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Annika M Dries
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Anna Kirillova
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Chloe M Reuter
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Hana Zouk
- Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine, Cambridge, MA, USA.,Dept. Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Megan Hawley
- Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine, Cambridge, MA, USA.,Dept. Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kalliopi Pilichou
- Dept. of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alexandros Protonotarios
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | | | | | - Aris Baras
- Regeneron Genetics Center, Tarrytown, NY, USA
| | - Jodie Ingles
- Cardio Genomics Program at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Sydney, Australia
| | - Barbara Bauce
- Dept. of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Rudy Celeghin
- Dept. of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Cristina Basso
- Dept. of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Jan D H Jongbloed
- University of Groningen Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Birgit Funke
- Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine, Cambridge, MA, USA.,Dept. Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marina Cerrone
- Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, NY, US
| | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Aurora, CO, US
| | | | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital, Zurich, Switzerland
| | - Perry M Elliott
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Petros Syrris
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - J Peter van Tintelen
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands.,Netherlands Heart Institute, Utrecht, the Netherlands
| | | | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Victoria N Parikh
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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17
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Choi SH, Jurgens SJ, Haggerty CM, Hall AW, Halford JL, Morrill VN, Weng LC, Lagerman B, Mirshahi T, Pettinger M, Guo X, Lin HJ, Alonso A, Soliman EZ, Kornej J, Lin H, Moscati A, Nadkarni GN, Brody JA, Wiggins KL, Cade BE, Lee J, Austin-Tse C, Blackwell T, Chaffin MD, Lee CJY, Rehm HL, Roselli C, Redline S, Mitchell BD, Sotoodehnia N, Psaty BM, Heckbert SR, Loos RJ, Vasan RS, Benjamin EJ, Correa A, Boerwinkle E, Arking DE, Rotter JI, Rich SS, Whitsel EA, Perez M, Kooperberg C, Fornwalt BK, Lunetta KL, Ellinor PT, Lubitz SA, Lubitz SA. Rare Coding Variants Associated With Electrocardiographic Intervals Identify Monogenic Arrhythmia Susceptibility Genes: A Multi-Ancestry Analysis. Circ Genom Precis Med 2021; 14:e003300. [PMID: 34319147 PMCID: PMC8373440 DOI: 10.1161/circgen.120.003300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Alterations in electrocardiographic (ECG) intervals are well-known markers for arrhythmia and sudden cardiac death (SCD) risk. While the genetics of arrhythmia syndromes have been studied, relations between electrocardiographic intervals and rare genetic variation at a population level are poorly understood. METHODS Using a discovery sample of 29 000 individuals with whole-genome sequencing from Trans-Omics in Precision Medicine and replication in nearly 100 000 with whole-exome sequencing from the UK Biobank and MyCode, we examined associations between low-frequency and rare coding variants with 5 routinely measured electrocardiographic traits (RR, P-wave, PR, and QRS intervals and corrected QT interval). RESULTS We found that rare variants associated with population-based electrocardiographic intervals identify established monogenic SCD genes (KCNQ1, KCNH2, and SCN5A), a controversial monogenic SCD gene (KCNE1), and novel genes (PAM and MFGE8) involved in cardiac conduction. Loss-of-function and pathogenic SCN5A variants, carried by 0.1% of individuals, were associated with a nearly 6-fold increased odds of the first-degree atrioventricular block (P=8.4×10-5). Similar variants in KCNQ1 and KCNH2 (0.2% of individuals) were associated with a 23-fold increased odds of marked corrected QT interval prolongation (P=4×10-25), a marker of SCD risk. Incomplete penetrance of such deleterious variation was common as over 70% of carriers had normal electrocardiographic intervals. CONCLUSIONS Our findings indicate that large-scale high-depth sequence data and electrocardiographic analysis identifies monogenic arrhythmia susceptibility genes and rare variants with large effects. Known pathogenic variation in conventional arrhythmia and SCD genes exhibited incomplete penetrance and accounted for only a small fraction of marked electrocardiographic interval prolongation.
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Affiliation(s)
- Seung Hoan Choi
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.)
| | - Sean J. Jurgens
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.)
| | - Christopher M. Haggerty
- Department of Translational Data Science and Informatics (C.M.H., B.K.F.), Geisinger, Danville, PA.,Heart Institute (C.M.H., B.K.F.), Geisinger, Danville, PA
| | - Amelia W. Hall
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.).,Cardiovascular Research Center (A.W.H., V.N.M., L.-C.W., P.T.E., S.A.L.), Boston, MA
| | - Jennifer L. Halford
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.).,Harvard Medical School (J.L.H., C.A.-T., H.L.R.), Boston, MA
| | - Valerie N. Morrill
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.).,Cardiovascular Research Center (A.W.H., V.N.M., L.-C.W., P.T.E., S.A.L.), Boston, MA
| | - Lu-Chen Weng
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.).,Cardiovascular Research Center (A.W.H., V.N.M., L.-C.W., P.T.E., S.A.L.), Boston, MA
| | - Braxton Lagerman
- Phenomic Analytics and Clinical Data Core (B.L.), Geisinger, Danville, PA
| | - Tooraj Mirshahi
- Department of Molecular and Functional Genomics (T.M.), Geisinger, Danville, PA
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (M.P., C.K.)
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Insti for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA (X.G., H.J.L., J.I.R.)
| | - Henry J. Lin
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Insti for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA (X.G., H.J.L., J.I.R.)
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
| | - Jelena Kornej
- NHLBI and Boston University’s Framingham Heart Study (J.K., E.J.B., R.S.V).,Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., R.S.V), Boston University School of Medicine, MA
| | - Honghuang Lin
- Section of Computational Biomedicine, Department of Medicine (H.L.), Boston University School of Medicine, MA
| | - Arden Moscati
- The Charles Bronfman Institute for Personalized Medicine (A.M., G.N., R.J.F.L.), Icahn School of Medicine, Mount Sinai, New York, NY
| | - Girish N. Nadkarni
- The Charles Bronfman Institute for Personalized Medicine (A.M., G.N., R.J.F.L.), Icahn School of Medicine, Mount Sinai, New York, NY.,Division of Nephrology, Department of Medicine (G.N.), Icahn School of Medicine, Mount Sinai, New York, NY
| | - Jennifer A. Brody
- Cardiovascular Health Research Unit, Department of Medicine (J.A.B., K.L.W., N.S., B.M.P., S.R.H.), University of Washington, Seattle
| | - Kerri L. Wiggins
- Cardiovascular Health Research Unit, Department of Medicine (J.A.B., K.L.W., N.S., B.M.P., S.R.H.), University of Washington, Seattle
| | - Brian E. Cade
- Massachusetts General Hospital. Division of Sleep Medicine, Department of Medicine (B.E.C.), Boston, MA.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology (B.E.C.), Harvard Medical School, Brigham and Women’s Hospital, Boston
| | - Jiwon Lee
- Division of Sleep and Circadian Disorders (J.L.), Harvard Medical School, Brigham and Women’s Hospital, Boston
| | - Christina Austin-Tse
- Center for Genomic Medicine (C.A.-T., H.L.R.), Boston, MA.,Harvard Medical School (J.L.H., C.A.-T., H.L.R.), Boston, MA.,Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, MA (C.A.-T.)
| | - Tom Blackwell
- Department of Biostatistics, University of Michigan, Ann Arbor (T.B.)
| | - Mark D. Chaffin
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.)
| | - Christina J.-Y. Lee
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.)
| | - Heidi L. Rehm
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.).,Center for Genomic Medicine (C.A.-T., H.L.R.), Boston, MA.,Harvard Medical School (J.L.H., C.A.-T., H.L.R.), Boston, MA
| | - Carolina Roselli
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.)
| | - Susan Redline
- Regeneron Genetics Center, Tarrytown, NY. Departments of Medicine, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.)
| | - Braxton D. Mitchell
- University of Maryland School of Medicine (B.D.M.).,Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, MD (B.D.M.)
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine (J.A.B., K.L.W., N.S., B.M.P., S.R.H.), University of Washington, Seattle.,Division of Cardiology, Department of Epidemiology (N.S.), University of Washington, Seattle
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine (J.A.B., K.L.W., N.S., B.M.P., S.R.H.), University of Washington, Seattle.,Department of Epidemiology (B.M.P., S.R.H.), University of Washington, Seattle.,Department of Health Services (B.M.P.), University of Washington, Seattle.,Kaiser Permanente Washington Health Research Institute, Seattle (B.M.P.)
| | - Susan R. Heckbert
- Cardiovascular Health Research Unit, Department of Medicine (J.A.B., K.L.W., N.S., B.M.P., S.R.H.), University of Washington, Seattle.,Department of Epidemiology (B.M.P., S.R.H.), University of Washington, Seattle
| | - Ruth J.F. Loos
- The Charles Bronfman Institute for Personalized Medicine (A.M., G.N., R.J.F.L.), Icahn School of Medicine, Mount Sinai, New York, NY.,The Mindich Child Health and Development Institute (R.J.F.L.), Icahn School of Medicine, Mount Sinai, New York, NY
| | - Ramachandran S. Vasan
- NHLBI and Boston University’s Framingham Heart Study (J.K., E.J.B., R.S.V).,Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., R.S.V), Boston University School of Medicine, MA.,Department of Medicine (E.J.B., R.S.V), Boston University School of Medicine, MA
| | - Emelia J. Benjamin
- NHLBI and Boston University’s Framingham Heart Study (J.K., E.J.B., R.S.V).,Department of Medicine (E.J.B., R.S.V), Boston University School of Medicine, MA.,Department of Epidemiology (E.J.B.), Boston University School of Public Health, MA
| | - Adolfo Correa
- Departments of Medicine, Pediatrics, and Population Health Science, University of Mississippi Medical Center, Jackson (A.C.)
| | - Eric Boerwinkle
- Human Genetics Center, University of Texas Health Science Center, Houston (E.B.)
| | - Dan E. Arking
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.E.A.)
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Insti for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA (X.G., H.J.L., J.I.R.)
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville (S.S.R.)
| | - Eric A. Whitsel
- Department of Epidemiology, Gillings School of Global Public Health (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill.,Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Marco Perez
- Division of Cardiovascular Medicine, Stanford University, CA (M.P.). Dr Sotoodehnia is supported by NIH grant R01HL141989, by AHA grant 19SFRN34830063, and by the Laughlin Family
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (M.P., C.K.)
| | - Brandon K. Fornwalt
- Department of Translational Data Science and Informatics (C.M.H., B.K.F.), Geisinger, Danville, PA.,Heart Institute (C.M.H., B.K.F.), Geisinger, Danville, PA.,Department of Radiology (B.K.F.), Geisinger, Danville, PA
| | - Kathryn L. Lunetta
- Department of Biostatistics (K.L.L.), Boston University School of Public Health, MA
| | - Patrick T. Ellinor
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.).,Cardiovascular Research Center (A.W.H., V.N.M., L.-C.W., P.T.E., S.A.L.), Boston, MA.,Cardiac Arrhythmia Service (P.T.E., S.A.L.), Boston, MA
| | - Steven A. Lubitz
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.).,Cardiovascular Research Center (A.W.H., V.N.M., L.-C.W., P.T.E., S.A.L.), Boston, MA.,Cardiac Arrhythmia Service (P.T.E., S.A.L.), Boston, MA
| | - Steven A Lubitz
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.H.C., S.J.J., A.W.H., J.L.H., V.N.M., L.-C.W., M.D.C., C.J.-Y.L., H.L.R., C.R., P.T.E., S.A.L.).,Cardiovascular Research Center (A.W.H., V.N.M., L.-C.W., P.T.E., S.A.L.), Boston, MA.,Cardiac Arrhythmia Service (P.T.E., S.A.L.), Boston, MA
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18
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Carruth ED, Fielden SW, Nevius CD, Fornwalt BK, Haggerty CM. 3D-Encoded DENSE MRI with Zonal Excitation for Quantifying Biventricular Myocardial Strain During a Breath-Hold. Cardiovasc Eng Technol 2021; 12:589-597. [PMID: 34244904 DOI: 10.1007/s13239-021-00561-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 06/15/2020] [Accepted: 06/25/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Right ventricular (RV) function is increasingly recognized for its prognostic value in many disease states. As with the left ventricle (LV), strain-based measurements may have better prognostic value than typical chamber volumes or ejection fraction. Complete functional characterization of the RV requires high-resolution, 3D displacement tracking methods, which have been prohibitively challenging to implement. Zonal excitation during Displacement ENcoding with Stimulated Echoes (DENSE) magnetic resonance imaging (MRI) has helped reduce scan time for 2D LV strain quantification. We hypothesized that zonal excitation could alternatively be used to reproducibly acquire higher resolution, 3D-encoded DENSE images for quantification of bi-ventricular strain within a single breath-hold. METHODS We modified sequence parameters for a 3D zonal excitation DENSE sequence to achieve in-plane resolution < 2 mm and acquired two sets of images in eight healthy adult male volunteers with median (IQR) age 32.5 (32.0-33.8) years. We assessed the inter-test reproducibility of this technique, and compared computed strains and torsion with previously published data. RESULTS Data for one subject was excluded based on image artifacts. Reproducibility for LV (CoV: 6.1-9.0%) and RV normal strains (CoV: 6.3-8.2%) and LV torsion (CoV = 7.1%) were all very good. Reproducibility of RV torsion was lower (CoV = 16.7%), but still within acceptable limits. Computed global strains and torsion were within reasonable agreement with published data, but further studies in larger cohorts are needed to confirm. CONCLUSION Reproducible acquisition of 3D-encoded biventricular myocardial strain data in a breath-hold is feasible using DENSE with zonal excitation.
