2
|
Ardissino M, Patel KHK, Rayes B, Reddy RK, Mellor GJ, Ng FS. Multiple anthropometric measures and proarrhythmic 12-lead ECG indices: A mendelian randomization study. PLoS Med 2023; 20:e1004275. [PMID: 37552661 PMCID: PMC10443852 DOI: 10.1371/journal.pmed.1004275] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 11/12/2022] [Revised: 08/22/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Observational studies suggest that electrocardiogram (ECG) indices might be influenced by obesity and other anthropometric measures, though it is difficult to infer causal relationships based on observational data due to risk of residual confounding. We utilized mendelian randomization (MR) to explore causal relevance of multiple anthropometric measures on P-wave duration (PWD), PR interval, QRS duration, and corrected QT interval (QTc). METHODS AND FINDINGS Uncorrelated (r2 < 0.001) genome-wide significant (p < 5 × 10-8) single nucleotide polymorphisms (SNPs) were extracted from genome-wide association studies (GWAS) on body mass index (BMI, n = 806,834), waist:hip ratio adjusted for BMI (aWHR, n = 697,734), height (n = 709,594), weight (n = 360,116), fat mass (n = 354,224), and fat-free mass (n = 354,808). Genetic association estimates for the outcomes were extracted from GWAS on PR interval and QRS duration (n = 180,574), PWD (n = 44,456), and QTc (n = 84,630). Data source GWAS studies were performed between 2018 and 2022 in predominantly European ancestry individuals. Inverse-variance weighted MR was used for primary analysis; weighted median MR and MR-Egger were used as sensitivity analyses. Higher genetically predicted BMI was associated with longer PWD (β 5.58; 95%CI [3.66,7.50]; p = < 0.001), as was higher fat mass (β 6.62; 95%CI [4.63,8.62]; p < 0.001), fat-free mass (β 9.16; 95%CI [6.85,11.47]; p < 0.001) height (β 4.23; 95%CI [3.16, 5.31]; p < 0.001), and weight (β 8.08; 95%CI [6.19,9.96]; p < 0.001). Finally, genetically predicted BMI was associated with longer QTc (β 3.53; 95%CI [2.63,4.43]; p < 0.001), driven by both fat mass (β 3.65; 95%CI [2.73,4.57]; p < 0.001) and fat-free mass (β 2.08; 95%CI [0.85,3.31]; p = 0.001). Additionally, genetically predicted height (β 0.98; 95%CI [0.46,1.50]; p < 0.001), weight (β 3.45; 95%CI [2.54,4.36]; p < 0.001), and aWHR (β 1.92; 95%CI [0.87,2.97]; p = < 0.001) were all associated with longer QTc. The key limitation is that due to insufficient power, we were not able to explore whether a single anthropometric measure is the primary driver of the associations observed. CONCLUSIONS The results of this study support a causal role of BMI on multiple ECG indices that have previously been associated with atrial and ventricular arrhythmic risk. Importantly, the results identify a role of both fat mass, fat-free mass, and height in this association.
Collapse
Affiliation(s)
- Maddalena Ardissino
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | - Bilal Rayes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Rohin K. Reddy
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Greg J. Mellor
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| |
Collapse
|
5
|
Mellor GJ, Blom LJ, Groeneveld SA, Winkel BG, Ensam B, Bargehr J, van Rees B, Scrocco C, Krapels IPC, Volders PGA, Tfelt-Hansen J, Krahn AD, Hassink RJ, Behr ER. Familial Evaluation in Idiopathic Ventricular Fibrillation: Diagnostic Yield and Significance of J Wave Syndromes. Circ Arrhythm Electrophysiol 2021; 14:e009089. [PMID: 33550818 DOI: 10.1161/circep.120.009089] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Greg J Mellor
- Cardiology Department, Royal Papworth Hospital, Cambridge (G.J.M., J.B.)
| | - Lennart J Blom
- Department of Cardiology, University Medical Centre, Utrecht, the Netherlands (L.J.B., S.A.G., R.J.H.)
| | - Sanne A Groeneveld
- Department of Cardiology, University Medical Centre, Utrecht, the Netherlands (L.J.B., S.A.G., R.J.H.)
| | - Bo G Winkel
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (B.G.W., J.T.-H.)
| | - Bode Ensam
- Cardiovascular Clinical Academic Group, Molecular & Clinical Sciences Rsrch Inst, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.E., C.S., E.R.B.)
| | - Johannes Bargehr
- Cardiology Department, Royal Papworth Hospital, Cambridge (G.J.M., J.B.).,Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.B.)
| | - Bianca van Rees
- Department of Cardiology, Cardiovascular Rsrch Inst Maastricht (CARIM) (B.v.R., P.G.V.A.), Maastricht University Medical Center, the Netherlands
| | - Chiara Scrocco
- Cardiovascular Clinical Academic Group, Molecular & Clinical Sciences Rsrch Inst, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.E., C.S., E.R.B.)
| | - Ingrid P C Krapels
- Department of Clinical Genetics (I.P.C.K.), Maastricht University Medical Center, the Netherlands
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Rsrch Inst Maastricht (CARIM) (B.v.R., P.G.V.A.), Maastricht University Medical Center, the Netherlands
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (B.G.W., J.T.-H.)
