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Godown J, Kim EH, Everitt MD, Chung WK, Lytrivi ID, Kirmani S, Kantor PF, Ware SM, Ballweg JA, Lal AK, Bansal N, Towbin J, Lipshultz SE, Lee TM. Genetic Testing Resources and Practice Patterns Among Pediatric Cardiomyopathy Programs. Pediatr Cardiol 2024:10.1007/s00246-024-03498-6. [PMID: 38714589 DOI: 10.1007/s00246-024-03498-6] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/11/2024] [Indexed: 05/10/2024]
Abstract
The use of genetic testing has enhanced the diagnostic accuracy of heritable genetic cardiomyopathies. However, it remains unclear how genetic information is interpreted and incorporated into clinical practice for children with cardiomyopathy. The primary aim of this study was to understand how clinical practice differs regarding sequence variant classifications amongst pediatric cardiologists who treat children with cardiomyopathy. A secondary aim was to understand the availability of genetic testing and counseling resources across participating pediatric cardiomyopathy programs. An electronic survey was distributed to pediatric heart failure, cardiomyopathy, or heart transplantation physicians between August and September 2022. A total of 106 individual providers from 68 unique centers responded to the survey. Resources for genetic testing and genetic counseling vary among large pediatric cardiomyopathy programs. A minority of centers reported having a geneticist (N = 16, 23.5%) or a genetic counselor (N = 21, 31%) on faculty within the division of pediatric cardiology. A total of 9 centers reported having both (13%). Few centers (N = 13, 19%) have a formal process in place to re-engage patients who were previously discharged from cardiology follow-up if variant reclassification would alter clinical management. Clinical practice patterns were uniform in response to pathogenic or likely pathogenic variants but were more variable for variants of uncertain significance. Efforts to better incorporate genetic expertise and resources into the clinical practice of pediatric cardiomyopathy may help to standardize the interpretation of genetic information and better inform clinical decision-making surrounding heritable cardiomyopathies.
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Affiliation(s)
- Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
- BioMarin Pharmaceutical Inc, Novato, CA, USA
| | - Emily H Kim
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Melanie D Everitt
- Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Wendy K Chung
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Irene D Lytrivi
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Sonya Kirmani
- Department of Pediatrics, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Paul F Kantor
- Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Stephanie M Ware
- Department of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jean A Ballweg
- Department of Pediatrics, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Ashwin K Lal
- Division of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Neha Bansal
- Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
| | - Jeffrey Towbin
- Heart Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Steven E Lipshultz
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 5018, Buffalo, NY, 14203, USA.
| | - Teresa M Lee
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
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Guerrier K, Gunturkun F, Wetzel G, Akbilgic O, Davis R, Towbin J. Human versus machine: does artificial intelligence add value to identification of hypertrophic cardiomyopathy in pediatric patients? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1859] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
An abnormal increase in left ventricular thickness is a hallmark of hypertrophic cardiomyopathy (HCM). Although standard measures of left ventricular voltage abnormalities on electrocardiograms (ECGs) have high false positive rates and poor correlation to left ventricular thickness, ECGs continue to be part of most screening programs. We developed a machine learning model for HCM classification from ECG in a pediatric cohort and compared its efficacy to that of clinician specialists.
Purpose
To compare clinician-based predictions of HCM to a machine learning model trained to classify pediatric patients with HCM utilizing 12-lead ECG.
Methods
ECGs from patients <19 years with HCM, including those with HCM gene mutations, were compared to those from age- and sex-matched controls with normal heart structure and function on echocardiogram. Patients with a known history of primary causes of left ventricular hypertrophy such as aortic stenosis or glycogen storage disease were excluded. A cascaded convolutional neural network was developed combining a residual neural network with a 2-layer dense neural network with 10-fold cross validation. The performance of the machine learning based HCM classification was compared to that of two independent clinicians.
Results
Analytic sample included data from 82 patients with clinical HCM compared to 91 healthy control subjects. The machine model AUC was 0.89 (0.84–0.94). Clinician inter-rater reliability was 0.8. The clinicians had a higher specificity (97% vs 82%) but lower sensitivity (50% vs 78%) than the machine learning model. Compared to clinician-classification, the positive predictive value was lower in the machine model (82% vs 93%).
Conclusion
In this preliminary study, machine learning classification of HCM utilizing 12-lead ECG had greater sensitivity than that of clinician interpretation. Machine learning may play a role in screening and diagnosis, including in subjects with normal-appearing ECG. Evaluation of its utility in a larger cohort is needed.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Le Bonheur Children's Hospital
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Affiliation(s)
- K Guerrier
- Methodist Lebonheur Children's Hospital , Memphis , United States of America
| | - F Gunturkun
- University of Tennessee , Memphis , United States of America
| | - G Wetzel
- Methodist Lebonheur Children's Hospital , Memphis , United States of America
| | - O Akbilgic
- Wake Forest University , Winston-Salem , United States of America
| | - R Davis
- University of Tennessee , Memphis , United States of America
| | - J Towbin
- Methodist Lebonheur Children's Hospital , Memphis , United States of America
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Guerrier K, Gunturkun F, Bennie I, Akbilgic O, Davis R, Towbin J. Machine learning can identify hypertrophic cardiomyopathy in pediatric patients using electrocardiogram. Europace 2022. [DOI: 10.1093/europace/euac053.549] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Le Bonheur Children’s Hospital
Background
Hypertrophic cardiomyopathy (HCM) is the most common genetic based heart disease and is associated with sudden cardiac death, particularly in young athletes. Standard measures of voltage abnormalities on electrocardiograms (ECGs) have demonstrated high false positive rates and poor correlation of LV thickness. Despite poor testing characteristics, ECGs continue to be part of most adolescent and family screening programs. While recent studies suggest that machine learning based analysis of ECGs may have utility in the identification of HCM in adult patients, there are limited data regarding its effectiveness in the pediatric population.
Purpose
The purpose of this study was to develop a deep learning model utilizing raw digital ECG data to accurately distinguish healthy pediatric patients from those with HCM.
Methods
ECGs from patients < 19 years with HCM were compared to ECGs from age- and sex-matched patients that underwent evaluation with ECG and echocardiogram for chest pain, sports clearance, syncope, or abnormal ECG between January 2011 and March 2021. Patients with a known clinical history of primary causes of left ventricular hypertrophy such as aortic stenosis, systemic hypertension, and glycogen storage disease were excluded from the study. Unsupervised signal processing tools including descriptive statistics and wavelet transformation were used to extract features from 12-lead ECG signals. A cascaded convolutional neural network was developed combining a residual neural network to extract features from waveform 12-lead ECG signals with a 2-layer dense neural network to embed features from signal processing tools. Model performance was evaluated by 10-fold stratified cross validation.
Results
The analytic sample included 181 patients (72% male; 63% Caucasian). Mean age was 12.3 ± 5.8 years. A cascaded deep learning model classified patients into healthy or HCM categories with a cross validation sensitivity of 77.7% and specificity of 81.6%. The positive predictive value was 82% and AUC of 0.89 (0.84-0.94).
Conclusion
This CNN trained with a relatively small number of images was able to accurately identify HCM in pediatric patients from standard 12-lead ECG. Evaluation of its potential utility in larger populations is needed.
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Affiliation(s)
- K Guerrier
- Methodist Lebonheur Children’s Hospital, Memphis, United States of America
| | - F Gunturkun
- Methodist Lebonheur Children’s Hospital, Memphis, United States of America
| | - I Bennie
- University of Tennessee, Memphis, United States of America
| | - O Akbilgic
- Wake Forest University, Winston-Salem, United States of America
| | - R Davis
- Methodist Lebonheur Children’s Hospital, Memphis, United States of America
| | - J Towbin
- Methodist Lebonheur Children’s Hospital, Memphis, United States of America
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Radel L, Boston U, Beasley G, Goldberg J, Martinez H, Ryan K, Kramer J, Rayburn M, Towbin J, Absi M. Impact of Cangrelor Use in Children Supported on Paracorporeal Ventricular Assist Devices. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1316] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Philip R, Towbin J, Tailor N, Joshi V, Johnson JN, Naik R, Waller BR, Sathanandam S. Feasibility and Safety of Percutaneous Cardiac Interventions for Congenital and Acquired Heart Defects in Infants ≤1000 g. Children 2021; 8:children8090826. [PMID: 34572258 PMCID: PMC8465089 DOI: 10.3390/children8090826] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/21/2022]
Abstract
The transcatheter closure of patent ductus arteriosus (TCPC) has been demonstrated to be feasible even in infants weighing ≤1000 g. However, other percutaneous cardiac interventions (PCI) for such small infants born with congenital heart defects (CHD) or acquired heart defects (AHD) have not been well described. The purpose of this study was to describe the feasibility and safety of PCI in infants ≤1000 g. A retrospective review was conducted between June 2015 and May 2021, looking at 148 consecutive PCIs performed on infants weighing ≤1000 g at the time of the procedure. The procedural success rate was 100%. The major adverse event (AE) rate for TCPC was 3%, while there were no major AEs for other PCI. It is feasible to perform PCIs in infants weighing ≤1000 g with CHD and AHD using currently available technologies.