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Affiliation(s)
- Eric D Carruth
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Samuel W Fielden
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,Medical and Health Physics, Geisinger, Danville, PA, USA
| | - Christopher D Nevius
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,The Heart Institute, Geisinger, Danville, PA, USA.,Department of Radiology, Geisinger, Danville, PA, USA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA. .,The Heart Institute, Geisinger, Danville, PA, USA.
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19
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Ulloa Cerna AE, Jing L, Good CW, vanMaanen DP, Raghunath S, Suever JD, Nevius CD, Wehner GJ, Hartzel DN, Leader JB, Alsaid A, Patel AA, Kirchner HL, Pfeifer JM, Carry BJ, Pattichis MS, Haggerty CM, Fornwalt BK. Deep-learning-assisted analysis of echocardiographic videos improves predictions of all-cause mortality. Nat Biomed Eng 2021; 5:546-554. [PMID: 33558735 DOI: 10.1038/s41551-020-00667-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 11/24/2020] [Indexed: 01/30/2023]
Abstract
Machine learning promises to assist physicians with predictions of mortality and of other future clinical events by learning complex patterns from historical data, such as longitudinal electronic health records. Here we show that a convolutional neural network trained on raw pixel data in 812,278 echocardiographic videos from 34,362 individuals provides superior predictions of one-year all-cause mortality. The model's predictions outperformed the widely used pooled cohort equations, the Seattle Heart Failure score (measured in an independent dataset of 2,404 patients with heart failure who underwent 3,384 echocardiograms), and a machine learning model involving 58 human-derived variables from echocardiograms and 100 clinical variables derived from electronic health records. We also show that cardiologists assisted by the model substantially improved the sensitivity of their predictions of one-year all-cause mortality by 13% while maintaining prediction specificity. Large unstructured datasets may enable deep learning to improve a wide range of clinical prediction models.
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Affiliation(s)
- Alvaro E Ulloa Cerna
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,Electrical and Computer Engineering Department, University of New Mexico, Albuquerque, NM, USA
| | - Linyuan Jing
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | | | - David P vanMaanen
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Sushravya Raghunath
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Jonathan D Suever
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Christopher D Nevius
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Gregory J Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
| | - Dustin N Hartzel
- Phenomic Analytics and Clinical Data Core, Geisinger, Danville, PA, USA
| | - Joseph B Leader
- Phenomic Analytics and Clinical Data Core, Geisinger, Danville, PA, USA
| | - Amro Alsaid
- Heart Institute, Geisinger, Danville, PA, USA
| | | | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | - John M Pfeifer
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,Heart and Vascular Center, Evangelical Hospital, Lewisburg, PA, USA
| | | | - Marios S Pattichis
- Electrical and Computer Engineering Department, University of New Mexico, Albuquerque, NM, USA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,Heart Institute, Geisinger, Danville, PA, USA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA. .,Heart Institute, Geisinger, Danville, PA, USA. .,Department of Radiology, Geisinger, Danville, PA, USA.
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20
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Wehner GJ, Jing L, Haggerty CM, Suever JD, Leader JB, Hartzel DN, Kirchner HL, Manus JNA, James N, Ayar Z, Gladding P, Good CW, Cleland JGF, Fornwalt BK. Routinely reported ejection fraction and mortality in clinical practice: where does the nadir of risk lie? Eur Heart J 2021; 41:1249-1257. [PMID: 31386109 DOI: 10.1093/eurheartj/ehz550] [Citation(s) in RCA: 140] [Impact Index Per Article: 46.7] [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] [Received: 03/05/2019] [Revised: 05/07/2019] [Accepted: 07/20/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS We investigated the relationship between clinically assessed left ventricular ejection fraction (LVEF) and survival in a large, heterogeneous clinical cohort. METHODS AND RESULTS Physician-reported LVEF on 403 977 echocardiograms from 203 135 patients were linked to all-cause mortality using electronic health records (1998-2018) from US regional healthcare system. Cox proportional hazards regression was used for analyses while adjusting for many patient characteristics including age, sex, and relevant comorbidities. A dataset including 45 531 echocardiograms and 35 976 patients from New Zealand was used to provide independent validation of analyses. During follow-up of the US cohort, 46 258 (23%) patients who had undergone 108 578 (27%) echocardiograms died. Overall, adjusted hazard ratios (HR) for mortality showed a u-shaped relationship for LVEF with a nadir of risk at an LVEF of 60-65%, a HR of 1.71 [95% confidence interval (CI) 1.64-1.77] when ≥70% and a HR of 1.73 (95% CI 1.66-1.80) at LVEF of 35-40%. Similar relationships with a nadir at 60-65% were observed in the validation dataset as well as for each age group and both sexes. The results were similar after further adjustments for conditions associated with an elevated LVEF, including mitral regurgitation, increased wall thickness, and anaemia and when restricted to patients reported to have heart failure at the time of the echocardiogram. CONCLUSION Deviation of LVEF from 60% to 65% is associated with poorer survival regardless of age, sex, or other relevant comorbidities such as heart failure. These results may herald the recognition of a new phenotype characterized by supra-normal LVEF.
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Affiliation(s)
- Gregory J Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, USA.,Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA
| | - Christopher M Haggerty
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, USA.,Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA
| | - Jonathan D Suever
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, USA.,Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA
| | - Joseph B Leader
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA
| | - Dustin N Hartzel
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA
| | - H Lester Kirchner
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA
| | - Joseph N A Manus
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA
| | - Nick James
- Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand
| | - Zina Ayar
- Clinical Informatics Service, Waitemata District Health Board, Auckland, New Zealand
| | - Patrick Gladding
- Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand
| | | | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow and National Heart & Lung Institute, Imperial College London, London, UK
| | - Brandon K Fornwalt
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, USA.,Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA.,Heart Institute, Geisinger, Danville, PA, USA.,Department of Radiology, Geisinger, 100 North Academy Avenue, Danville 17822-4400, PA, USA
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21
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El-Manzalawy Y, Abbas M, Hoaglund I, Cerna AU, Morland TB, Haggerty CM, Hall ES, Fornwalt BK. OASIS +: leveraging machine learning to improve the prognostic accuracy of OASIS severity score for predicting in-hospital mortality. BMC Med Inform Decis Mak 2021; 21:156. [PMID: 33985483 PMCID: PMC8118103 DOI: 10.1186/s12911-021-01517-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Severity scores assess the acuity of critical illness by penalizing for the deviation of physiologic measurements from normal and aggregating these penalties (also called “weights” or “subscores”) into a final score (or probability) for quantifying the severity of critical illness (or the likelihood of in-hospital mortality). Although these simple additive models are human readable and interpretable, their predictive performance needs to be further improved. Methods We present OASIS +, a variant of the Oxford Acute Severity of Illness Score (OASIS) in which an ensemble of 200 decision trees is used to predict in-hospital mortality based on the 10 same clinical variables in OASIS. Results Using a test set of 9566 admissions extracted from the MIMIC-III database, we show that OASIS + outperforms nine previously developed severity scoring methods (including OASIS) in predicting in-hospital mortality. Furthermore, our results show that the supervised learning algorithms considered in our experiments demonstrated higher predictive performance when trained using the observed clinical variables as opposed to OASIS subscores. Conclusions Our results suggest that there is room for improving the prognostic accuracy of the OASIS severity scores by replacing the simple linear additive scoring function with more sophisticated non-linear machine learning models such as RF and XGB. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01517-7.
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Affiliation(s)
- Yasser El-Manzalawy
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, 17822, USA.
| | - Mostafa Abbas
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, 17822, USA
| | - Ian Hoaglund
- College of Information Sciences and Technology, Pennsylvania State University, University Park, PA, 16802, USA
| | - Alvaro Ulloa Cerna
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, 17822, USA
| | - Thomas B Morland
- Department of General Internal Medicine, Geisinger, Danville, PA, 17822, USA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, 17822, USA
| | - Eric S Hall
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, 17822, USA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, 17822, USA.,Department of Radiology, Geisinger, Danville, PA, 17822, USA
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22
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Schwartz MLB, Buchanan AH, Hallquist MLG, Haggerty CM, Sturm AC. Genetic counseling for patients with positive genomic screening results: Considerations for when the genetic test comes first. J Genet Couns 2021; 30:634-644. [PMID: 33786929 DOI: 10.1002/jgc4.1386] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/18/2020] [Accepted: 12/31/2020] [Indexed: 01/06/2023]
Abstract
Emerging genetic testing delivery models have enabled individuals to receive testing without a medical indication. This article will highlight key considerations for patient care in the setting of adult patients with positive results for monogenic disease identified through genomic screening. Suggestions for how to adapt genetic counseling to a genomic screening population will encompass topics such as phenotyping, risk assessments, and the use of existing guidelines and resources. Case examples will demonstrate principles of genotype-first patient care.
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Affiliation(s)
| | | | | | - Christopher M Haggerty
- The Heart Institute, Geisinger, Danville, PA, USA.,Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
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23
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Carruth ED, Beer D, Alsaid A, Schwartz MLB, McMinn M, Kelly MA, Buchanan AH, Nevius CD, Calkins H, James CA, Murray B, Tichnell C, Matsumura ME, Kirchner HL, Fornwalt BK, Sturm AC, Haggerty CM. Clinical Findings and Diagnostic Yield of Arrhythmogenic Cardiomyopathy Through Genomic Screening of Pathogenic or Likely Pathogenic Desmosome Gene Variants. Circ Genom Precis Med 2021; 14:e003302. [PMID: 33684294 DOI: 10.1161/circgen.120.003302] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genomic screening holds great promise for presymptomatic identification of hidden disease, and prevention of dramatic events, including sudden cardiac death associated with arrhythmogenic cardiomyopathy (ACM). Herein, we present findings from clinical follow-up of carriers of ACM-associated pathogenic/likely pathogenic desmosome variants ascertained through genomic screening. METHODS Of 64 548 eligible participants in Geisinger MyCode Genomic Screening and Counseling program (2015-present), 92 individuals (0.14%) identified with pathogenic/likely pathogenic desmosome variants by clinical laboratory testing were referred for evaluation. We reviewed preresult medical history, patient-reported family history, and diagnostic testing results to assess both arrhythmogenic right ventricular cardiomyopathy and left-dominant ACM. RESULTS One carrier had a prior diagnosis of dilated cardiomyopathy with arrhythmia; no other related diagnoses or diagnostic family history criteria were reported. Fifty-nine carriers (64%) had diagnostic testing in follow-up. Excluding the variant, 21/59 carriers satisfied at least one arrhythmogenic right ventricular cardiomyopathy task force criterion, 11 (52%) of whom harbored DSP variants, but only 5 exhibited multiple criteria. Six (10%) carriers demonstrated evidence of left-dominant ACM, including high rates of atypical late gadolinium enhancement by magnetic resonance imaging and nonsustained ventricular tachycardia. Two individuals received new cardiomyopathy diagnoses and received defibrillators for primary prevention. CONCLUSIONS Genomic screening for pathogenic/likely pathogenic variants in desmosome genes can uncover both left- and right-dominant ACM. Findings of overt cardiomyopathy were limited but were most common in DSP-variant carriers and notably absent in PKP2-variant carriers. Consideration of the pathogenic/likely pathogenic variant as a major criterion for diagnosis is inappropriate in the setting of genomic screening.
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Affiliation(s)
- Eric D Carruth
- Department of Translational Data Science and Informatics (E.D.C., C.D.N., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Dominik Beer
- The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA
| | - Amro Alsaid
- The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA
| | - Marci L B Schwartz
- Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Megan McMinn
- Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Melissa A Kelly
- Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Adam H Buchanan
- Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Christopher D Nevius
- Department of Translational Data Science and Informatics (E.D.C., C.D.N., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Center, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Center, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Center, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Center, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Martin E Matsumura
- The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA
| | - H Lester Kirchner
- Department of Population Health Sciences (H.L.K.), Geisinger, Danville, PA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics (E.D.C., C.D.N., B.K.F., C.M.H.), Geisinger, Danville, PA.,The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA.,Department of Radiology (B.K.F.), Geisinger, Danville, PA
| | - Amy C Sturm
- The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA.,Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics (E.D.C., C.D.N., B.K.F., C.M.H.), Geisinger, Danville, PA.,The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA
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24
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Raghunath S, Pfeifer JM, Ulloa-Cerna AE, Nemani A, Carbonati T, Jing L, vanMaanen DP, Hartzel DN, Ruhl JA, Lagerman BF, Rocha DB, Stoudt NJ, Schneider G, Johnson KW, Zimmerman N, Leader JB, Kirchner HL, Griessenauer CJ, Hafez A, Good CW, Fornwalt BK, Haggerty CM. Deep Neural Networks Can Predict New-Onset Atrial Fibrillation From the 12-Lead ECG and Help Identify Those at Risk of Atrial Fibrillation-Related Stroke. Circulation 2021; 143:1287-1298. [PMID: 33588584 PMCID: PMC7996054 DOI: 10.1161/circulationaha.120.047829] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Atrial fibrillation (AF) is associated with substantial morbidity, especially when it goes undetected. If new-onset AF could be predicted, targeted screening could be used to find it early. We hypothesized that a deep neural network could predict new-onset AF from the resting 12-lead ECG and that this prediction may help identify those at risk of AF-related stroke.
