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Puckelwartz MJ, Pesce LL, Hernandez EJ, Webster G, Dellefave-Castillo LM, Russell MW, Geisler SS, Kearns SD, Karthik F, Etheridge SP, Monroe TO, Pottinger TD, Kannankeril PJ, Shoemaker MB, Fountain D, Roden DM, Faulkner M, MacLeod HM, Burns KM, Yandell M, Tristani-Firouzi M, George AL, McNally EM. The impact of damaging epilepsy and cardiac genetic variant burden in sudden death in the young. Genome Med 2024; 16:13. [PMID: 38229148 PMCID: PMC10792876 DOI: 10.1186/s13073-024-01284-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Sudden unexpected death in children is a tragic event. Understanding the genetics of sudden death in the young (SDY) enables family counseling and cascade screening. The objective of this study was to characterize genetic variation in an SDY cohort using whole genome sequencing. METHODS The SDY Case Registry is a National Institutes of Health/Centers for Disease Control and Prevention surveillance effort to discern the prevalence, causes, and risk factors for SDY. The SDY Case Registry prospectively collected clinical data and DNA biospecimens from SDY cases < 20 years of age. SDY cases were collected from medical examiner and coroner offices spanning 13 US jurisdictions from 2015 to 2019. The cohort included 211 children (median age 0.33 year; range 0-20 years), determined to have died suddenly and unexpectedly and from whom DNA biospecimens for DNA extractions and next-of-kin consent were ascertained. A control cohort consisted of 211 randomly sampled, sex- and ancestry-matched individuals from the 1000 Genomes Project. Genetic variation was evaluated in epilepsy, cardiomyopathy, and arrhythmia genes in the SDY and control cohorts. American College of Medical Genetics/Genomics guidelines were used to classify variants as pathogenic or likely pathogenic. Additionally, pathogenic and likely pathogenic genetic variation was identified using a Bayesian-based artificial intelligence (AI) tool. RESULTS The SDY cohort was 43% European, 29% African, 3% Asian, 16% Hispanic, and 9% with mixed ancestries and 39% female. Six percent of the cohort was found to harbor a pathogenic or likely pathogenic genetic variant in an epilepsy, cardiomyopathy, or arrhythmia gene. The genomes of SDY cases, but not controls, were enriched for rare, potentially damaging variants in epilepsy, cardiomyopathy, and arrhythmia-related genes. A greater number of rare epilepsy genetic variants correlated with younger age at death. CONCLUSIONS While damaging cardiomyopathy and arrhythmia genes are recognized contributors to SDY, we also observed an enrichment in epilepsy-related genes in the SDY cohort and a correlation between rare epilepsy variation and younger age at death. These findings emphasize the importance of considering epilepsy genes when evaluating SDY.