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Affiliation(s)
- Ranjit Philip
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (J.T.); (N.T.); (V.J.); (J.N.J.); (R.N.); (B.R.W.III); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA
- Correspondence:
| | - Jeffrey Towbin
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (J.T.); (N.T.); (V.J.); (J.N.J.); (R.N.); (B.R.W.III); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA
| | - Neil Tailor
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (J.T.); (N.T.); (V.J.); (J.N.J.); (R.N.); (B.R.W.III); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA
| | - Vijaya Joshi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (J.T.); (N.T.); (V.J.); (J.N.J.); (R.N.); (B.R.W.III); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA
| | - Jason N. Johnson
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (J.T.); (N.T.); (V.J.); (J.N.J.); (R.N.); (B.R.W.III); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA
| | - Ronak Naik
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (J.T.); (N.T.); (V.J.); (J.N.J.); (R.N.); (B.R.W.III); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA
| | - B. Rush Waller
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (J.T.); (N.T.); (V.J.); (J.N.J.); (R.N.); (B.R.W.III); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA
| | - Shyam Sathanandam
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (J.T.); (N.T.); (V.J.); (J.N.J.); (R.N.); (B.R.W.III); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA
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Angelini P, Muthupillai R, Lopez A, Cheong B, Uribe C, Hernandez E, Coulter S, Perin E, Molossi S, Gentile F, Flamm S, Lorenz G, D'Ascenzi F, Tobis J, Sarnari R, Corno A, Furgerson J, Chiribiri A, Villa ADM, Orzan F, Brugada P, Jefferies J, Aubry P, Towbin J, Thiene G, Tomanek R. Young athletes: Preventing sudden death by adopting a modern screening approach? A critical review and the opening of a debate. Int J Cardiol Heart Vasc 2021; 34:100790. [PMID: 34124338 PMCID: PMC8175289 DOI: 10.1016/j.ijcha.2021.100790] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/07/2021] [Accepted: 04/23/2021] [Indexed: 10/29/2022]
Abstract
Preventing sudden cardiac death (SCD) in athletes is a primary duty of sports cardiologists. Current recommendations for detecting high-risk cardiovascular conditions (hr-CVCs) are history and physical examination (H&P)-based. We discuss the effectiveness of H&P-based screening versus more-modern and accurate methods. In this position paper, we review current authoritative statements and suggest a novel alternative: screening MRI (s-MRI), supported by evidence from a preliminary population-based study (completed in 2018), and a prospective, controlled study in military recruits (in development). We present: 1. Literature-Based Comparisons (for diagnosing hr-CVCs): Two recent studies using traditional methods to identify hr-CVCs in >3,000 young athletes are compared with our s-MRI-based study of 5,169 adolescents. 2. Critical Review of Previous Results: The reported incidence of SCD in athletes is presently based on retrospective, observational, and incomplete studies. H&P's screening value seems minimal for structural heart disease, versus echocardiography (which improves diagnosis for high-risk cardiomyopathies) and s-MRI (which also identifies high-risk coronary artery anomalies). Electrocardiography is valuable in screening for potentially high-risk electrophysiological anomalies. 3. Proposed Project : We propose a prospective, controlled study (2 comparable large cohorts: one historical, one prospective) to compare: (1) diagnostic accuracy and resulting mortality-prevention performance of traditional screening methods versus questionnaire/electrocardiography/s-MRI, during 2-month periods of intense, structured exercise (in military recruits, in advanced state of preparation); (2) global costs and cost/efficiency between these two methods. This study should contribute significantly toward a comprehensive understanding of the incidence and causes of exercise-related mortality (including establishing a definition of hr-CVCs) while aiming to reduce mortality.
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Affiliation(s)
- Paolo Angelini
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Raja Muthupillai
- Department of Radiology, University of Houston, Houston, TX, USA
| | - Alberto Lopez
- Electrophysiology Laboratory, Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Benjamin Cheong
- Department of Radiology, Texas Heart Institute, Houston, TX, USA
| | - Carlo Uribe
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | | | | | - Emerson Perin
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Silvana Molossi
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | | | - Scott Flamm
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Giovanni Lorenz
- Department of Radiology, Wilford Hall Ambulatory Center, San Antonio Military Health System, Joint Base San Antonio, San Antonio, TX, USA
| | | | - Jonathan Tobis
- Department of Cardiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Roberto Sarnari
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Antonio Corno
- Department of Congenital Cardiac Surgery, Children's Memorial Hermann Hospital, UTHealth, Houston, TX, USA
| | - James Furgerson
- Department of Cardio-Radiology, US Air Force Lackland Hospital, San Antonio, TX, USA
| | - Amedeo Chiribiri
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Adriana D M Villa
- Department of Radiology, St. Thomas Hospital, King's College London, United Kingdom
| | - Fulvio Orzan
- Division of Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Pedro Brugada
- Cardiovascular Division, Free University of Brussels (UZ Brussel) VUB, Brussels, Belgium
| | - John Jefferies
- The Cardiac Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pierre Aubry
- Department of Cardiology, Bichat Hospital, Paris, France
| | - Jeffrey Towbin
- Division of Adult Cardiovascular Diseases, Methodist University of Tennessee Cardiovascular Institute and Department of Preventive Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gaetano Thiene
- Department of Pathologic Anatomy, University of Padua, Italy
| | - Robert Tomanek
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA, USA
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Gropler M, Lavine K, Lipshultz S, Wilkinson J, Colan S, Towbin J, Si L, Canter C, Simpson K. Distinction of Serum Biomarker Profiles between Adults and Children with Dilated Cardiomyopathy. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.490] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Vigneault DM, Yang E, Jensen PJ, Tee MW, Farhad H, Chu L, Noble JA, Day SM, Colan SD, Russell MW, Towbin J, Sherrid MV, Canter CE, Shi L, Ho CY, Bluemke DA. Left Ventricular Strain Is Abnormal in Preclinical and Overt Hypertrophic Cardiomyopathy: Cardiac MR Feature Tracking. Radiology 2019; 290:640-648. [PMID: 30561279 PMCID: PMC6394738 DOI: 10.1148/radiol.2018180339] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate myocardial strain and circumferential transmural strain difference (cTSD; the difference between epicardial and endocardial circumferential strain) in a genotyped cohort with hypertrophic cardiomyopathy (HCM) and to explore correlations between cTSD and other anatomic and functional markers of disease status. Left ventricular (LV) dysfunction may indicate early disease in preclinical HCM (sarcomere mutation carriers without LV hypertrophy). Cardiac MRI feature tracking may be used to evaluate myocardial strain in carriers of HCM sarcomere mutation. Materials and Methods Participants with HCM and their family members participated in a prospective, multicenter, observational study (HCMNet). Genetic testing was performed in all participants. Study participants underwent cardiac MRI with temporal resolution at 40 msec or less. LV myocardial strain was analyzed by using feature-tracking software. Circumferential strain was measured at the epicardial and endocardial surfaces; their difference yielded the circumferential transmural strain difference (cTSD). Multivariable analysis to predict HCM status was performed by using multinomial logistic regression adjusting for age, sex, and LV parameters. Results Ninety-nine participants were evaluated (23 control participants, 34 participants with preclinical HCM [positive for sarcomere mutation and negative for LV hypertrophy], and 42 participants with overt HCM [positive for sarcomere mutation and negative for LV hypertrophy]). The average age was 25 years ± 11 and 44 participants (44%) were women. Maximal LV wall thickness was 9.5 mm ± 1.4, 9.8 mm ± 2.2, and 16.1 mm ± 5.3 in control participants, participants with preclinical HCM (P = .496 vs control participants), and participants with overt HCM (P < .001 vs control participants), respectively. cTSD for control participants, preclinical HCM, and overt HCM was 14% ± 4, 17% ± 4, and 22% ± 7, respectively (P < .01 for all comparisons). In multivariable models (controlling for septal thickness and log-transformed N-terminal brain-type natriuretic peptide), cTSD was predictive of preclinical and overt HCM disease status (P < .01). Conclusion Cardiac MRI feature tracking identifies myocardial dysfunction not only in participants with overt hypertrophic cardiomyopathy, but also in carriers of sarcomere mutation without left ventricular hypertrophy, suggesting that contractile abnormalities are present even when left ventricular wall thickness is normal. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Davis M. Vigneault
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Eunice Yang
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Patrick J. Jensen
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Michael W. Tee
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Hoshang Farhad
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Linda Chu
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - J. Alison Noble
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Sharlene M. Day
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Steven D. Colan
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Mark W. Russell
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Jeffrey Towbin
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Mark V. Sherrid
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Charles E. Canter
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Ling Shi
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - Carolyn Y. Ho
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
| | - David A. Bluemke
- From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children’s Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.)