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Affiliation(s)
- Sushravya Raghunath
- Department of Translational Data Science and Informatics (S.R., A.E.U.-C., L.J., D.P.v.M, J.A.R., N.J.S., G.S., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - John M Pfeifer
- Heart and Vascular Center, Evangelical Hospital, Lewisburg, PA (J.M.P.)
| | - Alvaro E Ulloa-Cerna
- Department of Translational Data Science and Informatics (S.R., A.E.U.-C., L.J., D.P.v.M, J.A.R., N.J.S., G.S., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Arun Nemani
- Tempus Labs Inc, Chicago, IL (A.N., T.C., K.W.J., N.Z., A.H.)
| | | | - Linyuan Jing
- Department of Translational Data Science and Informatics (S.R., A.E.U.-C., L.J., D.P.v.M, J.A.R., N.J.S., G.S., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - David P vanMaanen
- Department of Translational Data Science and Informatics (S.R., A.E.U.-C., L.J., D.P.v.M, J.A.R., N.J.S., G.S., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Dustin N Hartzel
- Phenomic Analytics and Clinical Data Core (D.N.H., B.F.L., D.B.R., J.B.L.), Geisinger, Danville, PA
| | - Jeffery A Ruhl
- Department of Translational Data Science and Informatics (S.R., A.E.U.-C., L.J., D.P.v.M, J.A.R., N.J.S., G.S., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Braxton F Lagerman
- Phenomic Analytics and Clinical Data Core (D.N.H., B.F.L., D.B.R., J.B.L.), Geisinger, Danville, PA
| | - Daniel B Rocha
- Phenomic Analytics and Clinical Data Core (D.N.H., B.F.L., D.B.R., J.B.L.), Geisinger, Danville, PA
| | - Nathan J Stoudt
- Department of Translational Data Science and Informatics (S.R., A.E.U.-C., L.J., D.P.v.M, J.A.R., N.J.S., G.S., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Gargi Schneider
- Department of Translational Data Science and Informatics (S.R., A.E.U.-C., L.J., D.P.v.M, J.A.R., N.J.S., G.S., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Kipp W Johnson
- Tempus Labs Inc, Chicago, IL (A.N., T.C., K.W.J., N.Z., A.H.)
| | - Noah Zimmerman
- Tempus Labs Inc, Chicago, IL (A.N., T.C., K.W.J., N.Z., A.H.)
| | - Joseph B Leader
- Phenomic Analytics and Clinical Data Core (D.N.H., B.F.L., D.B.R., J.B.L.), Geisinger, Danville, PA
| | - H Lester Kirchner
- Department of Population Health Sciences (H.L.K.), Geisinger, Danville, PA
| | - Christoph J Griessenauer
- Department of Vascular and Endovascular Neurosurgery (C.J.G.), Geisinger, Danville, PA.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria (C.J.G.)
| | - Ashraf Hafez
- Tempus Labs Inc, Chicago, IL (A.N., T.C., K.W.J., N.Z., A.H.)
| | - Christopher W Good
- Heart Institute (C.W.G., B.K.F., C.M.H.), Geisinger, Danville, PA.,Heart and Vascular Institute at University of Pittsburgh Medical Center Hamot, Erie, PA (C.W.G.)
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics (S.R., A.E.U.-C., L.J., D.P.v.M, J.A.R., N.J.S., G.S., B.K.F., C.M.H.), Geisinger, Danville, PA.,Heart Institute (C.W.G., B.K.F., C.M.H.), Geisinger, Danville, PA.,Department of Radiology (B.K.F.), Geisinger, Danville, PA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics (S.R., A.E.U.-C., L.J., D.P.v.M, J.A.R., N.J.S., G.S., B.K.F., C.M.H.), Geisinger, Danville, PA.,Heart Institute (C.W.G., B.K.F., C.M.H.), Geisinger, Danville, PA
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25
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Jing L, Haggerty CM, Fornwalt BK. Reply: The Competitive Advantage of Adaptability in the Approach to Heart Failure Populations. JACC Heart Fail 2020; 8:877-878. [PMID: 33004121 DOI: 10.1016/j.jchf.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 06/11/2023]
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26
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Jing L, Ulloa Cerna AE, Good CW, Sauers NM, Schneider G, Hartzel DN, Leader JB, Kirchner HL, Hu Y, Riviello DM, Stough JV, Gazes S, Haggerty A, Raghunath S, Carry BJ, Haggerty CM, Fornwalt BK. A Machine Learning Approach to Management of Heart Failure Populations. JACC Heart Fail 2020; 8:578-587. [PMID: 32387064 DOI: 10.1016/j.jchf.2020.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Heart failure is a prevalent, costly disease for which new value-based payment models demand optimized population management strategies. OBJECTIVES This study sought to generate a strategy for managing populations of patients with heart failure by leveraging large clinical datasets and machine learning. METHODS Geisinger electronic health record data were used to train machine learning models to predict 1-year all-cause mortality in 26,971 patients with heart failure who underwent 276,819 clinical episodes. There were 26 clinical variables (demographics, laboratory test results, medications), 90 diagnostic codes, 41 electrocardiogram measurements and patterns, 44 echocardiographic measurements, and 8 evidence-based "care gaps": flu vaccine, blood pressure of <130/80 mm Hg, A1c of <8%, cardiac resynchronization therapy, and active medications (active angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker/angiotensin receptor-neprilysin inhibitor, aldosterone receptor antagonist, hydralazine, and evidence-based beta-blocker) were collected. Care gaps represented actionable variables for which associations with all-cause mortality were modeled from retrospective data and then used to predict the benefit of prospective interventions in 13,238 currently living patients. RESULTS Machine learning models achieved areas under the receiver-operating characteristic curve (AUCs) of 0.74 to 0.77 in a split-by-year training/test scheme, with the nonlinear XGBoost model (AUC: 0.77) outperforming linear logistic regression (AUC: 0.74). Out of 13,238 currently living patients, 2,844 were predicted to die within a year, and closing all care gaps was predicted to save 231 of these lives. Prioritizing patients for intervention by using the predicted reduction in 1-year mortality risk outperformed all other priority rankings (e.g., random selection or Seattle Heart Failure risk score). CONCLUSIONS Machine learning can be used to priority-rank patients most likely to benefit from interventions to optimize evidence-based therapies. This approach may prove useful for optimizing heart failure population health management teams within value-based payment models.
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Affiliation(s)
- Linyuan Jing
- Department of Translational Data Science and Informatics, Geisinger, Danville, Pennsylvania
| | - Alvaro E Ulloa Cerna
- Department of Translational Data Science and Informatics, Geisinger, Danville, Pennsylvania
| | | | - Nathan M Sauers
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, Pennsylvania
| | | | - Dustin N Hartzel
- Phenomic Analytics and Clinical Data Core, Geisinger, Danville, Pennsylvania
| | - Joseph B Leader
- Phenomic Analytics and Clinical Data Core, Geisinger, Danville, Pennsylvania
| | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | - David M Riviello
- Steele Institute for Health Innovation, Geisinger, Danville, Pennsylvania
| | - Joshua V Stough
- Department of Translational Data Science and Informatics, Geisinger, Danville, Pennsylvania; Department of Computer Science, Bucknell University, Lewisburg, Pennsylvania
| | - Seth Gazes
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, Pennsylvania
| | - Allyson Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, Pennsylvania
| | - Sushravya Raghunath
- Department of Translational Data Science and Informatics, Geisinger, Danville, Pennsylvania
| | | | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, Pennsylvania; Heart Institute, Geisinger, Danville, Pennsylvania
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics, Geisinger, Danville, Pennsylvania; Heart Institute, Geisinger, Danville, Pennsylvania; Department of Radiology, Geisinger, Danville, Pennsylvania.
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27
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Shah S, Henry A, Roselli C, Lin H, Sveinbjörnsson G, Fatemifar G, Hedman ÅK, Wilk JB, Morley MP, Chaffin MD, Helgadottir A, Verweij N, Dehghan A, Almgren P, Andersson C, Aragam KG, Ärnlöv J, Backman JD, Biggs ML, Bloom HL, Brandimarto J, Brown MR, Buckbinder L, Carey DJ, Chasman DI, Chen X, Chen X, Chung J, Chutkow W, Cook JP, Delgado GE, Denaxas S, Doney AS, Dörr M, Dudley SC, Dunn ME, Engström G, Esko T, Felix SB, Finan C, Ford I, Ghanbari M, Ghasemi S, Giedraitis V, Giulianini F, Gottdiener JS, Gross S, Guðbjartsson DF, Gutmann R, Haggerty CM, van der Harst P, Hyde CL, Ingelsson E, Jukema JW, Kavousi M, Khaw KT, Kleber ME, Køber L, Koekemoer A, Langenberg C, Lind L, Lindgren CM, London B, Lotta LA, Lovering RC, Luan J, Magnusson P, Mahajan A, Margulies KB, März W, Melander O, Mordi IR, Morgan T, Morris AD, Morris AP, Morrison AC, Nagle MW, Nelson CP, Niessner A, Niiranen T, O'Donoghue ML, Owens AT, Palmer CNA, Parry HM, Perola M, Portilla-Fernandez E, Psaty BM, Rice KM, Ridker PM, Romaine SPR, Rotter JI, Salo P, Salomaa V, van Setten J, Shalaby AA, Smelser DT, Smith NL, Stender S, Stott DJ, Svensson P, Tammesoo ML, Taylor KD, Teder-Laving M, Teumer A, Thorgeirsson G, Thorsteinsdottir U, Torp-Pedersen C, Trompet S, Tyl B, Uitterlinden AG, Veluchamy A, Völker U, Voors AA, Wang X, Wareham NJ, Waterworth D, Weeke PE, Weiss R, Wiggins KL, Xing H, Yerges-Armstrong LM, Yu B, Zannad F, Zhao JH, Hemingway H, Samani NJ, McMurray JJV, Yang J, Visscher PM, Newton-Cheh C, Malarstig A, Holm H, Lubitz SA, Sattar N, Holmes MV, Cappola TP, Asselbergs FW, Hingorani AD, Kuchenbaecker K, Ellinor PT, Lang CC, Stefansson K, Smith JG, Vasan RS, Swerdlow DI, Lumbers RT. Genome-wide association and Mendelian randomisation analysis provide insights into the pathogenesis of heart failure. Nat Commun 2020; 11:163. [PMID: 31919418 PMCID: PMC6952380 DOI: 10.1038/s41467-019-13690-5] [Citation(s) in RCA: 360] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022] Open
Abstract
Heart failure (HF) is a leading cause of morbidity and mortality worldwide. A small proportion of HF cases are attributable to monogenic cardiomyopathies and existing genome-wide association studies (GWAS) have yielded only limited insights, leaving the observed heritability of HF largely unexplained. We report results from a GWAS meta-analysis of HF comprising 47,309 cases and 930,014 controls. Twelve independent variants at 11 genomic loci are associated with HF, all of which demonstrate one or more associations with coronary artery disease (CAD), atrial fibrillation, or reduced left ventricular function, suggesting shared genetic aetiology. Functional analysis of non-CAD-associated loci implicate genes involved in cardiac development (MYOZ1, SYNPO2L), protein homoeostasis (BAG3), and cellular senescence (CDKN1A). Mendelian randomisation analysis supports causal roles for several HF risk factors, and demonstrates CAD-independent effects for atrial fibrillation, body mass index, and hypertension. These findings extend our knowledge of the pathways underlying HF and may inform new therapeutic strategies.