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Affiliation(s)
- Megan J Puckelwartz
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Lorenzo L Pesce
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Gregory Webster
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Mark W Russell
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Sarah S Geisler
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Samuel D Kearns
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Felix Karthik
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Susan P Etheridge
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Tanner O Monroe
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tess D Pottinger
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Prince J Kannankeril
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Benjamin Shoemaker
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Darlene Fountain
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dan M Roden
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Kristin M Burns
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Yandell
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | | | - Alfred L George
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elizabeth M McNally
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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2
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Vissing CR, Axelsson Raja A, Day SM, Russell MW, Zahka K, Lever HM, Pereira AC, Colan SD, Margossian R, Murphy AM, Canter C, Bach RG, Wheeler MT, Rossano JW, Owens AT, Benson L, Mestroni L, Taylor MRG, Patel AR, Wilmot I, Thrush P, Soslow JH, Becker JR, Seidman CE, Lakdawala NK, Cirino AL, McMurray JJV, MacRae CA, Solomon SD, Bundgaard H, Orav EJ, Ho CY. Cardiac Remodeling in Subclinical Hypertrophic Cardiomyopathy: The VANISH Randomized Clinical Trial. JAMA Cardiol 2023; 8:1083-1088. [PMID: 37672268 PMCID: PMC10483382 DOI: 10.1001/jamacardio.2023.2808] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/23/2023] [Indexed: 09/07/2023]
Abstract
Importance Valsartan has shown promise in attenuating cardiac remodeling in patients with early-stage sarcomeric hypertrophic cardiomyopathy (HCM). Genetic testing can identify individuals at risk of HCM in a subclinical stage who could benefit from therapies that prevent disease progression. Objective To explore the potential for valsartan to modify disease development, and to characterize short-term phenotypic progression in subclinical HCM. Design, Setting, and Participants The multicenter, double-blind, placebo-controlled Valsartan for Attenuating Disease Evolution in Early Sarcomeric Hypertrophic Cardiomyopathy (VANISH) randomized clinical trial was conducted from April 2014 to July 2019 at 17 sites in 4 countries (Brazil, Canada, Denmark, and the US), with 2 years of follow-up. The prespecified exploratory VANISH cohort studied here included sarcomere variant carriers with subclinical HCM and early phenotypic manifestations (reduced E' velocity, electrocardiographic abnormalities, or an increased left ventricular [LV] wall thickness [LVWT] to cavity diameter ratio) but no LV hypertrophy (LVH). Data were analyzed between March and December 2022. Interventions Treatment with placebo or valsartan (80 mg/d for children weighing <35 kg, 160 mg/d for children weighing ≥35 kg, or 320 mg/d for adults aged ≥18 years). Main Outcomes and Measures The primary outcome was a composite z score incorporating changes in 9 parameters of cardiac remodeling (LV cavity volume, LVWT, and LV mass; left atrial [LA] volume; E' velocity and S' velocity; and serum troponin and N-terminal prohormone of brain natriuretic peptide levels). Results This study included 34 participants, with a mean (SD) age of 16 (5) years (all were White). A total of 18 participants (8 female [44%] and 10 male [56%]) were randomized to valsartan and 16 (9 female [56%] and 7 male [44%]) were randomized to placebo. No statistically significant effects of valsartan on cardiac remodeling were detected (mean change in composite z score compared with placebo: -0.01 [95% CI, -0.29 to 0.26]; P = .92). Overall, 2-year phenotypic progression was modest, with only a mild increase in LA volume detected (increased by 3.5 mL/m2 [95% CI, 1.4-6.0 mL/m2]; P = .002). Nine participants (26%) had increased LVWT, including 6 (18%) who developed clinically overt HCM. Baseline LA volume index (LAVI; 35 vs 28 mL/m2; P = .01) and average interventricular septum thickness (8.5 vs 7.0 mm; P = .009) were higher in participants who developed HCM. Conclusions and Relevance In this exploratory cohort, valsartan was not proven to slow progression of subclinical HCM. Minimal changes in markers of cardiac remodeling were observed, although nearly one-fifth of patients developed clinically overt HCM. Transition to disease was associated with greater baseline interventricular septum thickness and LAVI. These findings highlight the importance of following sarcomere variant carriers longitudinally and the critical need to improve understanding of factors that drive disease penetrance and progression. Trial Registration ClinicalTrials.gov Identifier: NCT01912534.