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Karki K, Towbin J, Philip R, Shah S, Tadphale S, Saini A. 256. Crit Care Med 2019. [DOI: 10.1097/01.ccm.0000551010.89859.a1] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Boston U, Kumar TS, Shah J, Street T, Towbin J, Knott-Craig CJ. Successful Heart Transplantation in Two Infants With Dextrocardia-Heterotaxy Syndrome. Ann Thorac Surg 2018; 107:e111-e114. [PMID: 30081023 DOI: 10.1016/j.athoracsur.2018.06.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 05/10/2018] [Revised: 06/03/2018] [Accepted: 06/08/2018] [Indexed: 02/01/2023]
Abstract
Infants with dextrocardia-heterotaxy syndrome pose significant surgical challenges to a successful orthotopic heart transplant. Herein we report on 2 infants with dextrocardia-heterotaxy syndrome who underwent complex heart transplantation. A combination of preoperative 3-dimensional chest computed tomography to predict optimal donor size and unique surgical technique resulted in successful outcomes.
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Affiliation(s)
- Umar Boston
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee, Memphis, Tennessee.
| | - Tk Susheel Kumar
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee, Memphis, Tennessee
| | - Jignesh Shah
- Department of Pediatric Radiology, Le Bonheur Children's Hospital and University of Tennessee, Memphis, Tennessee
| | - Tiffany Street
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee, Memphis, Tennessee
| | - Jeffrey Towbin
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee, Memphis, Tennessee
| | - Christopher J Knott-Craig
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee, Memphis, Tennessee
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Karki K, Towbin J, Harrell C, Tansey J, Krebs J, Smith J, Bigelow W, Saini A, Tadphale S. EARLY OBSERVATIONS FROM CONCURRENT USE OF CALCIUM CHLORIDE AND VASOPRESSIN INFUSIONS IN PEDIATRIC HEART FAILURE. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31511-0] [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: 10/17/2022]
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Farhad H, Seidelmann SB, Vigneault D, Abbasi SA, Yang E, Day SM, Colan SD, Russell MW, Towbin J, Sherrid MV, Canter CE, Shi L, Jerosch-Herold M, Bluemke DA, Ho C, Neilan TG. Left Atrial structure and function in hypertrophic cardiomyopathy sarcomere mutation carriers with and without left ventricular hypertrophy. J Cardiovasc Magn Reson 2017; 19:107. [PMID: 29284499 PMCID: PMC5745877 DOI: 10.1186/s12968-017-0420-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 01/06/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Impaired left atrial (LA) function is an early marker of cardiac dysfunction and predictor of adverse cardiac events. Herein, we assess LA structure and function in hypertrophy in hypertrophic cardiomyopathy (HCM) sarcomere mutation carriers with and without left ventricular hypertrophy (LVH). METHOD Seventy-three participants of the HCMNet study who underwent cardiovascular magnetic resonance (CMR) imaging were studied, including mutation carriers with overt HCM (n = 34), preclinical mutation carriers without HCM (n = 24) and healthy, familial controls (n = 15). RESULTS LA volumes were similar between preclinical, control and overt HCM cohorts after covariate adjustment. However, there was evidence of impaired LA function with decreased LA total emptying function in both preclinical (64 ± 8%) and overt HCM (59 ± 10%), compared with controls (70 ± 7%; p = 0.002 and p = 0.005, respectively). LA passive emptying function was also decreased in overt HCM (35 ± 11%) compared with controls (47 ± 10%; p = 0.006). Both LAtotal emptying function and LA passive emptying function were inversely correlated with the extent of late gadolinium enhancement (LGE; p = 0.005 and p < 0.05, respectively), LV mass (p = 0.02 and p < 0.001) and interventricular septal thickness (p < 0.001 for both) and serum NT-proBNP levels (p < 0.001 for both). CONCLUSION LA dysfunction is detectable by CMR in preclinical HCM mutation carriers despite non-distinguishable LV wall thickness and LA volume. LA function appears most impaired in subjects with overt HCM and a greater extent of LV fibrosis.
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MESH Headings
- Adolescent
- Adult
- Atrial Function, Left
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/genetics
- Cardiomyopathy, Hypertrophic/physiopathology
- Case-Control Studies
- Cross-Sectional Studies
- DNA Mutational Analysis
- Female
- Fibrosis
- Genetic Predisposition to Disease
- Heart Atria/diagnostic imaging
- Heart Atria/physiopathology
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Mutation
- Phenotype
- Predictive Value of Tests
- Sarcomeres/genetics
- Ventricular Function, Left
- Ventricular Remodeling
- Young Adult
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Affiliation(s)
- Hoshang Farhad
- Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 USA
| | - Sara B. Seidelmann
- Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 USA
| | - Davis Vigneault
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD USA
| | - Siddique A. Abbasi
- Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 USA
| | - Eunice Yang
- Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Sharlene M. Day
- Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, MI USA
| | - Steven D. Colan
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Mark W. Russell
- Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, MI USA
| | - Jeffrey Towbin
- The Heart Institute and Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Mark V. Sherrid
- New York University Langone Medical Center, New York, NY USA
| | - Charles E. Canter
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO USA
| | - Ling Shi
- New England Research Institutes, Watertown, MA USA
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - David A. Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD USA
| | - Carolyn Ho
- Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 USA
| | - Tomas G. Neilan
- Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, USA
- Division of Cardiology, Department of Medicine, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge St, Boston, MA 02114 USA
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Patel MD, Mohan J, Schneider C, Bajpai G, Purevjav E, Canter CE, Towbin J, Bredemeyer A, Lavine KJ. Pediatric and adult dilated cardiomyopathy represent distinct pathological entities. JCI Insight 2017; 2:94382. [PMID: 28724792 DOI: 10.1172/jci.insight.94382] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 04/03/2017] [Accepted: 06/06/2017] [Indexed: 01/15/2023] Open
Abstract
Pediatric dilated cardiomyopathy (DCM) is the most common indication for heart transplantation in children. Despite similar genetic etiologies, medications routinely used in adult heart failure patients do not improve outcomes in the pediatric population. The mechanistic basis for these observations is unknown. We hypothesized that pediatric and adult DCM comprise distinct pathological entities, in that children do not undergo adverse remodeling, the target of adult heart failure therapies. To test this hypothesis, we examined LV specimens obtained from pediatric and adult donor controls and DCM patients. Consistent with the established pathophysiology of adult heart failure, adults with DCM displayed marked cardiomyocyte hypertrophy and myocardial fibrosis compared with donor controls. In contrast, pediatric DCM specimens demonstrated minimal cardiomyocyte hypertrophy and myocardial fibrosis compared with both age-matched controls and adults with DCM. Strikingly, RNA sequencing uncovered divergent gene expression profiles in pediatric and adult patients, including enrichment of transcripts associated with adverse remodeling and innate immune activation in adult DCM specimens. Collectively, these findings reveal that pediatric and adult DCM represent distinct pathological entities, provide a mechanistic basis to explain why children fail to respond to adult heart failure therapies, and suggest the need to develop new approaches for pediatric DCM.