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Affiliation(s)
- Sonia Shah
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, 4072, Australia
- Institute of Cardiovascular Science, University College London, London, UK
- British Heart Foundation Research Accelerator, University College London, London, UK
| | - Albert Henry
- Institute of Cardiovascular Science, University College London, London, UK
- British Heart Foundation Research Accelerator, University College London, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Carolina Roselli
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Honghuang Lin
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA
| | | | - Ghazaleh Fatemifar
- British Heart Foundation Research Accelerator, University College London, London, UK
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK London, University College London, London, UK
| | - Åsa K Hedman
- Cardiovascular Medicine unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Jemma B Wilk
- Pfizer Worldwide Research & Development, 1 Portland St, Cambridge, MA, USA
| | - Michael P Morley
- Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark D Chaffin
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Anna Helgadottir
- deCODE genetics/Amgen Inc., Sturlugata 8, 101, Reykjavik, Iceland
| | - Niek Verweij
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Abbas Dehghan
- Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, London, W2 1PG, UK
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, London, W2 1PG, UK
| | - Peter Almgren
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Charlotte Andersson
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA
- Department of Cardiology, Herlev Gentofte Hospital, Herlev Ringvej 57, 2650, Herlev, Denmark
| | - Krishna G Aragam
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Johan Ärnlöv
- Department of Neurobiology, Care Sciences and Society/ Section of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
- School of Health and Social Sciences, Dalarna University, Falun, Sweden
| | - Joshua D Backman
- Regeneron Genetics Center, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Mary L Biggs
- Department of Biostatistics, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Heather L Bloom
- Division of Cardiology, Department of Medicine, Emory University Medical Center, Atlanta, GA, USA
| | - Jeffrey Brandimarto
- Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael R Brown
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA
| | - Leonard Buckbinder
- Pfizer Worldwide Research & Development, 1 Portland St, Cambridge, MA, USA
| | - David J Carey
- Department of Molecular and Functional Genomics, Geisinger, Danville, PA, USA
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Xing Chen
- Pfizer Worldwide Research & Development, 1 Portland St, Cambridge, MA, USA
| | - Xu Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonathan Chung
- Regeneron Genetics Center, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - William Chutkow
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - James P Cook
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Graciela E Delgado
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Spiros Denaxas
- British Heart Foundation Research Accelerator, University College London, London, UK
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK London, University College London, London, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
- The Alan Turing Institute, London, United Kingdom
| | - Alexander S Doney
- Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Samuel C Dudley
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Michael E Dunn
- Regeneron Pharmaceuticals, Cardiovascular Research, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Tõnu Esko
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, 51010, Estonia
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Chris Finan
- Institute of Cardiovascular Science, University College London, London, UK
- British Heart Foundation Research Accelerator, University College London, London, UK
| | - Ian Ford
- Robertson Center for Biostatistics, University of Glasgow, Glasgow, UK
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sahar Ghasemi
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, 75185, Sweden
| | - Franco Giulianini
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, 02215, USA
| | - John S Gottdiener
- Department of Medicine, Division of Cardiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stefan Gross
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Daníel F Guðbjartsson
- deCODE genetics/Amgen Inc., Sturlugata 8, 101, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, 101, Reykjavik, Iceland
| | - Rebecca Gutmann
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | | | - Pim van der Harst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
| | - Craig L Hyde
- Pfizer Worldwide Research & Development, 1 Portland St, Cambridge, MA, USA
| | - Erik Ingelsson
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, 94305, USA
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, 94305, USA
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, LUMC, Leiden, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Marcus E Kleber
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andrea Koekemoer
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Cecilia M Lindgren
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Barry London
- Division of Cardiovascular Medicine and Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA, USA
| | - Luca A Lotta
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Ruth C Lovering
- Institute of Cardiovascular Science, University College London, London, UK
- British Heart Foundation Research Accelerator, University College London, London, UK
| | - Jian'an Luan
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Patrik Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anubha Mahajan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Kenneth B Margulies
- Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Winfried März
- Department of Biostatistics, University of Liverpool, Liverpool, UK
- Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Olle Melander
- Department of Internal Medicine, Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Ify R Mordi
- Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Thomas Morgan
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Andrew D Morris
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew P Morris
- Department of Biostatistics, University of Liverpool, Liverpool, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Alanna C Morrison
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA
| | - Michael W Nagle
- Pfizer Worldwide Research & Development, 1 Portland St, Cambridge, MA, USA
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Teemu Niiranen
- National Institute for Health and Welfare, Helsinki, Finland
- Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Michelle L O'Donoghue
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Anjali T Owens
- Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Colin N A Palmer
- Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Helen M Parry
- Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki, Finland
| | - Eliana Portilla-Fernandez
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bruce M Psaty
- Department of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Kenneth M Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Simon P R Romaine
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Perttu Salo
- National Institute for Health and Welfare, Helsinki, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jessica van Setten
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Alaa A Shalaby
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center and VA Pittsburgh HCS, Pittsburgh, PA, USA
| | - Diane T Smelser
- Department of Molecular and Functional Genomics, Geisinger, Danville, PA, USA
| | - Nicholas L Smith
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research & Development, Seattle, WA, USA
| | - Steen Stender
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte, København, Denmark
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Per Svensson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Mari-Liis Tammesoo
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, 51010, Estonia
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences, LABiomed and Departments of Pediatrics at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Maris Teder-Laving
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, 51010, Estonia
| | - Alexander Teumer
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Guðmundur Thorgeirsson
- deCODE genetics/Amgen Inc., Sturlugata 8, 101, Reykjavik, Iceland
- Division of Cardiology, Department of Internal Medicine, Landspitali, National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland
| | - Unnur Thorsteinsdottir
- deCODE genetics/Amgen Inc., Sturlugata 8, 101, Reykjavik, Iceland
- Faculty of Medicine, Department of Medicine, University of Iceland, Saemundargata 2, 101, Reykjavik, Iceland
| | - Christian Torp-Pedersen
- Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- Department of Health, Science and Technology, Aalborg University Hospital, Aalborg, Denmark
- Departments of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Benoit Tyl
- Translational and Clinical Research, Servier Cardiovascular Center for Therapeutic Innovation, 50 rue Carnot, 92284, Suresnes, France
| | - Andre G Uitterlinden
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Abirami Veluchamy
- Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Uwe Völker
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Adriaan A Voors
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Xiaosong Wang
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | | | - Peter E Weeke
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Raul Weiss
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA
| | - Kerri L Wiggins
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Heming Xing
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | - Bing Yu
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA
| | - Faiez Zannad
- Université de Lorraine, CHU de Nancy, Inserm and INI-CRCT (F-CRIN), Institut Lorrain du Coeur et des Vaisseaux, 54500, Vandoeuvre Lès, Nancy, France
| | - Jing Hua Zhao
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Harry Hemingway
- British Heart Foundation Research Accelerator, University College London, London, UK
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK London, University College London, London, UK
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Jian Yang
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, 4072, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Peter M Visscher
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, 4072, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Christopher Newton-Cheh
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - Anders Malarstig
- Cardiovascular Medicine unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Pfizer Worldwide Research & Development, 1 Portland St, Cambridge, MA, USA
| | - Hilma Holm
- deCODE genetics/Amgen Inc., Sturlugata 8, 101, Reykjavik, Iceland
| | - Steven A Lubitz
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Naveed Sattar
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Michael V Holmes
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, UK
| | - Thomas P Cappola
- Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Folkert W Asselbergs
- Institute of Cardiovascular Science, University College London, London, UK
- British Heart Foundation Research Accelerator, University College London, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, University College London, London, UK
- British Heart Foundation Research Accelerator, University College London, London, UK
| | - Karoline Kuchenbaecker
- Division of Psychiatry, University College of London, London, W1T 7NF, UK
- UCL Genetics Institute, University College London, London, WC1E 6BT, UK
| | - Patrick T Ellinor
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Chim C Lang
- Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Kari Stefansson
- deCODE genetics/Amgen Inc., Sturlugata 8, 101, Reykjavik, Iceland
- Faculty of Medicine, Department of Medicine, University of Iceland, Saemundargata 2, 101, Reykjavik, Iceland
| | - J Gustav Smith
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA
- Sections of Cardiology, Preventive Medicine and Epidemiology, Department of Medicine, Boston University Schools of Medicine and Public Health, Boston, MA, USA
| | - Daniel I Swerdlow
- Institute of Cardiovascular Science, University College London, London, UK
| | - R Thomas Lumbers
- British Heart Foundation Research Accelerator, University College London, London, UK.
- Institute of Health Informatics, University College London, London, UK.
- Health Data Research UK London, University College London, London, UK.
- Bart's Heart Centre, St. Bartholomew's Hospital, London, UK.
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Raghunath S, Ulloa Cerna AE, Jing L, van Maanen DP, Hartzel DN, Good CW, Patel AA, Delisle BP, Haggerty CM, Fornwalt BK. Deep neural networks can predict one-year mortality and incident atrial fibrillation from raw 12-lead electrocardiogram voltage data. J Electrocardiol 2019. [DOI: 10.1016/j.jelectrocard.2019.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carruth ED, Young W, Beer D, James CA, Calkins H, Jing L, Raghunath S, Hartzel DN, Leader JB, Kirchner HL, Smelser DT, Carey DJ, Kelly MA, Sturm AC, Alsaid A, Fornwalt BK, Haggerty CM. Prevalence and Electronic Health Record-Based Phenotype of Loss-of-Function Genetic Variants in Arrhythmogenic Right Ventricular Cardiomyopathy-Associated Genes. Circ Genom Precis Med 2019; 12:e002579. [PMID: 31638835 DOI: 10.1161/circgen.119.002579] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with variants in desmosome genes. Secondary findings of pathogenic/likely pathogenic variants, primarily loss-of-function (LOF) variants, are recommended for clinical reporting; however, their prevalence and associated phenotype in a general clinical population are not fully characterized. METHODS From whole-exome sequencing of 61 019 individuals in the DiscovEHR cohort, we screened for putative loss-of-function variants in PKP2, DSC2, DSG2, and DSP. We evaluated measures from prior clinical ECG and echocardiograms, manually over-read to evaluate ARVC diagnostic criteria, and performed a PheWAS (phenome-wide association study). Finally, we estimated expected penetrance using Bayesian inference. RESULTS One hundred forty individuals (0.23%; 59±18 years old at last encounter; 33% male) had an ARVC variant (G+). None had an existing diagnosis of ARVC in the electronic health record, nor significant differences in prior ECG or echocardiogram findings compared with matched controls without variants. Several G+ individuals satisfied major repolarization (n=4) and ventricular function (n=5) criteria, but this prevalence matched controls. PheWAS showed no significant associations of other heart disease diagnoses. Combining our best genetic and disease prevalence estimates yields an estimated penetrance of 6.0%. CONCLUSIONS The prevalence of ARVC loss-of-function variants is ≈1:435 in a general clinical population of predominantly European descent, but with limited electronic health record-based evidence of phenotypic association in our population, consistent with a low penetrance estimate. Prospective deep phenotyping and longitudinal follow-up of a large sequenced cohort is needed to determine the true clinical relevance of an incidentally identified ARVC loss-of-function variant.
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Affiliation(s)
- Eric D Carruth
- Department of Imaging Science and Innovation (E.D.C., L.J., S.R., B.K.F., C.M.H.), Geisinger, Danville, PA.,Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Wilson Young
- The Heart Institute (W.Y., D.B., A.A., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Dominik Beer
- The Heart Institute (W.Y., D.B., A.A., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Cynthia A James
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Center, Baltimore, MD (C.A.J., H.C.)
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Center, Baltimore, MD (C.A.J., H.C.)
| | - Linyuan Jing
- Department of Imaging Science and Innovation (E.D.C., L.J., S.R., B.K.F., C.M.H.), Geisinger, Danville, PA.,Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Sushravya Raghunath
- Department of Imaging Science and Innovation (E.D.C., L.J., S.R., B.K.F., C.M.H.), Geisinger, Danville, PA.,Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Dustin N Hartzel
- Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Joseph B Leader
- Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - H Lester Kirchner
- Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Diane T Smelser
- Department of Molecular and Functional Genomics (D.T.S., D.J.C.), Geisinger, Danville, PA
| | - David J Carey
- Department of Molecular and Functional Genomics (D.T.S., D.J.C.), Geisinger, Danville, PA
| | - Melissa A Kelly
- Genomic Medicine Institute (M.A.K., A.C.S.), Geisinger, Danville, PA
| | - Amy C Sturm
- Genomic Medicine Institute (M.A.K., A.C.S.), Geisinger, Danville, PA
| | - Amro Alsaid
- The Heart Institute (W.Y., D.B., A.A., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Brandon K Fornwalt
- Department of Imaging Science and Innovation (E.D.C., L.J., S.R., B.K.F., C.M.H.), Geisinger, Danville, PA.,Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA.,The Heart Institute (W.Y., D.B., A.A., B.K.F., C.M.H.), Geisinger, Danville, PA.,Department of Radiology (B.K.F.), Geisinger, Danville, PA
| | - Christopher M Haggerty
- Department of Imaging Science and Innovation (E.D.C., L.J., S.R., B.K.F., C.M.H.), Geisinger, Danville, PA.,Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA.,The Heart Institute (W.Y., D.B., A.A., B.K.F., C.M.H.), Geisinger, Danville, PA
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30
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Haggerty CM, Murray B, Tichnell C, Judge DP, Tandri H, Schwartz M, Sturm AC, Matsumura ME, Murray MF, Calkins H, Fornwalt BK, James CA. Managing Secondary Genomic Findings Associated With Arrhythmogenic Right Ventricular Cardiomyopathy: Case Studies and Proposal for Clinical Surveillance. Circ Genom Precis Med 2019; 11:e002237. [PMID: 29997227 DOI: 10.1161/circgen.118.002237] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | - Brittney Murray
- Geisinger, Danville, PA (C.M.H., M.S., A.C.S., M.E.M., M.F.M., B.K.F.).,Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| | - Crystal Tichnell
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| | - Daniel P Judge
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.).,Medical University of South Carolina, Charleston, SC (D.P.J.)
| | - Harikrishna Tandri
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| | - Marci Schwartz
- Geisinger, Danville, PA (C.M.H., M.S., A.C.S., M.E.M., M.F.M., B.K.F.)
| | - Amy C Sturm
- Geisinger, Danville, PA (C.M.H., M.S., A.C.S., M.E.M., M.F.M., B.K.F.)