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Affiliation(s)
- Christoffer Rasmus Vissing
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna Axelsson Raja
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sharlene M. Day
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | | | | | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Steven D. Colan
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Renee Margossian
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Anne M. Murphy
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles Canter
- Washington University School of Medicine, St Louis, Missouri
| | - Richard G. Bach
- Washington University School of Medicine, St Louis, Missouri
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Anjali T. Owens
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Lee Benson
- Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Amit R. Patel
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville
| | - Ivan Wilmot
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Philip Thrush
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | - Jason R. Becker
- Division of Cardiology, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, Pennsylvania
| | - Christine E. Seidman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Neal K. Lakdawala
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Allison L. Cirino
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - John J. V. McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Calum A. MacRae
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott D. Solomon
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - E. John Orav
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carolyn Y. Ho
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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3
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Miller TA, Hernandez EJ, Gaynor JW, Russell MW, Newburger JW, Chung W, Goldmuntz E, Cnota JF, Zyblewski SC, Mahle WT, Zak V, Ravishankar C, Kaltman JR, McCrindle BW, Clarke S, Votava-Smith JK, Graham EM, Seed M, Rudd N, Bernstein D, Lee TM, Yandell M, Tristani-Firouzi M. Genetic and clinical variables act synergistically to impact neurodevelopmental outcomes in children with single ventricle heart disease. Commun Med (Lond) 2023; 3:127. [PMID: 37758840 PMCID: PMC10533527 DOI: 10.1038/s43856-023-00361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Recent large-scale sequencing efforts have shed light on the genetic contribution to the etiology of congenital heart defects (CHD); however, the relative impact of genetics on clinical outcomes remains less understood. Outcomes analyses using genetics are complicated by the intrinsic severity of the CHD lesion and interactions with conditionally dependent clinical variables. METHODS Bayesian Networks were applied to describe the intertwined relationships between clinical variables, demography, and genetics in a cohort of children with single ventricle CHD. RESULTS As isolated variables, a damaging genetic variant in a gene related to abnormal heart morphology and prolonged ventilator support following stage I palliative surgery increase the probability of having a low Mental Developmental Index (MDI) score at 14 months of age by 1.9- and 5.8-fold, respectively. However, in combination, these variables act synergistically to further increase the probability of a low MDI score by 10-fold. The absence of a damaging variant in a known syndromic CHD gene and a shorter post-operative ventilator support increase the probability of a normal MDI score 1.7- and 2.4-fold, respectively, but in combination increase the probability of a good outcome by 59-fold. CONCLUSIONS Our analyses suggest a modest genetic contribution to neurodevelopmental outcomes as isolated variables, similar to known clinical predictors. By contrast, genetic, demographic, and clinical variables interact synergistically to markedly impact clinical outcomes. These findings underscore the importance of capturing and quantifying the impact of damaging genomic variants in the context of multiple, conditionally dependent variables, such as pre- and post-operative factors, and demography.
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Grants
- UM1 HL098123 NHLBI NIH HHS
- P50 HD105351 NICHD NIH HHS
- U01 HL068269 NHLBI NIH HHS
- U01 HL068279 NHLBI NIH HHS
- U01 HL068288 NHLBI NIH HHS
- U10 HL068270 NHLBI NIH HHS
- U01 HL068270 NHLBI NIH HHS
- UM1 HL128711 NHLBI NIH HHS
- S10 OD021644 NIH HHS
- UM1 HL098147 NHLBI NIH HHS
- U01 HL068292 NHLBI NIH HHS
- U01 HL085057 NHLBI NIH HHS
- U01 HL068285 NHLBI NIH HHS
- U01 HL098163 NHLBI NIH HHS
- UM1 HL098162 NHLBI NIH HHS
- U01 HL098153 NHLBI NIH HHS
- U01 HL131003 NHLBI NIH HHS
- R01 GM104390 NIGMS NIH HHS
- U01 HL068290 NHLBI NIH HHS
- U01 HL068281 NHLBI NIH HHS
- UM1 HL128761 NHLBI NIH HHS
- The clinical data for this project was supported by National Heart, Lung, and Blood Institute (NHLBI) Pediatric Heart Network grants HL068269, HL068270, HL068279, HL068281, HL068285, HL068288, HL068290, HL068292, and HL085057. The genomic data for this project was supported by the NHLBI Pediatric Cardiac Genomics Consortium (UM1-HL098147, UM1-HL128761, UM1-HL098123, UM1-HL128711, UM1-HL098162, U01-HL131003, U01-HL098153, U01-HL098163), the National Center for Research Resources (U01-HL098153), and the National Institutes for Health (R01-GM104390, 1S10OD021644-01A1).