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Affiliation(s)
| | - Jayaram Mohan
- Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Caralin Schneider
- Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Geetika Bajpai
- Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Enkhsaikhan Purevjav
- Department of Pediatrics, Division of Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Jeffrey Towbin
- Department of Pediatrics, Division of Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrea Bredemeyer
- Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kory J Lavine
- Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Developmental Biology, and.,Department of Immunology and Pathology, Washington University School of Medicine, St. Louis, Missouri, USA
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Miyatake S, Mitsuhashi S, Hayashi YK, Purevjav E, Nishikawa A, Koshimizu E, Suzuki M, Yatabe K, Tanaka Y, Ogata K, Kuru S, Shiina M, Tsurusaki Y, Nakashima M, Mizuguchi T, Miyake N, Saitsu H, Ogata K, Kawai M, Towbin J, Nonaka I, Nishino I, Matsumoto N. Biallelic Mutations in MYPN, Encoding Myopalladin, Are Associated with Childhood-Onset, Slowly Progressive Nemaline Myopathy. Am J Hum Genet 2017; 100:169-178. [PMID: 28017374 DOI: 10.1016/j.ajhg.2016.11.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 11/22/2016] [Indexed: 01/16/2023] Open
Abstract
Nemaline myopathy (NM) is a common form of congenital nondystrophic skeletal muscle disease characterized by muscular weakness of proximal dominance, hypotonia, and respiratory insufficiency but typically not cardiac dysfunction. Wide variation in severity has been reported. Intranuclear rod myopathy is a subtype of NM in which rod-like bodies are seen in the nucleus, and it often manifests as a severe phenotype. Although ten mutant genes are currently known to be associated with NM, only ACTA1 is associated with intranuclear rod myopathy. In addition, the genetic cause remains unclear in approximately 25%-30% of individuals with NM. We performed whole-exome sequencing on individuals with histologically confirmed but genetically unsolved NM. Our study included individuals with milder, later-onset NM and identified biallelic loss-of-function mutations in myopalladin (MYPN) in four families. Encoded MYPN is a sarcomeric protein exclusively localized in striated muscle in humans. Individuals with identified MYPN mutations in all four of these families have relatively mild, childhood- to adult-onset NM with slowly progressive muscle weakness. Walking difficulties were recognized around their forties. Decreased respiratory function, cardiac involvement, and intranuclear rods in biopsied muscle were observed in two individuals. MYPN was localized at the Z-line in control skeletal muscles but was absent from affected individuals. Homozygous knockin mice with a nonsense mutation in Mypn showed Z-streaming and nemaline-like bodies adjacent to a disorganized Z-line on electron microscopy, recapitulating the disease. Our results suggest that MYPN screening should be considered in individuals with mild NM, especially when cardiac problems or intranuclear rods are present.
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Sathanandam S, Kashyap P, Zurakowski D, Bird L, McGhee V, Towbin J, Rush Waller B. Effect of solute temperature in the measurement of cardiac output in children using the thermodilution technique. CONGENIT HEART DIS 2016; 12:181-187. [DOI: 10.1111/chd.12423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Shyam Sathanandam
- Department of Pediatrics, Division of Pediatric Cardiology; LeBonheur Children's Hospital, University of Tennessee; Memphis Tennessee USA
| | - Pooja Kashyap
- Department of Pediatrics, Division of Pediatric Cardiology; LeBonheur Children's Hospital, University of Tennessee; Memphis Tennessee USA
| | - David Zurakowski
- Department of Biostatistics; Harvard Medical School; Boston Massachusetts USA
| | - Lindsey Bird
- Department of Pediatrics, Division of Pediatric Cardiology; LeBonheur Children's Hospital, University of Tennessee; Memphis Tennessee USA
| | - Vera McGhee
- UTHSC Health Science Center; College of Medicine; Memphis Tennessee USA
| | - Jeffrey Towbin
- Department of Pediatrics, Division of Pediatric Cardiology; LeBonheur Children's Hospital, University of Tennessee; Memphis Tennessee USA
| | - Benjamin Rush Waller
- Department of Pediatrics, Division of Pediatric Cardiology; LeBonheur Children's Hospital, University of Tennessee; Memphis Tennessee USA
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Lipshultz S, Wilkinson J, Shi L, Towbin J, Canter C, Hsu D, Webber S, Kantor P, Everitt M, Pahl E, Jefferies J, Rossano J, Addonizio L, Dodd D, Ware S, Molina K, Colan S. THE CARDIAC BIOMARKERS IN CHILDREN WITH CARDIOMYOPATHY MULTICENTER STUDY: PRELIMINARY RESULTS FOR PEDIATRIC HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31510-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ryan TD, Lucky AW, Towbin J, Jefferies J. VENTRICULAR DYSFUNCTION AND AORTIC DILATION IN PATIENTS WITH RECESSIVE DYSTROPHIC EPIDERMOLYSIS BULLOSA. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60944-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liu JF, Jons C, Moss AJ, McNitt S, Peterson DR, Qi M, Zareba W, Robinson JL, Barsheshet A, Ackerman MJ, Benhorin J, Kaufman ES, Locati EH, Napolitano C, Priori SG, Schwartz PJ, Towbin J, Vincent M, Zhang L, Goldenberg I. Risk factors for recurrent syncope and subsequent fatal or near-fatal events in children and adolescents with long QT syndrome. J Am Coll Cardiol 2013; 57:941-50. [PMID: 21329841 DOI: 10.1016/j.jacc.2010.10.025] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [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] [Received: 06/07/2010] [Revised: 10/12/2010] [Accepted: 10/18/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aimed to identify risk factors for recurrent syncope in children and adolescents with congenital long QT syndrome (LQTS). BACKGROUND Data regarding risk assessment in LQTS after the occurrence of the first syncope episode are limited. METHODS The Prentice-Williams-Peterson conditional gap time model was used to identify risk factors for recurrent syncope from birth through age 20 years among 1,648 patients from the International Long QT Syndrome Registry. RESULTS Multivariate analysis demonstrated that corrected QT interval (QTc) duration (≥500 ms) was a significant predictor of a first syncope episode (hazard ratio: 2.16), whereas QTc effect was attenuated when the end points of the second, third, and fourth syncope episodes were evaluated (hazard ratios: 1.29, 0.99, 0.90, respectively; p < 0.001 for the null hypothesis that all 4 hazard ratios are identical). A genotype-specific subanalysis showed that during childhood (0 to 12 years), males with LQTS type 1 had the highest rate of a first syncope episode (p = 0.001) but exhibited similar rates of subsequent events as other genotype-sex subsets (p = 0.63). In contrast, in the age range of 13 to 20 years, long QT syndrome type 2 females experienced the highest rate of both first and subsequent syncope events (p < 0.001 and p = 0.01, respectively). Patients who experienced ≥1 episodes of syncope had a 6- to 12-fold (p < 0.001 for all) increase in the risk of subsequent fatal/near-fatal events independently of QTc duration. Beta-blocker therapy was associated with a significant reduction in the risk of recurrent syncope and subsequent fatal/near-fatal events. CONCLUSIONS Children and adolescents who present after an episode of syncope should be considered to be at a high risk of the development of subsequent syncope episodes and fatal/near-fatal events regardless of QTc duration.