| | | | - Michael F Murray
- Geisinger, Danville, PA (C.M.H., M.S., A.C.S., M.E.M., M.F.M., B.K.F.).,Yale School of Medicine, New Haven, CT (M.F.M.)
| | - Hugh Calkins
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| | | | - Cynthia A James
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
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31
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Park J, Levin MG, Haggerty CM, Hartzel DN, Judy R, Kember RL, Reza N, Ritchie MD, Owens AT, Damrauer SM, Rader DJ. A genome-first approach to aggregating rare genetic variants in LMNA for association with electronic health record phenotypes. Genet Med 2019; 22:102-111. [PMID: 31383942 DOI: 10.1038/s41436-019-0625-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/18/2019] [Indexed: 01/21/2023] Open
Abstract
PURPOSE "Genome-first" approaches, in which genetic sequencing is agnostically linked to associated phenotypes, can enhance our understanding of rare variants' contributions to disease. Loss-of-function variants in LMNA cause a range of rare diseases, including cardiomyopathy. METHODS We leveraged exome sequencing from 11,451 unselected individuals in the Penn Medicine Biobank to associate rare variants in LMNA with diverse electronic health record (EHR)-derived phenotypes. We used Rare Exome Variant Ensemble Learner (REVEL) to annotate rare missense variants, clustered predicted deleterious and loss-of-function variants into a "gene burden" (N = 72 individuals), and performed a phenome-wide association study (PheWAS). Major findings were replicated in DiscovEHR. RESULTS The LMNA gene burden was significantly associated with primary cardiomyopathy (p = 1.78E-11) and cardiac conduction disorders (p = 5.27E-07). Most patients had not been clinically diagnosed with LMNA cardiomyopathy. We also noted an association with chronic kidney disease (p = 1.13E-06). Regression analyses on echocardiography and serum labs revealed that LMNA variant carriers had dilated cardiomyopathy and primary renal disease. CONCLUSION Pathogenic LMNA variants are an underdiagnosed cause of cardiomyopathy. We also find that LMNA loss of function may be a primary cause of renal disease. Finally, we show the value of aggregating rare, annotated variants into a gene burden and using PheWAS to identify novel ontologies for pleiotropic human genes.
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Affiliation(s)
- Joseph Park
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael G Levin
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher M Haggerty
- Department of Imaging Science and Innovation and The Heart Institute, Geisinger, Danville, PA, USA.,Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA
| | - Dustin N Hartzel
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA
| | - Renae Judy
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel L Kember
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nosheen Reza
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Marylyn D Ritchie
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anjali T Owens
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott M Damrauer
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Rader
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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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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Choi SH, Lu-Chen W, Roselli C, Lin H, Haggerty CM, Shoemaker MB, Barnard J, Arking DE, Chasman DI, Albert CM, Chaffin M, Tucker NR, Smith JD, Gupta N, Gabriel S, Margolin L, Shea MA, Shaffer CM, Yoneda ZT, Boerwinkle E, Smith NL, Silverman EK, Redline S, Vasan RS, Burchard EG, Gogarten SM, Laurie C, Blackwell TW, Abecasis G, Carey DJ, Fornwalt BK, Smelser DT, Baras A, Dewey FE, Jaquish CE, Papanicolaou GJ, Sotoodehnia N, Van Wagoner DR, Psaty BM, Kathiresan S, Darbar D, Alonso A, Heckbert SR, Chung MK, Roden DM, Benjamin EJ, Murray MF, Lunetta KL, Lubitz SA, Ellinor PT. Association Between Titin Loss-of-Function Variants and Early-Onset Atrial Fibrillation. JAMA 2018; 320:2354-2364. [PMID: 30535219 PMCID: PMC6436530 DOI: 10.1001/jama.2018.18179] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Atrial fibrillation (AF) is the most common arrhythmia affecting 1% of the population. Young individuals with AF have a strong genetic association with the disease, but the mechanisms remain incompletely understood. OBJECTIVE To perform large-scale whole-genome sequencing to identify genetic variants related to AF. DESIGN, SETTING, AND PARTICIPANTS The National Heart, Lung, and Blood Institute's Trans-Omics for Precision Medicine Program includes longitudinal and cohort studies that underwent high-depth whole-genome sequencing between 2014 and 2017 in 18 526 individuals from the United States, Mexico, Puerto Rico, Costa Rica, Barbados, and Samoa. This case-control study included 2781 patients with early-onset AF from 9 studies and identified 4959 controls of European ancestry from the remaining participants. Results were replicated in the UK Biobank (346 546 participants) and the MyCode Study (42 782 participants). EXPOSURES Loss-of-function (LOF) variants in genes at AF loci and common genetic variation across the whole genome. MAIN OUTCOMES AND MEASURES Early-onset AF (defined as AF onset in persons <66 years of age). Due to multiple testing, the significance threshold for the rare variant analysis was P = 4.55 × 10-3. RESULTS Among 2781 participants with early-onset AF (the case group), 72.1% were men, and the mean (SD) age of AF onset was 48.7 (10.2) years. Participants underwent whole-genome sequencing at a mean depth of 37.8 fold and mean genome coverage of 99.1%. At least 1 LOF variant in TTN, the gene encoding the sarcomeric protein titin, was present in 2.1% of case participants compared with 1.1% in control participants (odds ratio [OR], 1.76 [95% CI, 1.04-2.97]). The proportion of individuals with early-onset AF who carried a LOF variant in TTN increased with an earlier age of AF onset (P value for trend, 4.92 × 10-4), and 6.5% of individuals with AF onset prior to age 30 carried a TTN LOF variant (OR, 5.94 [95% CI, 2.64-13.35]; P = 1.65 × 10-5). The association between TTN LOF variants and AF was replicated in an independent study of 1582 patients with early-onset AF (cases) and 41 200 control participants (OR, 2.16 [95% CI, 1.19-3.92]; P = .01). CONCLUSIONS AND RELEVANCE In a case-control study, there was a statistically significant association between an LOF variant in the TTN gene and early-onset AF, with the variant present in a small percentage of participants with early-onset AF (the case group). Further research is necessary to understand whether this is a causal relationship.
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Affiliation(s)
- Seung Hoan Choi
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Weng Lu-Chen
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Carolina Roselli
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Honghuang Lin
- NHLBI and Boston University’s Framingham Heart Study, Framingham, MA, USA
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - M. Benjamin Shoemaker
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John Barnard
- Departments of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Dan E. Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel I. Chasman
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Divisions of Preventive Medicine and Genetics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | - Christine M. Albert
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | - Mark Chaffin
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Nathan R. Tucker
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan D. Smith
- Departments of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Namrata Gupta
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Stacey Gabriel
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lauren Margolin
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Marisa A. Shea
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Christian M. Shaffer
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary T. Yoneda
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nicholas L. Smith
- Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Esteban G. Burchard
- Department of Bioengineering, School of Pharmacy, University of California, San Francisco, CA, USA
| | | | - Cecelia Laurie
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Thomas W. Blackwell
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Gonçalo Abecasis
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - David J. Carey
- Department of Molecular and Functional Genomics, Geisinger, Danville, PA, USA
| | | | - Diane T. Smelser
- Department of Molecular and Functional Genomics, Geisinger, Danville, PA, USA
| | - Aris Baras
- Regeneron Genetics Center, Tarrytown, NY, USA
| | | | - Cashell E. Jaquish
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - George J. Papanicolaou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Bruce M. Psaty
- Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Sekar Kathiresan
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Dawood Darbar
- Division of Cardiology, Department of Medicine, University of Illinois, Chicago, IL, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Susan R. Heckbert
- Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Mina K. Chung
- Departments of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Dan M. Roden
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emelia J. Benjamin
- NHLBI and Boston University’s Framingham Heart Study, Framingham, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Kathryn L. Lunetta
- NHLBI and Boston University’s Framingham Heart Study, Framingham, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Steven A. Lubitz
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick T. Ellinor
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
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Wehner GJ, Jing L, Haggerty CM, Suever JD, Chen J, Hamlet SM, Feindt JA, Dimitri Mojsejenko W, Fogel MA, Fornwalt BK. Comparison of left ventricular strains and torsion derived from feature tracking and DENSE CMR. J Cardiovasc Magn Reson 2018; 20:63. [PMID: 30208894 PMCID: PMC6136226 DOI: 10.1186/s12968-018-0485-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 08/20/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) feature tracking is increasingly used to quantify cardiac mechanics from cine CMR imaging, although validation against reference standard techniques has been limited. Furthermore, studies have suggested that commonly-derived metrics, such as peak global strain (reported in 63% of feature tracking studies), can be quantified using contours from just two frames - end-diastole (ED) and end-systole (ES) - without requiring tracking software. We hypothesized that mechanics derived from feature tracking would not agree with those derived from a reference standard (displacement-encoding with stimulated echoes (DENSE) imaging), and that peak strain from feature tracking would agree with that derived using simple processing of only ED and ES contours. METHODS We retrospectively identified 88 participants with 186 pairs of DENSE and balanced steady state free precession (bSSFP) image slices acquired at the same locations across two institutions. Left ventricular (LV) strains, torsion, and dyssynchrony were quantified from both feature tracking (TomTec Imaging Systems, Circle Cardiovascular Imaging) and DENSE. Contour-based strains from bSSFP images were derived from ED and ES contours. Agreement was assessed with Bland-Altman analyses and coefficients of variation (CoV). All biases are reported in absolute percentage. RESULTS Comparison results were similar for both vendor packages (TomTec and Circle), and thus only TomTec Imaging System data are reported in the abstract for simplicity. Compared to DENSE, mid-ventricular circumferential strain (Ecc) from feature tracking had acceptable agreement (bias: - 0.4%, p = 0.36, CoV: 11%). However, feature tracking significantly overestimated the magnitude of Ecc at the base (bias: - 4.0% absolute, p < 0.001, CoV: 18%) and apex (bias: - 2.4% absolute, p = 0.01, CoV: 15%), underestimated torsion (bias: - 1.4 deg/cm, p < 0.001, CoV: 41%), and overestimated dyssynchrony (bias: 26 ms, p < 0.001, CoV: 76%). Longitudinal strain (Ell) had borderline-acceptable agreement (bias: - 0.2%, p = 0.77, CoV: 19%). Contour-based strains had excellent agreement with feature tracking (biases: - 1.3-0.2%, CoVs: 3-7%). CONCLUSION Compared to DENSE as a reference standard, feature tracking was inaccurate for quantification of apical and basal LV circumferential strains, longitudinal strain, torsion, and dyssynchrony. Feature tracking was only accurate for quantification of mid LV circumferential strain. Moreover, feature tracking is unnecessary for quantification of whole-slice strains (e.g. base, apex), since simplified processing of only ED and ES contours yields very similar results to those derived from feature tracking. Current feature tracking technology therefore has limited utility for quantification of cardiac mechanics.
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Affiliation(s)
- Gregory J. Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Christopher M. Haggerty
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Jonathan D. Suever
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Jing Chen
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
| | - Sean M. Hamlet
- Department of Electrical Engineering, University of Kentucky, Lexington, KY USA
| | - Jared A. Feindt
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
| | | | - Mark A. Fogel
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Brandon K. Fornwalt
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Electrical Engineering, University of Kentucky, Lexington, KY USA
- Department of Radiology, Geisinger, Danville, PA USA
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Wehner GJ, Suever JD, Fielden SW, Powell DK, Hamlet SM, Vandsburger MH, Haggerty CM, Zhong X, Fornwalt BK. Typical readout durations in spiral cine DENSE yield blurred images and underestimate cardiac strains at both 3.0 T and 1.5 T. Magn Reson Imaging 2018; 54:90-100. [PMID: 30099059 DOI: 10.1016/j.mri.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/10/2018] [Accepted: 08/08/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Displacement encoding with stimulated echoes (DENSE) is a phase contrast technique that encodes tissue displacement into phase images, which are typically processed into measures of cardiac function such as strains. For improved signal to noise ratio and spatiotemporal resolution, DENSE is often acquired with a spiral readout using an 11.1 ms readout duration. However, long spiral readout durations are prone to blurring due to common phenomena such as off-resonance and T2* decay, which may alter the resulting quantifications of strain. We hypothesized that longer readout durations would reduce image quality and underestimate cardiac strains at both 3.0 T and 1.5 T and that using short readout durations could overcome these limitations. MATERIAL AND METHODS Computational simulations were performed to investigate the relationship between off-resonance and T2* decay, the spiral cine DENSE readout duration, and measured radial and circumferential strain. Five healthy participants subsequently underwent 2D spiral cine DENSE at both 3.0 T and 1.5 T with several different readout durations 11.1 ms and shorter. Pearson correlations were used to assess the relationship between cardiac strains and the spiral readout duration. RESULTS Simulations demonstrated that long readout durations combined with off-resonance and T2* decay yield blurred images and underestimate strains. With the typical 11.1 ms DENSE readout, blurring was present in the anterior and lateral left ventricular segments of participants and was markedly improved with shorter readout durations. Radial and circumferential strains from those segments were significantly correlated with the readout duration. Compared to the 1.9 ms readout, the 11.1 ms readout underestimated radial and circumferential strains in those segments at both field strengths by up to 19.6% and 1.5% (absolute), or 42% and 7% (relative), respectively. CONCLUSIONS Blurring is present in spiral cine DENSE images acquired at both 3.0 T and 1.5 T using the typical 11.1 ms readout duration, which yielded substantially reduced radial strains and mildly reduced circumferential strains. Clinical studies using spiral cine DENSE should consider these limitations, while future technical advances may need to leverage accelerated techniques to improve the robustness and accuracy of the DENSE acquisition rather than focusing solely on reduced acquisition time.