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, Canada (A.D.K.)
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre, Utrecht, the Netherlands (L.J.B., S.A.G., R.J.H.)
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular & Clinical Sciences Rsrch Inst, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.E., C.S., E.R.B.)
| |
Collapse
|
6
|
Mellor GJ, Panwar P, Lee AK, Steinberg C, Hathaway JA, Bartels K, Christian S, Balaji S, Roberts JD, Simpson CS, Boczek NJ, Tester DJ, Radbill AE, Mok NS, Hamilton RM, Kaufman ES, Eugenio PL, Weiss R, January C, McDaniel GM, Leather RA, Erickson C, Falik S, Behr ER, Wilde AAM, Sanatani S, Ackerman MJ, Van Petegem F, Krahn AD, Laksman Z. Type 8 long QT syndrome: pathogenic variants in CACNA1C-encoded Cav1.2 cluster in STAC protein binding site. Europace 2019; 21:1725-1732. [DOI: 10.1093/europace/euz215] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/18/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Pathogenic gain-of-function variants in CACAN1C cause type-8 long QT syndrome (LQT8). We sought to describe the electrocardiographic features in LQT8 and utilize molecular modelling to gain mechanistic insights into its genetic culprits.
Methods and results
Rare variants in CACNA1C were identified from genetic testing laboratories. Treating physicians provided clinical information. Variant pathogenicity was independently assessed according to recent guidelines. Pathogenic (P) and likely pathogenic (LP) variants were mapped onto a 3D modelled structure of the Cav1.2 protein. Nine P/LP variants, identified in 23 patients from 19 families with non-syndromic LQTS were identified. Six variants, found in 79% of families, clustered to a 4-residue section in the cytosolic II–III loop region which forms a region capable of binding STAC SH3 domains. Therefore, variants may affect binding of SH3-domain containing proteins. Arrhythmic events occurred in similar proportions of patients with II–III loop variants and with other P/LP variants (53% vs. 48%, P = 0.41) despite shorter QTc intervals (477 ± 31 ms vs. 515 ± 37 ms, P = 0.03). A history of sudden death was reported only in families with II–III loop variants (60% vs. 0%, P = 0.03). The predominant T-wave morphology was a late peaking T wave with a steep descending limb. Exercise testing demonstrated QTc prolongation on standing and at 4 min recovery after exercise.
Conclusion
The majority of P/LP variants in patients with CACNA1C-mediated LQT8 cluster in an SH3-binding domain of the cytosolic II–III loop. This represents a ‘mutation hotspot’ in LQT8. A late-peaking T wave with a steep descending limb and QT prolongation on exercise are commonly seen.
Collapse
Affiliation(s)
- Greg J Mellor
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
- Cardiology Department, Royal Papworth Hospital, Cambridge, UK
| | - Pankaj Panwar
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - Andrea K Lee
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
| | - Christian Steinberg
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
| | - Julie A Hathaway
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
| | - Kirsten Bartels
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
| | - Susan Christian
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Seshadri Balaji
- Division of Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Chris S Simpson
- Heart Rhythm Service, Division of Cardiology, Queen’s University, Kingston, ON, Canada
| | - Nicole J Boczek
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - David J Tester
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | | | - Ngai-Shing Mok
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Robert M Hamilton
- Labatt Family Heart Centre and Division of Cardiology, Department of Pediatrics, and Translational Medicine, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | | | - Paul L Eugenio
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Raul Weiss
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Craig January
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - George M McDaniel
- Division of Pediatric Cardiology, University of Virginia, Charlottesville, VA, USA
| | | | - Christopher Erickson
- Pediatric Cardiology, Children’s Hospital & Medical Center/University of Nebraska Medical Center, Omaha, NA, USA
| | - Shelley Falik
- Division of Cardiology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Elijah R Behr
- Cardiology Clinical Academic Group, St. George’s, University of London, London, UK
| | - Arthur A M Wilde
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | | | - Michael J Ackerman
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Filip Van Petegem
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
| | - Zachary Laksman
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
| |
Collapse
|