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Affiliation(s)
- Judy F Liu
- Heart Research Follow-up Program, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA
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Kantor PF, Orav E, Wilkinson J, Webber S, Canter C, Colan S, Towbin J, Everitt M, Pahl E, Ware S, Kaufman B, Rusconi P, Lamour J, Jefferies J, Addonizio L, Lipshultz S. PROGRESSIVE LEFT VENTRICULAR CHANGES PREDICT THE LIKELIHOOD OF SURVIVAL IN PEDIATRIC DILATED CARDIOMYOPATHY: FINDINGS FROM THE PEDIATRIC CARDIOMYOPATHY REGISTRY. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60741-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, Fedson S, Fisher P, Gonzales-Stawinski G, Martinelli L, McGiffin D, Smith J, Taylor D, Meiser B, Webber S, Baran D, Carboni M, Dengler T, Feldman D, Frigerio M, Kfoury A, Kim D, Kobashigawa J, Shullo M, Stehlik J, Teuteberg J, Uber P, Zuckermann A, Hunt S, Burch M, Bhat G, Canter C, Chinnock R, Crespo-Leiro M, Delgado R, Dobbels F, Grady K, Kao W, Lamour J, Parry G, Patel J, Pini D, Towbin J, Wolfel G, Delgado D, Eisen H, Goldberg L, Hosenpud J, Johnson M, Keogh A, Lewis C, O'Connell J, Rogers J, Ross H, Russell S, Vanhaecke J, Russell S, Vanhaecke J. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant 2010; 29:914-56. [PMID: 20643330 DOI: 10.1016/j.healun.2010.05.034] [Citation(s) in RCA: 1134] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 05/31/2010] [Indexed: 12/26/2022] Open
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22
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Villamizar C, Regalado ES, Fadulu VT, Hasham SN, Gupta P, Willing MC, Kuang SQ, Guo D, Muilenburg A, Yee RW, Fan Y, Towbin J, Coselli JS, LeMaire SA, Milewicz DM. Paucity of skeletal manifestations in Hispanic families with FBN1 mutations. Eur J Med Genet 2009; 53:80-4. [PMID: 19941982 DOI: 10.1016/j.ejmg.2009.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 11/16/2009] [Indexed: 11/25/2022]
Abstract
Marfan syndrome (MFS) is an autosomal dominant condition with pleiotropic manifestations involving the skeletal, ocular, and cardiovascular systems. The diagnosis is based primarily on clinical involvement of these and other systems, referred to as the Ghent criteria. We have identified three Hispanic families from Mexico with cardiovascular and ocular manifestations due to novel FBN1 mutations but with paucity of skeletal features. The largest family, hMFS001, had a frameshift mutation in exon 24 (3075delC) identified as the cause of aortic disease in the family. Assessment of eight affected adults revealed no major skeletal manifestation of MFS. Family hMFS002 had a missense mutation (R1530C) in exon 37. Four members fulfilled the criteria for ocular and cardiovascular phenotype but lacked skeletal manifestations. Family hMFS003 had two consecutive missense FBN1 mutations (C515W and R516G) in exon 12. Eight members fulfilled the ocular criteria for MFS and two members had major cardiovascular manifestations, however none of them met criteria for skeletal system. These data suggest that individuals of Hispanic descent with FBN1 mutations may not manifest skeletal features of the MFS to the same extent as Caucasians. We recommend that echocardiogram, ocular examination and FBN1 molecular testing be considered for any patients with possible MFS even in the absence of skeletal features, including Hispanic patients.
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Affiliation(s)
- Carlos Villamizar
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
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Lizotte E, Junttila MJ, Dube MP, Hong K, Benito B, DE Zutter M, Henkens S, Sarkozy A, Huikuri HV, Towbin J, Vatta M, Brugada P, Brugada J, Brugada R. Genetic modulation of brugada syndrome by a common polymorphism. J Cardiovasc Electrophysiol 2009; 20:1137-41. [PMID: 19549036 DOI: 10.1111/j.1540-8167.2009.01508.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Brugada syndrome predisposes some subjects to ventricular tachyarrhythmias and sudden cardiac death. Mutations in SCN5A gene have been associated with approximately 25% of Brugada syndrome patients. A common variant in SCN5A, H558R has shown to improve sodium channel activity in mutated channels. We studied whether common variant H558R has any clinical implications in the phenotype of Brugada syndrome. METHODS Our study population consisted of Brugada syndrome subjects 75 with SCN5A mutation and 92 without SCN5A mutation. Their mean age was 39 +/- 15 and 42 +/- 17 years, and 65% and 86% were male, respectively. We measured PR-, QRS-, QTc-intervals from leads II and V2 of the 12-lead ECG. We also evaluated J-point amplitude from lead V2 and R'/S ratio from lead aVR (the "aVR sign"). The H558R (A-->G) genotype was detected with direct sequencing of the SCN5A gene. RESULTS The AA genotype carriers had longer QRS duration in lead II (P = 0.017) and higher J-point elevation in lead V2 (P = 0.013), higher "aVR sign" (P = 0.005) and a trend toward more subjects with symptoms (P = 0.067) than G allele carriers. None of the results were significant in Brugada syndrome subjects without SCN5A mutation. CONCLUSION The common variant H558R seems to be a genetic modulator of Brugada syndrome among carriers of a SCN5A mutation, in whom the presence of the less common allele G improves the ECG characteristics and clinical phenotype.
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Affiliation(s)
- Eric Lizotte
- Montreal Heart Institute and University of Montreal, Montreal, Canada
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24
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Brunetti-Pierri N, Fouladi N, Towbin J, Jefferies J, Sutton V, Belmont J, Craigen W, Wong LJ, Scaglia F, Scaglia F. 19. Aortic root dilatation: a previously unrecognized clinical feature of mitochondrial cytopathies. Mitochondrion 2009. [DOI: 10.1016/j.mito.2008.12.017] [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] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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25
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Lu X, Xie M, Tomberlin D, Klas B, Nadvoretskiy V, Ayres N, Towbin J, Ge S. How accurately, reproducibly, and efficiently can we measure left ventricular indices using M-mode, 2-dimensional, and 3-dimensional echocardiography in children? Am Heart J 2008; 155:946-53. [PMID: 18440346 DOI: 10.1016/j.ahj.2007.11.034] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Accepted: 11/12/2007] [Indexed: 01/21/2023]
Abstract
BACKGROUND Measurements of left ventricular (LV) size, mass, and function are the most common and important tasks for echocardiography in clinical practice and research in children with congenital and acquired heart diseases. There are little data to compare the utility of M-mode (MM), 2-dimensional (2D), and 3-dimensional (3D) echocardiographic techniques for quantification of LV indices. The objective of the study was to assess the accuracy, reproducibility, and efficiency of these echocardiographic methods for measurement of LV indices in children. METHODS A prospective study was conducted in 20 consecutive children (mean 10.6 +/- 2.8 years, 11 male and 9 female subjects) using conventional MM, 2D, and real-time 3D echocardiography (RT3DE). A Sonos 7500 system (Philips Medical Systems, Andover, MA) was used. M-mode and 2DE measurements were made according to the American Society of echocardiography recommendations. To include the entire LV for volumetric measurement, full-volume 3D data sets were acquired from 4 electrocardiogram gated subvolumes. The 3DE measurements were made off-line manually using 4-plane and 8-plane algorithms by 4D Echo-View (TomTec Imaging Systems, Munich, Germany) and a semiautomated algorithm by QLAB (Philips Medical Systems). Magnetic resonance imaging studies were also performed to determine the LV indices by a disk summation method based on the Simpson principle. RESULTS The correlation and agreement between MM, 2D, and RT3D echocardiography and magnetic resonance imaging measurements are good (r = 0.81-0.97) for the 3 methods. The correlation was superior for RT3DE compared with 2DE and MM. The correlation and agreement were similar for the three 3DE methods. The intra- and interobserver variabilities ranged from MM (4.3%-4.8% and 7.0%-8.7%), 2DE (3.3%-4.5% and 5.5%-7.3%), and 3DE (0.4%-2.3%, and 0.2%-4.8%). The total time (acquisition and analysis) used for MM measurements was the least compared with 2DE and 3DE. The total time for 3DE using the semiautomated algorithms was not significantly different compared with that for 2DE. CONCLUSIONS Our study showed that MM provides the most efficient assessment of LV indices but is the least accurate and reproducible technique compared with 2DE and 3DE. Three-dimensional echocardiography using both automated and manual analysis algorithm is superior to MM and 2DE for measurements of LV indices, and the automated 3DE algorithm is as efficient as 2DE. Therefore, 3DE using the automated algorithm is the method of choice for quantification of LV indices.
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Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, Levine GN, Narula J, Starling RC, Towbin J, Virmani R. The role of endomyocardial biopsy in the management of cardiovascular disease: A Scientific Statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 2007; 28:3076-93. [DOI: 10.1093/eurheartj/ehm456] [Citation(s) in RCA: 269] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Karkera JD, Lee JS, Roessler E, Banerjee-Basu S, Ouspenskaia MV, Mez J, Goldmuntz E, Bowers P, Towbin J, Belmont JW, Baxevanis AD, Schier AF, Muenke M. Loss-of-function mutations in growth differentiation factor-1 (GDF1) are associated with congenital heart defects in humans. Am J Hum Genet 2007; 81:987-94. [PMID: 17924340 DOI: 10.1086/522890] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 07/13/2007] [Indexed: 01/07/2023] Open
Abstract
Congenital heart defects (CHDs) are among the most common birth defects in humans (incidence 8-10 per 1,000 live births). Although their etiology is often poorly understood, most are considered to arise from multifactorial influences, including environmental and genetic components, as well as from less common syndromic forms. We hypothesized that disturbances in left-right patterning could contribute to the pathogenesis of selected cardiac defects by interfering with the extrinsic cues leading to the proper looping and vessel remodeling of the normally asymmetrically developed heart and vessels. Here, we show that heterozygous loss-of-function mutations in the human GDF1 gene contribute to cardiac defects ranging from tetralogy of Fallot to transposition of the great arteries and that decreased TGF- beta signaling provides a framework for understanding their pathogenesis. These findings implicate perturbations of the TGF- beta signaling pathway in the causation of a major subclass of human CHDs.