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Affiliation(s)
- Gregory J Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States.
| | - Jonathan D Suever
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, United States.
| | - Samuel W Fielden
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, United States; Department of Medical & Health Physics, Geisinger, Danville, PA, United States.
| | - David K Powell
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States.
| | - Sean M Hamlet
- Department of Electrical Engineering, University of Kentucky, Lexington, KY, United States.
| | - Moriel H Vandsburger
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States; Department of Physiology, University of Kentucky, Lexington, KY, United States.
| | | | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Atlanta, GA, United States.
| | - Brandon K Fornwalt
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, United States; Department of Radiology, Geisinger, Danville, PA, United States.
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Samad MD, Wehner GJ, Arbabshirani MR, Jing L, Powell AJ, Geva T, Haggerty CM, Fornwalt BK. Predicting deterioration of ventricular function in patients with repaired tetralogy of Fallot using machine learning. Eur Heart J Cardiovasc Imaging 2018; 19:730-738. [PMID: 29538684 PMCID: PMC6012881 DOI: 10.1093/ehjci/jey003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/05/2018] [Indexed: 12/23/2022] Open
Abstract
Aims Previous studies using regression analyses have failed to identify which patients with repaired tetralogy of Fallot (rTOF) are at risk for deterioration in ventricular size and function despite using common clinical and cardiac function parameters as well as cardiac mechanics (strain and dyssynchrony). This study used a machine learning pipeline to comprehensively investigate the predictive value of the baseline variables derived from cardiac magnetic resonance (CMR) imaging and provide models for identifying patients at risk for deterioration. Methods and results Longitudinal deterioration for 153 patients with rTOF was categorized as 'none', 'minor', or 'major' based on changes in ventricular size and ejection fraction between two CMR scans at least 6 months apart (median 2.7 years). Baseline variables were measured at the time of the first CMR. An exhaustive variable search with a support vector machine classifier and five-fold cross-validation was used to predict deterioration and identify the most useful variables. For predicting any deterioration (minor or major) vs. no deterioration, the mean area under the curve (AUC) was 0.82 ± 0.06. For predicting major deterioration vs. minor or no deterioration, the AUC was 0.77 ± 0.07. Baseline left ventricular (LV) ejection fraction, LV circumferential strain, and pulmonary regurgitation were most useful for achieving accurate predictions. Conclusion For the prediction of deterioration in patients with rTOF, a machine learning pipeline uncovered the utility of baseline variables that was previously lost to regression analyses. The predictive models may be useful for planning early interventions in patients with high risk.
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Affiliation(s)
- Manar D Samad
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
| | - Gregory J Wehner
- Department of Biomedical Engineering, University of Kentucky, 522 Robotics and Manufacturing Building, Lexington, 40506-0108 KY, USA
| | - Mohammad R Arbabshirani
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, 02115 MA, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, 02115 MA, USA
| | - Christopher M Haggerty
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
| | - Brandon K Fornwalt
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
- Department of Radiology, Geisinger, 100 North Academy Ave, Danville, 17822 PA, USA
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Samad MD, Ulloa A, Wehner GJ, Jing L, Hartzel D, Good CW, Williams BA, Haggerty CM, Fornwalt BK. Predicting Survival From Large Echocardiography and Electronic Health Record Datasets: Optimization With Machine Learning. JACC Cardiovasc Imaging 2018; 12:681-689. [PMID: 29909114 DOI: 10.1016/j.jcmg.2018.04.026] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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] [Received: 01/22/2018] [Revised: 04/17/2018] [Accepted: 04/26/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES The goal of this study was to use machine learning to more accurately predict survival after echocardiography. BACKGROUND Predicting patient outcomes (e.g., survival) following echocardiography is primarily based on ejection fraction (EF) and comorbidities. However, there may be significant predictive information within additional echocardiography-derived measurements combined with clinical electronic health record data. METHODS Mortality was studied in 171,510 unselected patients who underwent 331,317 echocardiograms in a large regional health system. The authors investigated the predictive performance of nonlinear machine learning models compared with that of linear logistic regression models using 3 different inputs: 1) clinical variables, including 90 cardiovascular-relevant International Classification of Diseases, Tenth Revision, codes, and age, sex, height, weight, heart rate, blood pressures, low-density lipoprotein, high-density lipoprotein, and smoking; 2) clinical variables plus physician-reported EF; and 3) clinical variables and EF, plus 57 additional echocardiographic measurements. Missing data were imputed with a multivariate imputation by using a chained equations algorithm (MICE). The authors compared models versus each other and baseline clinical scoring systems by using a mean area under the curve (AUC) over 10 cross-validation folds and across 10 survival durations (6 to 60 months). RESULTS Machine learning models achieved significantly higher prediction accuracy (all AUC >0.82) over common clinical risk scores (AUC = 0.61 to 0.79), with the nonlinear random forest models outperforming logistic regression (p < 0.01). The random forest model including all echocardiographic measurements yielded the highest prediction accuracy (p < 0.01 across all models and survival durations). Only 10 variables were needed to achieve 96% of the maximum prediction accuracy, with 6 of these variables being derived from echocardiography. Tricuspid regurgitation velocity was more predictive of survival than LVEF. In a subset of studies with complete data for the top 10 variables, multivariate imputation by chained equations yielded slightly reduced predictive accuracies (difference in AUC of 0.003) compared with the original data. CONCLUSIONS Machine learning can fully utilize large combinations of disparate input variables to predict survival after echocardiography with superior accuracy.
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Affiliation(s)
- Manar D Samad
- Department of Imaging Science and Innovation, Geisinger, Danville, Pennsylvania
| | - Alvaro Ulloa
- Department of Imaging Science and Innovation, Geisinger, Danville, Pennsylvania
| | - Gregory J Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger, Danville, Pennsylvania
| | - Dustin Hartzel
- Department of Imaging Science and Innovation, Geisinger, Danville, Pennsylvania
| | | | - Brent A Williams
- Department of Epidemiology and Health Services Research, Geisinger, Danville, Pennsylvania
| | | | - Brandon K Fornwalt
- Department of Imaging Science and Innovation, Geisinger, Danville, Pennsylvania; Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky; Department of Radiology, Geisinger, Danville, Pennsylvania.
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Manning JR, Chelvarajan L, Levitan BM, Withers CN, Nagareddy PR, Haggerty CM, Fornwalt BK, Gao E, Tripathi H, Abdel-Latif A, Andres DA, Satin J. Rad GTPase deletion attenuates post-ischemic cardiac dysfunction and remodeling. ACTA ACUST UNITED AC 2018; 3:83-96. [PMID: 29732439 PMCID: PMC5931223 DOI: 10.1016/j.jacbts.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Rad-GTPase is an LTCC component that functions to govern calcium current in the myocardium. Deletion of Rad increases myocardial contractility secondary to increased trigger calcium entry. AMI induces heart failure, including reduced calcium homeostasis, but deletion of Rad prevents AMI myocardial calcium alterations. Rad deletion prevents post-MI scar spread by attenuating the inflammatory response. Future studies will explore whether Rad deletion is an effective therapeutic direction for providing combined safe, stable inotropic support to the failing heart in concert with protection against inflammatory signaling.
The protein Rad interacts with the L-type calcium channel complex to modulate trigger Ca2+ and hence to govern contractility. Reducing Rad levels increases cardiac output. Ablation of Rad also attenuated the inflammatory response following acute myocardial infarction. Future studies to target deletion of Rad in the heart could be conducted to establish a novel treatment paradigm whereby pathologically stressed hearts would be given safe, stable positive inotropic support without arrhythmias and without pathological structural remodeling. Future investigations will also focus on establishing inhibitors of Rad and testing the efficacy of Rad deletion in cardioprotection relative to the time of onset of acute myocardial infarction.
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Affiliation(s)
- Janet R Manning
- Department of Physiology, University of Kentucky, Lexington KY.,Department of Biochemistry, University of Kentucky, Lexington KY
| | - Lakshman Chelvarajan
- Saha Cardiovascular Research Center, Department of Medicine, University of Kentucky, Lexington, KY
| | - Bryana M Levitan
- Department of Physiology, University of Kentucky, Lexington KY.,Gill Heart and Vascular Institute, University of Kentucky, Lexington KY
| | | | | | - Christopher M Haggerty
- Saha Cardiovascular Research Center, Department of Medicine, University of Kentucky, Lexington, KY.,Department of Imaging Science and Innovation, Geisinger, Danville PA
| | - Brandon K Fornwalt
- Saha Cardiovascular Research Center, Department of Medicine, University of Kentucky, Lexington, KY.,Department of Imaging Science and Innovation, Geisinger, Danville PA
| | - Erhe Gao
- Department of Physiology, University of Kentucky, Lexington KY.,Center for Translational Medicine, Temple University School of Medicine, Philadelphia PA
| | - Himi Tripathi
- Saha Cardiovascular Research Center, Department of Medicine, University of Kentucky, Lexington, KY
| | - Ahmed Abdel-Latif
- Saha Cardiovascular Research Center, Department of Medicine, University of Kentucky, Lexington, KY.,Gill Heart and Vascular Institute, University of Kentucky, Lexington KY
| | - Douglas A Andres
- Department of Biochemistry, University of Kentucky, Lexington KY
| | - Jonathan Satin
- Department of Physiology, University of Kentucky, Lexington KY
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Haggerty CM, Suever JD, Pulenthiran A, Mejia-Spiegeler A, Wehner GJ, Jing L, Charnigo RJ, Fornwalt BK, Fogel MA. Association between left ventricular mechanics and diffuse myocardial fibrosis in patients with repaired Tetralogy of Fallot: a cross-sectional study. J Cardiovasc Magn Reson 2017; 19:100. [PMID: 29228952 PMCID: PMC5724335 DOI: 10.1186/s12968-017-0410-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 11/20/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Patients with repaired tetralogy of Fallot (TOF) have progressive, adverse biventricular remodeling, leading to abnormal contractile mechanics. Defining the mechanisms underlying this dysfunction, such as diffuse myocardial fibrosis, may provide insights into poor long-term outcomes. We hypothesized that left ventricular (LV) diffuse fibrosis is related to impaired LV mechanics. METHODS Patients with TOF were evaluated with cardiac magnetic resonance in which modified Look-Locker (MOLLI) T1-mapping and spiral cine Displacement encoding (DENSE) sequences were acquired at three LV short-axis positions. Linear mixed modeling was used to define the association between regional LV mechanics from DENSE based on regional T1-derived diffuse fibrosis measures, such as extracellular volume fraction (ECV). RESULTS Forty patients (26 ± 11 years) were included. LV ECV was generally within normal range (0.24 ± 0.05). For LV mechanics, peak circumferential strains (-15 ± 3%) and dyssynchrony indices (16 ± 8 ms) were moderately impaired, while peak radial strains (29 ± 8%) were generally normal. After adjusting for patient age, sex, and regional LV differences, ECV was associated with log-adjusted LV dyssynchrony index (β = 0.67) and peak LV radial strain (β = -0.36), but not LV circumferential strain. Moreover, post-contrast T1 was associated with log-adjusted LV diastolic circumferential strain rate (β = 0.37). CONCLUSIONS We observed several moderate associations between measures of fibrosis and impaired mechanics, particularly the LV dyssynchrony index and peak radial strain. Diffuse fibrosis may therefore be a causal factor in some ventricular dysfunction in TOF.