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Affiliation(s)
- Thomas A Miller
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA.
| | - Edgar J Hernandez
- Department of Human Genetics and Utah Center for Genetic Discovery, University of Utah, Salt Lake City, UT, USA
| | - J William Gaynor
- Department of Surgery, Children's Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark W Russell
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Wendy Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James F Cnota
- Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Sinai C Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Chitra Ravishankar
- Division of Cardiology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan R Kaltman
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Shanelle Clarke
- Department of Pediatrics Emory University School of Medicine, Atlanta, GA, USA
| | | | - Eric M Graham
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Mike Seed
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Nancy Rudd
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Teresa M Lee
- Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Mark Yandell
- Department of Human Genetics and Utah Center for Genetic Discovery, University of Utah, Salt Lake City, UT, USA.
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4
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Marshall M, Malik A, Shah M, Fish FA, Etheridge SP, Aziz PF, Russell MW, Tisma S, Pflaumer A, Sreeram N, Kubus P, Law IH, Kantoch MJ, Kertesz NJ, Strieper M, Erickson CC, Moore JP, Nakano SJ, Singh HR, Chang P, Cohen M, Fournier A, Ilina MV, Zimmermann F, Horndasch M, Li W, Batra AS, Liberman L, Hamilton R, Janson CM, Sanatani S, Zeltser I, McDaniel G, Blaufox AD, Garnreiter JM, Balaji S. Patterns of Electrocardiographic Abnormalities in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol 2023:10.1007/s00246-023-03252-4. [PMID: 37684488 DOI: 10.1007/s00246-023-03252-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/25/2023] [Indexed: 09/10/2023]
Abstract
Hypertrophic cardiomyopathy (HCM), a common cardiomyopathy in children, is an important cause of morbidity and mortality. Early recognition and appropriate management are important. An electrocardiogram (ECG) is often used as a screening tool in children to detect heart disease. The ECG patterns in children with HCM are not well described.ECGs collected from an international cohort of children, and adolescents (≤ 21 years) with HCM were reviewed. 482 ECGs met inclusion criteria. Age ranged from 1 day to 21 years, median 13 years. Of the 482 ECGs, 57 (12%) were normal. The most common abnormalities noted were left ventricular hypertrophy (LVH) in 108/482 (22%) and biventricular hypertrophy (BVH) in 116/482 (24%) Of the patients with LVH/BVH (n = 224), 135 (60%) also had a strain pattern (LVH in 83, BVH in 52). Isolated strain pattern (in the absence of criteria for hypertrophy) was seen in 43/482 (9%). Isolated pathologic Q waves were seen in 71/482 (15%). Pediatric HCM, 88% have an abnormal ECG. The most common ECG abnormalities were LVH or BVH with or without strain. Strain pattern without hypertrophy and a pathologic Q wave were present in a significant proportion (24%) of patients. Thus, a significant number of children with HCM have ECG abnormalities that are not typical for "hypertrophy". The presence of the ECG abnormalities described above in a child should prompt further examination with an echocardiogram to rule out HCM.
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Affiliation(s)
- Mayme Marshall
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Aneeq Malik
- University of Los Angeles Olive View, Los Angeles, CA, USA
| | - Maully Shah
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Peter F Aziz
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | | | | | - Andreas Pflaumer
- Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | | | | | - Ian H Law
- University of Iowa, Iowa City, IA, USA
| | | | | | - Margaret Strieper
- Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | | | | | | | - Harinder R Singh
- Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX, USA
| | | | - Mitchell Cohen
- Inova LJ Murphy Children's Hospital, Falls Church, VA, USA
| | | | | | | | | | - Walter Li
- University of California, San Francisco, CA, USA
| | | | | | | | | | | | | | | | - Andrew D Blaufox
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Seshadri Balaji
- Oregon Health and Science University, 707 SW Gaines Street, Portland, OR, 97239, USA.