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Affiliation(s)
- J D Karkera
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, Levine GN, Narula J, Starling RC, Towbin J, Virmani R. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation 2007; 116:2216-33. [PMID: 17959655 DOI: 10.1161/circulationaha.107.186093] [Citation(s) in RCA: 549] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Baschat A, Reddy U, Towbin J, Harman C, Weiner C. When are amniotic fluid viral PCR studies indicated in prenatal diagnosis? Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.544] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Torre-Amione G, Oliveira G, Thohan V, Becker KA, Towbin J, Bavouset E, Nasir N. Increase Myocyte Size Predicts Reverse Cellular Reverses Remodeling Following Cardiac Resychronization Therapy. J Card Fail 2006. [DOI: 10.1016/j.cardfail.2006.06.198] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pilichou K, Nava A, Basso C, Beffagna G, Bauce B, Lorenzon A, Frigo G, Vettori A, Valente M, Towbin J, Thiene G, Danieli GA, Rampazzo A. Mutations in desmoglein-2 gene are associated with arrhythmogenic right ventricular cardiomyopathy. Circulation 2006; 113:1171-9. [PMID: 16505173 DOI: 10.1161/circulationaha.105.583674] [Citation(s) in RCA: 385] [Impact Index Per Article: 21.4] [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: 11/16/2022]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by progressive myocardial atrophy with fibrofatty replacement. The recent identification of causative mutations in plakoglobin, desmoplakin (DSP), and plakophilin-2 (PKP2) genes led to the hypothesis that ARVC is due to desmosomal defects. Therefore, desmoglein-2 (DSG2), the only desmoglein isoform expressed in cardiac myocytes, was screened in subjects with ARVC. METHODS AND RESULTS In a series of 80 unrelated ARVC probands, 26 carried a mutation in DSP (16%), PKP2 (14%), and transforming growth factor-beta3 (2.5%) genes; the remaining 54 were screened for DSG2 mutations by denaturing high-performance liquid chromatography and direct sequencing. Nine heterozygous DSG2 mutations (5 missense, 2 insertion-deletions, 1 nonsense, and 1 splice site mutation) were detected in 8 probands (10%). All probands fulfilled task force criteria for ARVC. An endomyocardial biopsy was obtained in 5, showing extensive loss of myocytes with fibrofatty tissue replacement. In 3 patients, electron microscopy investigation was performed, showing intercalated disc paleness, decreased desmosome number, and intercellular gap widening. CONCLUSIONS This is the first investigation demonstrating DSG2 gene mutations in a significant number of ARVC-unrelated probands. Cardiac phenotype is characterized clinically by typical ARVC features with frequent left ventricular involvement and morphologically by fibrofatty myocardial replacement and desmosomal remodeling. The presence of mutations in desmosomal encoding genes in 40% of cases confirms that many forms of ARVC are due to alterations in the desmosome complex.
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Affiliation(s)
- Kalliopi Pilichou
- Department of Biology, University of Padua Medical School, Padua, Italy
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Rosenthal D, Chrisant MRK, Edens E, Mahony L, Canter C, Colan S, Dubin A, Lamour J, Ross R, Shaddy R, Addonizio L, Beerman L, Berger S, Bernstein D, Blume E, Boucek M, Checchia P, Dipchand A, Drummond-Webb J, Fricker J, Friedman R, Hallowell S, Jaquiss R, Mital S, Pahl E, Pearce FB, Pearce B, Rhodes L, Rotondo K, Rusconi P, Scheel J, Pal Singh T, Towbin J. International Society for Heart and Lung Transplantation: Practice guidelines for management of heart failure in children. J Heart Lung Transplant 2005; 23:1313-33. [PMID: 15607659 DOI: 10.1016/j.healun.2004.03.018] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- David Rosenthal
- International Society for Heart and Lung Transplantation, Addison, Texas.
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Connuck D, Sleeper L, Towbin J, Colan S, Cox G, Cuniberti L, Orav J, Anne Salbert B, Lipshultz S. 1164-126 Characteristics of Duchenne and Becker muscular dystrophy patients in the pediatric cardiomyopathy registry. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90979-5] [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: 10/26/2022]
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Ware SM, Peng J, Zhu L, Fernbach S, Colicos S, Casey B, Towbin J, Belmont JW. Identification and functional analysis of ZIC3 mutations in heterotaxy and related congenital heart defects. Am J Hum Genet 2004; 74:93-105. [PMID: 14681828 PMCID: PMC1181916 DOI: 10.1086/380998] [Citation(s) in RCA: 213] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2003] [Accepted: 10/20/2003] [Indexed: 11/03/2022] Open
Abstract
Mutations in the zinc finger transcription factor ZIC3 cause X-linked heterotaxy and have also been identified in patients with isolated congenital heart disease (CHD). To determine the relative contribution of ZIC3 mutations to both heterotaxy and isolated CHD, we screened the coding region of ZIC3 in 194 unrelated patients, including 61 patients with classic heterotaxy, 93 patients with heart defects characteristic of heterotaxy, and 11 patients with situs inversus totalis. Five novel ZIC3 mutations in three classic heterotaxy kindreds and two sporadic CHD cases were identified. None of these alleles was found in 97 ethnically matched control samples. On the basis of these analyses, we conclude that the phenotypic spectrum of ZIC3 mutations should be expanded to include affected females and CHD not typical for heterotaxy. This screening of a cohort of patients with sporadic heterotaxy indicates that ZIC3 mutations account for approximately 1% of affected individuals. Missense and nonsense mutations were found in the highly conserved zinc finger-binding domain and in the N-terminal protein domain. Functional analysis of all currently known ZIC3 point mutations indicates that mutations in the putative zinc finger DNA binding domain and in the N-terminal domain result in loss of reporter gene transactivation. It is surprising that transfection studies demonstrate aberrant cytoplasmic localization resulting from mutations between amino acids 253-323 of the ZIC3 protein, indicating that the pathogenesis of a subset of ZIC3 mutations results at least in part from failure of appropriate nuclear localization. These results further expand the phenotypic and genotypic spectrum of ZIC3 mutations and provide initial mechanistic insight into their functional consequences.
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Affiliation(s)
- Stephanie M. Ware
- Departments of Molecular and Human Genetics and Pediatrics, Cardiology Section, Baylor College of Medicine, Houston; and Children’s & Women’s Health Centre, Vancouver
| | - Jianlan Peng
- Departments of Molecular and Human Genetics and Pediatrics, Cardiology Section, Baylor College of Medicine, Houston; and Children’s & Women’s Health Centre, Vancouver
| | - Lirong Zhu
- Departments of Molecular and Human Genetics and Pediatrics, Cardiology Section, Baylor College of Medicine, Houston; and Children’s & Women’s Health Centre, Vancouver
| | - Susan Fernbach
- Departments of Molecular and Human Genetics and Pediatrics, Cardiology Section, Baylor College of Medicine, Houston; and Children’s & Women’s Health Centre, Vancouver
| | - Suzanne Colicos
- Departments of Molecular and Human Genetics and Pediatrics, Cardiology Section, Baylor College of Medicine, Houston; and Children’s & Women’s Health Centre, Vancouver
| | - Brett Casey
- Departments of Molecular and Human Genetics and Pediatrics, Cardiology Section, Baylor College of Medicine, Houston; and Children’s & Women’s Health Centre, Vancouver
| | - Jeffrey Towbin
- Departments of Molecular and Human Genetics and Pediatrics, Cardiology Section, Baylor College of Medicine, Houston; and Children’s & Women’s Health Centre, Vancouver
| | - John W. Belmont
- Departments of Molecular and Human Genetics and Pediatrics, Cardiology Section, Baylor College of Medicine, Houston; and Children’s & Women’s Health Centre, Vancouver
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Baschat A, Towbin J, Harman C, Weiner C. Outcome after second-trimester detection of amniotic fluid viral genome. Am J Obstet Gynecol 2003. [DOI: 10.1016/j.ajog.2003.10.117] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVES The purpose of this study was to test the relationship between adenovirus genetic material in the amniotic fluid and adverse pregnancy outcome. STUDY DESIGN This was a prospective, observational study of women who were referred in the second trimester of gestation for either genetic amniocentesis or evaluation of fetal malformation. A 2-mL aliquot of amniotic fluid was subjected to multiplex polymerase chain reaction for a panel of viruses that included adenovirus and human genome controls. Fetuses with an abnormal karyotype were excluded from analysis. RESULTS The prevalence of adenovirus was similar in normal (39/652) and anomalous fetuses (23/364; chi(2) test, P=.376). There was significant seasonal variation in the prevalence in both normal and anomalous fetuses (chi(2) exact test, P<.001), but no significant difference between groups. The monthly proportion of patients who underwent amniocentesis remained constant throughout the year (mean, 8.3%; chi(2) test, P=.67). Central nervous system anomalies and echogenic liver foci were significantly more common among fetuses with positive amniotic fluid polymerase chain reaction results for adenovirus (P<.005, respectively). CONCLUSION Adenovirus is found in a similar prevalence and seasonal variation in sonographically normal and abnormal pregnancies. Although a specific fetal presentation was not identified, echogenic liver lesions with or without hydrops and neural tube defects were significantly more common in the presence of adenovirus. The significance of these findings deserves further study.