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Affiliation(s)
- Christopher M. Haggerty
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Jonathan D. Suever
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Arichanah Pulenthiran
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Abba Mejia-Spiegeler
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Gregory J. Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | | | - Brandon K. Fornwalt
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
- Department of Radiology, Geisinger, Danville, PA USA
| | - Mark A. Fogel
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
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Jing L, Nevius CD, Friday CM, Suever JD, Pulenthiran A, Mejia-Spiegeler A, Kirchner HL, Cochran WJ, Wehner GJ, Chishti AS, Haggerty CM, Fornwalt BK. Ambulatory systolic blood pressure and obesity are independently associated with left ventricular hypertrophic remodeling in children. J Cardiovasc Magn Reson 2017; 19:86. [PMID: 29117866 PMCID: PMC5679494 DOI: 10.1186/s12968-017-0401-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/16/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Children with obesity have hypertrophic cardiac remodeling. Hypertension is common in pediatric obesity, and may independently contribute to hypertrophy. We hypothesized that both the degree of obesity and ambulatory blood pressure (ABP) would independently associate with measures of hypertrophic cardiac remodeling in children. METHODS Children, aged 8-17 years, prospectively underwent cardiovascular magnetic resonance (CMR) and ABP monitoring. Left ventricular (LV) mass indexed to height2.7 (LVMI), myocardial thickness and end-diastolic volume were quantified from a 3D LV model reconstructed from cine balanced steady state free precession images. Categories of remodeling were determined based on cutoff values for LVMI and mass/volume. Principal component analysis was used to define a "hypertrophy score" to study the continuous relationship between concentric hypertrophy and ABP. RESULTS Seventy-two children were recruited, and 68 of those (37 healthy weight and 31 obese/overweight) completed both CMR and ABP monitoring. Obese/overweight children had increased LVMI (27 ± 4 vs 22 ± 3 g/m2.7, p < 0.001), myocardial thickness (5.6 ± 0.9 vs 4.9 ± 0.7 mm, p < 0.001), mass/volume (0.69 ± 0.1 vs 0.61 ± 0.06, p < 0.001), and hypertrophy score (1.1 ± 2.2 vs -0.96 ± 1.1, p < 0.001). Thirty-five percent of obese/overweight children had concentric hypertrophy. Ambulatory hypertension was observed in 26% of the obese/overweight children and none of the controls while masked hypertension was observed in 32% of the obese/overweight children and 16% of the controls. Univariate linear regression showed that BMI z-score, systolic BP (24 h, day and night), and systolic load correlated with LVMI, thickness, mass/volume and hypertrophy score, while 24 h and nighttime diastolic BP and load also correlated with thickness and mass/volume. Multivariate analysis showed body mass index z-score and systolic blood pressure were both independently associated with left ventricular mass index (β=0.54 [p < 0.001] and 0.22 [p = 0.03]), thickness (β=0.34 [p < 0.001] and 0.26 [p = 0.001]) and hypertrophy score (β=0.47 and 0.36, both p < 0.001). CONCLUSIONS In children, both the degree of obesity and ambulatory blood pressures are independently associated with measures of cardiac hypertrophic remodeling, however the correlations were generally stronger for the degree of obesity. This suggests that interventions targeted at weight loss or obesity-associated co-morbidities including hypertension may be effective in reversing or preventing cardiac remodeling in obese children.
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Affiliation(s)
- Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Christopher D. Nevius
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Cassi M. Friday
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Jonathan D. Suever
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Arichanah Pulenthiran
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Abba Mejia-Spiegeler
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - H. Lester Kirchner
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | | | - Gregory J. Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Aftab S. Chishti
- Division of Nephrology, Hypertension and Renal Transplantation, University of Kentucky, Lexington, KY USA
| | - Christopher M. Haggerty
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Brandon K. Fornwalt
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
- Department of Radiology, Geisinger, Danville, PA USA
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Manning JR, Chelvarajan L, Withers CN, Nagareddy PR, Haggerty CM, Fornwalt BK, Tripathi H, Abdel-Latif A, Andres DA, Satin J. Abstract 457: Rad-deletion Provides Dual Therapeutic Benefits for the Heart. Circ Res 2017. [DOI: 10.1161/res.121.suppl_1.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rationale:
Myocardial infarction (MI) compromises the overall mechanical function of the heart, reducing cardiac output and triggering decompensatory remodeling. Rad GTPase is an L-type calcium channel complex (LTCC) constituent that governs trigger calcium in the myocardium. Rad deletion in mice results in increased Ca
2+
handling and a sustained non-pathological improvement in left ventricular function compared to wildtype.
Hypothesis:
Rad-ablation attenuates post-ischemic loss of function, resulting in reduced remodeling and improved long-term contractility.
Methods and Results:
We subjected Rad-deficient (Rad
-/-
) mice to ligation of the left anterior descending (LAD) coronary artery, and monitored cardiac structure and function using echocardiography and single cell Ca
2+
measurements. We found that Rad deletion reduces both mortality and contractile dysfunction after MI, as well as ventricular dilation over five weeks. This improvement is also accompanied by preserved Ca
2+
handling in isolated myocytes. Histological and MRI examination of
ex vivo
global ischemia and
in vivo
24 hour post-MI myocardium revealed that initial infarct size and area at risk are comparable between knockout and wildtype. Rad loss reduced scar spread independent of preserving tissue viability. mRNA microarray findings implicated differential inflammatory pathway activation with Rad-deletion. Rad
-/-
showed reduced neutrophil extravasation and reduced inflammatory cytokines in the left ventricle 24 hours after MI.
Conclusion:
Rad deletion results in reduced cardiac remodeling, diminished myocardial inflammation, and improved contractile function before and after MI. These results suggest that Rad-deletion is a novel therapeutic direction that may serve as a combined positive inotrope and regulator of acute MI inflammatory response.
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Jing L, Pulenthiran A, Nevius CD, Mejia-Spiegeler A, Suever JD, Wehner GJ, Kirchner HL, Haggerty CM, Fornwalt BK. Impaired right ventricular contractile function in childhood obesity and its association with right and left ventricular changes: a cine DENSE cardiac magnetic resonance study. J Cardiovasc Magn Reson 2017; 19:49. [PMID: 28659144 PMCID: PMC5490166 DOI: 10.1186/s12968-017-0363-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/17/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Pediatric obesity is a growing public health problem, which is associated with increased risk of cardiovascular disease and premature death. Left ventricular (LV) remodeling (increased myocardial mass and thickness) and contractile dysfunction (impaired longitudinal strain) have been documented in obese children, but little attention has been paid to the right ventricle (RV). We hypothesized that obese/overweight children would have evidence of RV remodeling and contractile dysfunction. METHODS One hundred and three children, ages 8-18 years, were prospectively recruited and underwent cardiovascular magnetic resonance (CMR), including both standard cine imaging and displacement encoding with stimulated echoes (DENSE) imaging, which allowed for quantification of RV geometry and function/mechanics. RV free wall longitudinal strain was quantified from the end-systolic four-chamber DENSE image. Linear regression was used to quantify correlations of RV strain with LV strain and measurements of body composition (adjusted for sex and height). Analysis of variance was used to study the relationship between RV strain and LV remodeling types (concentric remodeling, eccentric/concentric hypertrophy). RESULTS The RV was sufficiently visualized with DENSE in 70 (68%) subjects, comprising 36 healthy weight (13.6 ± 2.7 years) and 34 (12.1 ± 2.9 years) obese/overweight children. Obese/overweight children had a 22% larger RV mass index (8.2 ± 0.9 vs 6.7 ± 1.1 g/m2.7, p < 0.001) compared to healthy controls. RV free wall longitudinal strain was impaired in obese/overweight children (-16 ± 4% vs -19 ± 5%, p = 0.02). Ten (14%) out of 70 children had LV concentric hypertrophy, and these children had the most impaired RV longitudinal strain compared to those with normal LV geometry (-13 ± 4% vs -19 ± 5%, p = 0.002). RV longitudinal strain was correlated with LV longitudinal strain (r = 0.34, p = 0.004), systolic blood pressure (r = 0.33, p = 0.006), as well as BMI z-score (r = 0.28, p = 0.02), waist (r = 0.31, p = 0.01), hip (r = 0.40, p = 0.004) and abdominal (r = 0.38, p = 0.002) circumference, height and sex adjusted. CONCLUSIONS Obese/overweight children have evidence of RV remodeling (increased RV mass) and RV contractile dysfunction (impaired free wall longitudinal strain). Moreover, RV longitudinal strain correlates with LV longitudinal strain, and children with LV concentric hypertrophy show the most impaired RV function. These results suggest there may be a common mechanism underlying both remodeling and dysfunction of the left and right ventricles in obese/overweight children.
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MESH Headings
- Adolescent
- Child
- Female
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Image Interpretation, Computer-Assisted
- Kentucky
- Linear Models
- Magnetic Resonance Imaging, Cine
- Male
- Myocardial Contraction
- Observer Variation
- Pediatric Obesity/complications
- Pediatric Obesity/diagnosis
- Pediatric Obesity/physiopathology
- Pennsylvania
- Predictive Value of Tests
- Prospective Studies
- Reproducibility of Results
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Ventricular Remodeling
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Affiliation(s)
- Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Arichanah Pulenthiran
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Christopher D. Nevius
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Abba Mejia-Spiegeler
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Jonathan D. Suever
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Gregory J. Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - H. Lester Kirchner
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Christopher M. Haggerty
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Brandon K. Fornwalt
- Department of Imaging Science and Innovation, Geisinger Health System, 100 North Academy Avenue, Danville, 17822-4400 PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
- Department of Radiology, Geisinger Health System, Danville, PA USA
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Haggerty CM, James CA, Calkins H, Tichnell C, Leader JB, Hartzel DN, Nevius CD, Pendergrass SA, Person TN, Schwartz M, Ritchie MD, Carey DJ, Ledbetter DH, Williams MS, Dewey FE, Lopez A, Penn J, Overton JD, Reid JG, Lebo M, Mason-Suares H, Austin-Tse C, Rehm HL, Delisle BP, Makowski DJ, Mehra VC, Murray MF, Fornwalt BK. Electronic health record phenotype in subjects with genetic variants associated with arrhythmogenic right ventricular cardiomyopathy: a study of 30,716 subjects with exome sequencing. Genet Med 2017; 19:1245-1252. [PMID: 28471438 PMCID: PMC5671380 DOI: 10.1038/gim.2017.40] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/03/2017] [Indexed: 01/24/2023] Open
Abstract
Purpose Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart disease. Clinical follow-up of incidental findings in ARVC-associated genes is recommended. We aimed to determine the prevalence of disease thus ascertained. Methods 30,716 individuals underwent exome sequencing. Variants in PKP2, DSG2, DSC2, DSP, JUP, TMEM43, or TGFβ3 that were database-listed as pathogenic or likely pathogenic were identified and evidence-reviewed. For subjects with putative loss-of-function (pLOF) variants or variants of uncertain significance (VUS), electronic health records (EHR) were reviewed for ARVC diagnosis, diagnostic criteria, and International Classification of Diseases (ICD-9) codes. Results 18 subjects had pLOF variants; none had an EHR diagnosis of ARVC. Of 14 patients with an electrocardiogram (ECG), one had a minor diagnostic criterion, 13 were normal. 184 subjects had VUSs; none had an ARVC diagnosis. In subjects with VUSs, there was no difference in the proportion with major (4%) or minor (13%) ECG diagnostic criteria compared to variant-negative controls. ICD-9 codes showed no difference in defibrillator utilization, electrophysiologic abnormalities or non-ischemic cardiomyopathies in patients with pLOF or VUSs compared to controls. Conclusion pLOF variants in an unselected cohort were not associated with ARVC phenotypes based on EHR review. The negative predictive value of EHR review remains uncertain.
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Affiliation(s)
- Christopher M Haggerty
- Department of Imaging Science and Innovation, Geisinger Health System, Danville, Pennsylvania, USA
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joseph B Leader
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Dustin N Hartzel
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Christopher D Nevius
- Department of Imaging Science and Innovation, Geisinger Health System, Danville, Pennsylvania, USA
| | - Sarah A Pendergrass
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Thomas N Person
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Marci Schwartz
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Marylyn D Ritchie
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - David J Carey
- Weis Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA
| | - David H Ledbetter
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Frederick E Dewey
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | - Alexander Lopez
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | - John Penn
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | - John D Overton
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | - Jeffrey G Reid
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | - Matthew Lebo
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Heather Mason-Suares
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christina Austin-Tse
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, Massachusetts, USA
| | - Heidi L Rehm
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian P Delisle
- Department of Physiology, University of Kentucky, Lexington, Kentucky, USA
| | - Daniel J Makowski
- Division of Cardiology, Geisinger Health System, Danville, Pennsylvania, USA
| | - Vishal C Mehra
- Division of Cardiology, Geisinger Health System, Danville, Pennsylvania, USA
| | - Michael F Murray
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Brandon K Fornwalt
- Department of Imaging Science and Innovation, Geisinger Health System, Danville, Pennsylvania, USA
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44
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Suever JD, Wehner GJ, Jing L, Powell DK, Hamlet SM, Grabau JD, Mojsejenko D, Andres KN, Haggerty CM, Fornwalt BK. Right Ventricular Strain, Torsion, and Dyssynchrony in Healthy Subjects Using 3D Spiral Cine DENSE Magnetic Resonance Imaging. IEEE Trans Med Imaging 2017; 36:1076-1085. [PMID: 28055859 PMCID: PMC5711416 DOI: 10.1109/tmi.2016.2646321] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mechanics of the left ventricle (LV) are important indicators of cardiac function. The role of right ventricular (RV) mechanics is largely unknown due to the technical limitations of imaging its thin wall and complex geometry and motion. By combining 3D Displacement Encoding with Stimulated Echoes (DENSE) with a post-processing pipeline that includes a local coordinate system, it is possible to quantify RV strain, torsion, and synchrony. In this study, we sought to characterize RV mechanics in 50 healthy individuals and compare these values to their LV counterparts. For each cardiac frame, 3D displacements were fit to continuous and differentiable radial basis functions, allowing for the computation of the 3D Cartesian Lagrangian strain tensor at any myocardial point. The geometry of the RV was extracted via a surface fit to manually delineated endocardial contours. Throughout the RV, a local coordinate system was used to transform from a Cartesian strain tensor to a polar strain tensor. It was then possible to compute peak RV torsion as well as peak longitudinal and circumferential strain. A comparable analysis was performed for the LV. Dyssynchrony was computed from the standard deviation of regional activation times. Global circumferential strain was comparable between the RV and LV (-18.0% for both) while longitudinal strain was greater in the RV (-18.1% vs. -15.7%). RV torsion was comparable to LV torsion (6.2 vs. 7.1 degrees, respectively). Regional activation times indicated that the RV contracted later but more synchronously than the LV. 3D spiral cine DENSE combined with a post-processing pipeline that includes a local coordinate system can resolve both the complex geometry and 3D motion of the RV.