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Affiliation(s)
- Ahmet A Baschat
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Advanced Fetal Care, University of Maryland, Baltimore 21201, USA.
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Baschat AA, Towbin J, Bowles NE, Harman CR, Weiner CP. Prevalence of viral DNA in amniotic fluid of low-risk pregnancies in the second trimester. J Matern Fetal Neonatal Med 2003; 13:381-4. [PMID: 12962262 DOI: 10.1080/jmf.13.6.381.384] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM The association between fetal viral infection and adverse pregnancy outcome is well documented. However, the prevalence of common viral pathogens in the amniotic fluid of normal pregnancies is not established. The purpose of this study was to determine this prevalence in asymptomatic patients. METHODS This was a prospective observational study of patients at low risk for viral infection who were referred for second-trimester genetic amniocentesis. In patients with normal fetal anatomy on ultrasound and a normal fetal karyotype, a 2-ml aliquot of amniotic fluid obtained at amniocentesis was analyzed by multiplex polymerase chain reaction for cytomegalovirus (CMV), parvovirus B19, adenovirus, enterovirus, herpes simplex virus (HSV), respiratory syncytial virus (RSV) and Epstein-Barr virus (EBV). RESULTS Among 686 patients, advanced maternal age was the most common indication for genetic testing (n = 469, 68.4%), followed by elevated aneuploidy risk on triple screen (n = 164, 23.9%), elevated maternal serum alpha-fetoprotein (n = 20, 2.9%), previous aneuploidy (n = 16, 2.3%) and family history of inheritable disease (n = 14, 2.1%). Forty-four (6.4%) amniotic fluid samples were positive for viral genome. A single genome was amplified in 41 samples (93%). In three samples, two viral genomes were identified. Adenovirus was most frequently identified (37/44), followed by CMV (5/44), EBV (2/44), enterovirus (2/44) and RSV (1/44). Parvovirus and HSV were not identified. There was a bimodal seasonal variation in prevalence, with the highest prevalence during the summer and late winter. CONCLUSION Viral genome is commonly found in amniotic fluid with a sonographically normal fetus, and the prevalence follows a seasonal pattern. The mechanism, significance and effects of this asymptomatic viral presence require further study.
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Affiliation(s)
- A A Baschat
- Center for Advanced Fetal Care, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, Maryland 21201-1703, USA
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38
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Rampazzo A, Beffagna G, Nava A, Occhi G, Bauce B, Noiato M, Basso C, Frigo G, Thiene G, Towbin J, Danieli GA. Arrhythmogenic right ventricular cardiomyopathy type 1 (ARVD1): confirmation of locus assignment and mutation screening of four candidate genes. Eur J Hum Genet 2003; 11:69-76. [PMID: 12529708 DOI: 10.1038/sj.ejhg.5200914] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2002] [Revised: 07/10/2002] [Accepted: 10/10/2002] [Indexed: 11/09/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy type 1 (ARVD1) is an autosomal dominant disorder characterised by progressive degeneration of right ventricular myocardium, arrhythmias and risk of sudden death. By linkage analysis, we previously mapped the involved gene to chromosome 14q24.3. In the present study we report on linkage analysis of one additional and unrelated family, which enabled to confirm previous locus assignment. Another family is reported, in which genetic and clinical data suggest linkage to the same locus. Direct sequencing of DNA from individuals belonging to established ARVD1 families failed to detect causative mutations in exonic sequences of four genes (POMT2, TGFbeta3, KIAAA1036 and KIAA0759) expressed in the heart and which defects could possibly induce plasma membrane instability or apoptosis, key features of ARVD pathogenesis.
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39
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Maheshwari M, Belmont J, Fernbach S, Ho T, Molinari L, Yakub I, Yu F, Combes A, Towbin J, Craigen WJ, Gibbs R. PTPN11 mutations in Noonan syndrome type I: detection of recurrent mutations in exons 3 and 13. Hum Mutat 2002; 20:298-304. [PMID: 12325025 DOI: 10.1002/humu.10129] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We surveyed 16 subjects with the clinical diagnosis of Noonan Syndrome (NS1) from 12 families and their relevant family members for mutations in PTPN11/SHP2 using direct DNA sequencing. We found three different mutations among five families. Two unrelated subjects shared the same de novo missense substitution in exon 13 (S502T); an additional two unrelated families had a mutation in exon 3 (Y63C); and one subject had the amino acid substitution Y62D, also in exon 3. None of the three mutations were present in ethnically matched controls. In the mature protein model, the exon 3 mutants and the exon 13 mutant amino acids cluster at the interface between the N' SH2 domain and the phosphatase catalytic domain. Six of eight subjects with PTPN11/SHP2 mutations had pulmonary valve stenosis while no mutations were identified in those subjects (N = 4) with hypertrophic cardiomyopathy. An additional four subjects with possible Noonan syndrome were evaluated, but no mutations in PTPN11/SHP2 were identified. These results confirm that mutations in PTPN11/SHP2 underlie a common form of Noonan syndrome, and that the disease exhibits both allelic and locus heterogeneity. The observation of recurrent mutations supports the hypothesis that a special class of gain-of-function mutations in SHP2 give rise to Noonan syndrome.
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Affiliation(s)
- M Maheshwari
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
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40
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Brugada J, Brugada R, Antzelevitch C, Towbin J, Nademanee K, Brugada P. Long-term follow-up of individuals with the electrocardiographic pattern of right bundle-branch block and ST-segment elevation in precordial leads V1 to V3. Circulation 2002; 105:73-8. [PMID: 11772879 DOI: 10.1161/hc0102.101354] [Citation(s) in RCA: 430] [Impact Index Per Article: 19.5] [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: 11/16/2022]
Abstract
BACKGROUND The electrocardiographic pattern of right bundle-branch block with ST-segment elevation in leads V1 to V3 is increasingly recognized among patients who have aborted sudden cardiac death, but also in asymptomatic individuals, raising questions about its prognostic significance. METHODS AND RESULTS The clinical, electrophysiological, and follow-up data of 334 patients with the Brugada phenotype were analyzed. A total of 79 women and 255 men with a mean age at diagnosis of 42+/-16 years were studied. The abnormal ECG was recognized after a resuscitated cardiac arrest in 71 patients (group A), after a syncopal episode in 73 patients (group B), and in 190 asymptomatic individuals (group C). Sustained ventricular arrhythmias were inducible in 83%, 63%, and 33% of patients in group A, group B, and group C, respectively. During 54+/-54 and 26+/-36 months of follow-up, respectively, 62% of patients in group A and 19% of group B patients had a new arrhythmic event. Inducibility of ventricular arrhythmias was the only predictor of arrhythmia occurrence in both groups. During a mean follow-up of 27+/-29 months, 8% of group C individuals had a first arrhythmic event. In these individuals, inducibility of ventricular arrhythmias and a basal abnormal ECG were predictors of arrhythmia occurrence. CONCLUSIONS An ECG showing right bundle-branch block and ST-segment elevation in the right precordial leads is a marker of malignant ventricular arrhythmias and sudden death. Recurrence of malignant arrhythmias is high after the occurrence of symptoms. Among asymptomatic individuals, those with a spontaneously abnormal ECG and inducible to ventricular arrhythmias have the poorer prognosis.
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Affiliation(s)
- Josep Brugada
- Arrhythmia Section, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Spain.
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41
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Reddy U, Zlatnik M, Baschat A, Towbin J, Harman C, Weiner C. 408 Detection of viral deoxyribonucleic acid in amniotic fluid: Predictor of abnormal pregnancy. Am J Obstet Gynecol 2001. [DOI: 10.1016/s0002-9378(01)80440-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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42
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Bamford RN, Roessler E, Burdine RD, Saplakoğlu U, dela Cruz J, Splitt M, Goodship JA, Towbin J, Bowers P, Ferrero GB, Marino B, Schier AF, Shen MM, Muenke M, Casey B. Loss-of-function mutations in the EGF-CFC gene CFC1 are associated with human left-right laterality defects. Nat Genet 2000; 26:365-9. [PMID: 11062482 DOI: 10.1038/81695] [Citation(s) in RCA: 271] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
All vertebrates display a characteristic asymmetry of internal organs with the cardiac apex, stomach and spleen towards the left, and the liver and gall bladder on the right. Left-right (L-R) axis abnormalities or laterality defects are common in humans (1 in 8,500 live births). Several genes (such as Nodal, Ebaf and Pitx2) have been implicated in L-R organ positioning in model organisms. In humans, relatively few genes have been associated with a small percentage of human situs defects. These include ZIC3 (ref. 5), LEFTB (formerly LEFTY2; ref. 6) and ACVR2B (encoding activin receptor IIB; ref. 7). The EGF-CFC genes, mouse Cfc1 (encoding the Cryptic protein; ref. 9) and zebrafish one-eyed pinhead (oep; refs 10, 11) are essential for the establishment of the L-R axis. EGF-CFC proteins act as co-factors for Nodal-related signals, which have also been implicated in L-R axis development. Here we identify loss-of-function mutations in human CFC1 (encoding the CRYPTIC protein) in patients with heterotaxic phenotypes (randomized organ positioning). The mutant proteins have aberrant cellular localization in transfected cells and are functionally defective in a zebrafish oep-mutant rescue assay. Our findings indicate that the essential role of EGF-CFC genes and Nodal signalling in left-right axis formation is conserved from fish to humans. Moreover, our results support a role for environmental and/or genetic modifiers in determining the ultimate phenotype in humans.
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Affiliation(s)
- R N Bamford
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
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43
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John Camm A, Antzelevitch C, Brugada P, Brugada J, Brugada R, Nademanee K, Towbin J, Curtis AB. Clinical approaches to tachyarrhythmias, volume 10: The brugada syndrome. Clin Cardiol 2000. [DOI: 10.1002/clc.4960231122] [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: 11/08/2022] Open
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44
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Waggoner DJ, Towbin J, Gottesman G, Gutmann DH. Clinic-based study of plexiform neurofibromas in neurofibromatosis 1. Am J Med Genet 2000; 92:132-5. [PMID: 10797438] [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] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Individuals with neurofibromatosis 1 (NF1) develop both benign and malignant tumors at an increased frequency. One of the most common benign tumors in NF1 is the plexiform neurofibroma. These tumors cause significant morbidity and mortality on account of their propensity to grow and affect adjacent normal tissues. To determine the clinical profile of plexiform neurofibromas in NF1, we conducted a retrospective review of 68 NF1 patients with plexiform neurofibroma. In our series, 44% of tumors were detected by 5 years of age and most were located in the trunk and extremities. Only two patients developed malignant peripheral nerve sheath tumors in their preexisting plexiform neurofibromas. Lastly, we demonstrate that there were no specific clinical features of NF1 associated with the presence of plexiform neurofibroma. These results underscore the importance of careful serial examinations in the evaluation of patients with NF1.
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Affiliation(s)
- D J Waggoner
- Department of Medical Genetics, Neurofibromatosis Program, St. Louis Children's Hospital, St. Louis, Missouri, USA
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45
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Benhorin J, Goldmit M, MacCluer JW, Blangero J, Goffen R, Leibovitch A, Rahat A, Wang Q, Medina A, Towbin J, Kerem B. Identification of a new SCN5A mutation, D1840G, associated with the long QT syndrome. Hum Mutat 1998. [DOI: 10.1002/(sici)1098-1004(1998)12:1<72::aid-humu17>3.0.co;2-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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46
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Benhorin J, Goldmit M, MacCluer JW, Blangero J, Goffen R, Leibovitch A, Rahat A, Wang Q, Medina A, Towbin J, Kerem B. Identification of a new SCN5A mutation, D1840G, associated with the long QT syndrome. Hum Mutat 1998. [DOI: 10.1002/(sici)1098-1004(1998)12:1<72::aid-humu17>3.3.co;2-q] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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McGiffin DC, Naftel DC, Kirklin JK, Morrow WR, Towbin J, Shaddy R, Alejos J, Rossi A. Predicting outcome after listing for heart transplantation in children: comparison of Kaplan-Meier and parametric competing risk analysis. Pediatric Heart Transplant Study Group. J Heart Lung Transplant 1997; 16:713-22. [PMID: 9257253] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
After listing for pediatric heart transplantation, at any point in time one of the following possibilities could have occurred; death, transplantation, removal from the list because of clinical improvement, or continuing to wait. In the setting of those competing outcomes, the Kaplan-Meier estimate portrays the time-relatedness of an event while ignoring the effect of the other possible outcomes. The competing outcomes method, however, depicts the time relatedness of an event while solving for all possible events simultaneously. The competing outcomes method may potentially provide more accurate information regarding the actual proportion of patients experience an outcome after listing.
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Affiliation(s)
- D C McGiffin
- Department of Surgery, University of Alabama at Birmingham 35294-0007, USA
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48
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Roden DM, Lazzara R, Rosen M, Schwartz PJ, Towbin J, Vincent GM. Multiple mechanisms in the long-QT syndrome. Current knowledge, gaps, and future directions. The SADS Foundation Task Force on LQTS. Circulation 1996; 94:1996-2012. [PMID: 8873679 DOI: 10.1161/01.cir.94.8.1996] [Citation(s) in RCA: 368] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The congenital long-QT syndrome (LQTS) is characterized by prolonged QT intervals, QT interval lability, and polymorphic ventricular tachycardia. The manifestations of the disease vary, with a high incidence of sudden death in some affected families but not in others. Mutations causing LQTS have been identified in three genes, each encoding a cardiac ion channel. In families linked to chromosome 3, mutations in SCN5A, the gene encoding the human cardiac sodium channel, cause the disease, Mutations in the human ether-à-go-go-related gene (HERG), which encodes a delayed-rectifier potassium channel, cause the disease in families linked to chromosome 7. Among affected individuals in families linked to chromosome 11, mutations have been identified in KVLQT1, a newly cloned gene that appears to encode a potassium channel. The SCN5A mutations result in defective sodium channel inactivation, whereas HERG mutations result in decreased outward potassium current. Either mutation would decrease net outward current during repolarization and would thereby account for prolonged QT intervals on the surface ECG. Preliminary data suggest that the clinical presentation in LQTS may be determined in part by the gene affected and possibly even by the specific mutation. The identification of disease genes in LQTS not only represents a major milestone in understanding the mechanisms underlying this disease but also presents new opportunities for combined research at the molecular, cellular, and clinical levels to understand issues such as adrenergic regulation of cardiac electrophysiology and mechanisms of susceptibility to arrhythmias in LQTS and other settings.
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Affiliation(s)
- D M Roden
- Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN 37232-6602, USA
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49
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Van Camp S, Neish S, Towbin J, Pyeritz R, Seidman C, Ballantyne C. THE MOLECULAR BIOLOGY OF CARDIOVASCULAR DISORDERS. Med Sci Sports Exerc 1995. [DOI: 10.1249/00005768-199505001-00753] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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50
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Greve G, Bachinski L, Friedman DL, Czernuzewicz G, Anan R, Towbin J, Seidman CE, Roberts R. Isolation of a de novo mutant myocardial beta MHC protein in a pedigree with hypertrophic cardiomyopathy. Hum Mol Genet 1994; 3:2073-5. [PMID: 7874131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- G Greve
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030
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