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45
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Hamlet SM, Haggerty CM, Suever JD, Wehner GJ, Andres KN, Powell DK, Charnigo RJ, Fornwalt BK. Using a respiratory navigator significantly reduces variability when quantifying left ventricular torsion with cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:25. [PMID: 28245864 PMCID: PMC5331707 DOI: 10.1186/s12968-017-0338-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/08/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Left ventricular (LV) torsion is an important indicator of cardiac function that is limited by high inter-test variability (50% of the mean value). We hypothesized that this high inter-test variability is partly due to inconsistent breath-hold positions during serial image acquisitions, which could be significantly improved by using a respiratory navigator for cardiovascular magnetic resonance (CMR) based quantification of LV torsion. METHODS We assessed respiratory-related variability in measured LV torsion with two distinct experimental protocols. First, 17 volunteers were recruited for CMR with cine displacement encoding with stimulated echoes (DENSE) in which a respiratory navigator was used to measure and then enforce variability in end-expiratory position between all LV basal and apical acquisitions. From these data, we quantified the inter-test variability of torsion in the absence and presence of enforced end-expiratory position variability, which established an upper bound for the expected torsion variability. For the second experiment (in 20 new, healthy volunteers), 10 pairs of cine DENSE basal and apical images were each acquired from consecutive breath-holds and consecutive navigator-gated scans (with a single acceptance position). Inter-test variability of torsion was compared between the breath-hold and navigator-gated scans to quantify the variability due to natural breath-hold variation. To demonstrate the importance of these variability reductions, we quantified the reduction in sample size required to detect a clinically meaningful change in LV torsion with the use of a respiratory navigator. RESULTS The mean torsion was 3.4 ± 0.2°/cm. From the first experiment, enforced variability in end-expiratory position translated to considerable variability in measured torsion (0.56 ± 0.34°/cm), whereas inter-test variability with consistent end-expiratory position was 57% lower (0.24 ± 0.16°/cm, p < 0.001). From the second experiment, natural respiratory variability from consecutive breath-holds translated to a variability in torsion of 0.24 ± 0.10°/cm, which was significantly higher than the variability from navigator-gated scans (0.18 ± 0.06°/cm, p = 0.02). By using a respiratory navigator with DENSE, theoretical sample sizes were reduced from 66 to 16 and 26 to 15 as calculated from the two experiments. CONCLUSIONS A substantial portion (22-57%) of the inter-test variability of LV torsion can be reduced by using a respiratory navigator to ensure a consistent breath-hold position between image acquisitions.
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Affiliation(s)
- Sean M. Hamlet
- Department of Electrical and Computer Engineering, University of Kentucky, Lexington, KY USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Christopher M. Haggerty
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Imaging Science and Innovation, Geisinger Health System, Danville, PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Jonathan D. Suever
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Imaging Science and Innovation, Geisinger Health System, Danville, PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Gregory J. Wehner
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | | | - David K. Powell
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Richard J. Charnigo
- Departments of Biostatistics and Statistics, University of Kentucky, Lexington, KY USA
| | - Brandon K. Fornwalt
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Imaging Science and Innovation, Geisinger Health System, Danville, PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
- Departments of Physiology and Medicine, University of Kentucky, Lexington, KY USA
- Department of Radiology, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822-4400 USA
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46
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Haggerty CM, Feindt JA, Mojsejenko D, Wehner GJ, Suever JD, Fogel MA, Fornwalt BK. Differences in left ventricular strain measurements between cine DENSE cardiac magnetic resonance and SSFP feature tracking. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032470 DOI: 10.1186/1532-429x-18-s1-o76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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47
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Suever JD, Wehner GJ, Haggerty CM, Jing L, Powell D, Hamlet SM, Grabau JD, Mojsejenko D, Andres KN, Vandsburger M, Fornwalt BK. Right ventricular strain, torsion and synchrony in healthy subjects using 3D spiral cine DENSE. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032212 DOI: 10.1186/1532-429x-18-s1-o83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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48
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Wei ZA, Trusty PM, Tree M, Haggerty CM, Tang E, Fogel M, Yoganathan AP. Can time-averaged flow boundary conditions be used to meet the clinical timeline for Fontan surgical planning? J Biomech 2016; 50:172-179. [PMID: 27855985 DOI: 10.1016/j.jbiomech.2016.11.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 11/15/2022]
Abstract
Cardiovascular simulations have great potential as a clinical tool for planning and evaluating patient-specific treatment strategies for those suffering from congenital heart diseases, specifically Fontan patients. However, several bottlenecks have delayed wider deployment of the simulations for clinical use; the main obstacle is simulation cost. Currently, time-averaged clinical flow measurements are utilized as numerical boundary conditions (BCs) in order to reduce the computational power and time needed to offer surgical planning within a clinical time frame. Nevertheless, pulsatile blood flow is observed in vivo, and its significant impact on numerical simulations has been demonstrated. Therefore, it is imperative to carry out a comprehensive study analyzing the sensitivity of using time-averaged BCs. In this study, sensitivity is evaluated based on the discrepancies between hemodynamic metrics calculated using time-averaged and pulsatile BCs; smaller discrepancies indicate less sensitivity. The current study incorporates a comparison between 3D patient-specific CFD simulations using both the time-averaged and pulsatile BCs for 101 Fontan patients. The sensitivity analysis involves two clinically important hemodynamic metrics: hepatic flow distribution (HFD) and indexed power loss (iPL). Paired demographic group comparisons revealed that HFD sensitivity is significantly different between single and bilateral superior vena cava cohorts but no other demographic discrepancies were observed for HFD or iPL. Multivariate regression analyses show that the best predictors for sensitivity involve flow pulsatilities, time-averaged flow rates, and geometric characteristics of the Fontan connection. These predictors provide patient-specific guidelines to determine the effectiveness of analyzing patient-specific surgical options with time-averaged BCs within a clinical time frame.
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Affiliation(s)
- Zhenglun Alan Wei
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Circle, Suite 232, Atlanta, GA 30313-2412, USA
| | - Phillip M Trusty
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Circle, Suite 232, Atlanta, GA 30313-2412, USA
| | - Mike Tree
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | | | - Elaine Tang
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Mark Fogel
- Division of Cardiology, Children׳s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Circle, Suite 232, Atlanta, GA 30313-2412, USA.
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49
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Hamlet SM, Haggerty CM, Suever JD, Wehner GJ, Grabau JD, Andres KN, Vandsburger MH, Powell DK, Sorrell VL, Fornwalt BK. An interactive videogame designed to improve respiratory navigator efficiency in children undergoing cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2016; 18:54. [PMID: 27599620 PMCID: PMC5012042 DOI: 10.1186/s12968-016-0272-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 08/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Advanced cardiovascular magnetic resonance (CMR) acquisitions often require long scan durations that necessitate respiratory navigator gating. The tradeoff of navigator gating is reduced scan efficiency, particularly when the patient's breathing patterns are inconsistent, as is commonly seen in children. We hypothesized that engaging pediatric participants with a navigator-controlled videogame to help control breathing patterns would improve navigator efficiency and maintain image quality. METHODS We developed custom software that processed the Siemens respiratory navigator image in real-time during CMR and represented diaphragm position using a cartoon avatar, which was projected to the participant in the scanner as visual feedback. The game incentivized children to breathe such that the avatar was positioned within the navigator acceptance window (±3 mm) throughout image acquisition. Using a 3T Siemens Tim Trio, 50 children (Age: 14 ± 3 years, 48 % female) with no significant past medical history underwent a respiratory navigator-gated 2D spiral cine displacement encoding with stimulated echoes (DENSE) CMR acquisition first with no feedback (NF) and then with the feedback game (FG). Thirty of the 50 children were randomized to undergo extensive off-scanner training with the FG using a MRI simulator, or no off-scanner training. Navigator efficiency, signal-to-noise ratio (SNR), and global left-ventricular strains were determined for each participant and compared. RESULTS Using the FG improved average navigator efficiency from 33 ± 15 to 58 ± 13 % (p < 0.001) and improved SNR by 5 % (p = 0.01) compared to acquisitions with NF. There was no difference in navigator efficiency (p = 0.90) or SNR (p = 0.77) between untrained and trained participants for FG acquisitions. Circumferential and radial strains derived from FG acquisitions were slightly reduced compared to NF acquisitions (-16 ± 2 % vs -17 ± 2 %, p < 0.001; 40 ± 10 % vs 44 ± 11 %, p = 0.005, respectively). There were no differences in longitudinal strain (p = 0.38). CONCLUSIONS Use of a respiratory navigator feedback game during navigator-gated CMR improved navigator efficiency in children from 33 to 58 %. This improved efficiency was associated with a 5 % increase in SNR for spiral cine DENSE. Extensive off-scanner training was not required to achieve the improvement in navigator efficiency.
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Affiliation(s)
- Sean M. Hamlet
- Department of Electrical Engineering, University of Kentucky, Lexington, KY USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Christopher M. Haggerty
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Institute for Advanced Application, Geisinger Health System, Danville, PA USA
| | - Jonathan D. Suever
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Institute for Advanced Application, Geisinger Health System, Danville, PA USA
| | - Gregory J. Wehner
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | | | | | - Moriel H. Vandsburger
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
- Department of Physiology, University of Kentucky, Lexington, KY USA
| | - David K. Powell
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | | | - Brandon K. Fornwalt
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Institute for Advanced Application, Geisinger Health System, Danville, PA USA
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
- Department of Physiology, University of Kentucky, Lexington, KY USA
- Department of Medicine, University of Kentucky, Lexington, KY USA
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50
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Jing L, Wehner GJ, Suever JD, Charnigo RJ, Alhadad S, Stearns E, Mojsejenko D, Haggerty CM, Hickey K, Valente AM, Geva T, Powell AJ, Fornwalt BK. Left and right ventricular dyssynchrony and strains from cardiovascular magnetic resonance feature tracking do not predict deterioration of ventricular function in patients with repaired tetralogy of Fallot. J Cardiovasc Magn Reson 2016; 18:49. [PMID: 27549809 PMCID: PMC4993000 DOI: 10.1186/s12968-016-0268-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/22/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients with repaired tetralogy of Fallot (rTOF) suffer from progressive ventricular dysfunction decades after their surgical repair. We hypothesized that measures of ventricular strain and dyssynchrony would predict deterioration of ventricular function in patients with rTOF. METHODS A database search identified all patients at a single institution with rTOF who underwent cardiovascular magnetic resonance (CMR) at least twice, >6 months apart, without intervening surgical or catheter procedures. Seven primary predictors were derived from the first CMR using a custom feature tracking algorithm: left (LV), right (RV) and inter-ventricular dyssynchrony, LV and RV peak global circumferential strains, and LV and RV peak global longitudinal strains. Three outcomes were defined, whose changes were assessed over time: RV end-diastolic volume, and RV and LV ejection fraction. Multivariate linear mixed models were fit to investigate relationships of outcomes to predictors and ten potential baseline confounders. RESULTS One hundred fifty-three patients with rTOF (23 ± 14 years, 50 % male) were included. The mean follow-up duration between the first and last CMR was 2.9 ± 1.3 years. After adjustment for confounders, none of the 7 primary predictors were significantly associated with change over time in the 3 outcome variables. Only 1-17 % of the variability in the change over time in the outcome variables was explained by the baseline predictors and potential confounders. CONCLUSIONS In patients with repaired tetralogy of Fallot, ventricular dyssynchrony and global strain derived from cine CMR were not significantly related to changes in ventricular size and function over time. The ability to predict deterioration in ventricular function in patients with rTOF using current methods is limited.
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MESH Headings
- Adolescent
- Algorithms
- Biomechanical Phenomena
- Cardiac Surgical Procedures/adverse effects
- Child
- Databases, Factual
- Disease Progression
- Female
- Humans
- Image Interpretation, Computer-Assisted
- Kentucky
- Linear Models
- Magnetic Resonance Imaging, Cine
- Male
- Multivariate Analysis
- Predictive Value of Tests
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Stress, Mechanical
- Stroke Volume
- Tetralogy of Fallot/complications
- Tetralogy of Fallot/diagnostic imaging
- Tetralogy of Fallot/physiopathology
- Tetralogy of Fallot/surgery
- Time Factors
- Treatment Outcome
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Young Adult
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Affiliation(s)
- Linyuan Jing
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
- Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822-4400 USA
| | - Gregory J. Wehner
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
| | - Jonathan D. Suever
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
- Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822-4400 USA
| | | | - Sudad Alhadad
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
| | - Evan Stearns
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
| | - Dimitri Mojsejenko
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
| | - Christopher M. Haggerty
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
- Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822-4400 USA
| | - Kelsey Hickey
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Andrew J. Powell
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Brandon K. Fornwalt
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
- Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822-4400 USA
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