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5
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Abou Alaiwi S, Roston TM, Marstrand P, Claggett BL, Parikh VN, Helms AS, Ingles J, Lampert R, Lakdawala NK, Michels M, Owens AT, Rossano JW, Saberi S, Abrams DJ, Ashley EA, Semsarian C, Stendahl JC, Ware JS, Miller E, Ryan TD, Russell MW, Day SM, Olivotto I, Vissing CR, Ho CY. Left Ventricular Systolic Dysfunction in Patients Diagnosed With Hypertrophic Cardiomyopathy During Childhood: Insights From the SHaRe Registry. Circulation 2023; 148:394-404. [PMID: 37226762 PMCID: PMC10373850 DOI: 10.1161/circulationaha.122.062517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The development of left ventricular systolic dysfunction (LVSD) in hypertrophic cardiomyopathy (HCM) is rare but serious and associated with poor outcomes in adults. Little is known about the prevalence, predictors, and prognosis of LVSD in patients diagnosed with HCM as children. METHODS Data from patients with HCM in the international, multicenter SHaRe (Sarcomeric Human Cardiomyopathy Registry) were analyzed. LVSD was defined as left ventricular ejection fraction <50% on echocardiographic reports. Prognosis was assessed by a composite of death, cardiac transplantation, and left ventricular assist device implantation. Predictors of developing incident LVSD and subsequent prognosis with LVSD were assessed using Cox proportional hazards models. RESULTS We studied 1010 patients diagnosed with HCM during childhood (<18 years of age) and compared them with 6741 patients with HCM diagnosed as adults. In the pediatric HCM cohort, median age at HCM diagnosis was 12.7 years (interquartile range, 8.0-15.3), and 393 (36%) patients were female. At initial SHaRe site evaluation, 56 (5.5%) patients with childhood-diagnosed HCM had prevalent LVSD, and 92 (9.1%) developed incident LVSD during a median follow-up of 5.5 years. Overall LVSD prevalence was 14.7% compared with 8.7% in patients with adult-diagnosed HCM. Median age at incident LVSD was 32.6 years (interquartile range, 21.3-41.6) for the pediatric cohort and 57.2 years (interquartile range, 47.3-66.5) for the adult cohort. Predictors of developing incident LVSD in childhood-diagnosed HCM included age <12 years at HCM diagnosis (hazard ratio [HR], 1.72 [CI, 1.13-2.62), male sex (HR, 3.1 [CI, 1.88-5.2), carrying a pathogenic sarcomere variant (HR, 2.19 [CI, 1.08-4.4]), previous septal reduction therapy (HR, 2.34 [CI, 1.42-3.9]), and lower initial left ventricular ejection fraction (HR, 1.53 [CI, 1.38-1.69] per 5% decrease). Forty percent of patients with LVSD and HCM diagnosed during childhood met the composite outcome, with higher rates in female participants (HR, 2.60 [CI, 1.41-4.78]) and patients with a left ventricular ejection fraction <35% (HR, 3.76 [2.16-6.52]). CONCLUSIONS Patients with childhood-diagnosed HCM have a significantly higher lifetime risk of developing LVSD, and LVSD emerges earlier than for patients with adult-diagnosed HCM. Regardless of age at diagnosis with HCM or LVSD, the prognosis with LVSD is poor, warranting careful surveillance for LVSD, especially as children with HCM transition to adult care.
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Affiliation(s)
- Sarah Abou Alaiwi
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
| | - Thomas M. Roston
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
- University of British Columbia, Vancouver, Canada (T.M.R.)
| | - Peter Marstrand
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Denmark (P.M.)
| | - Brian Lee Claggett
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
| | - Victoria N. Parikh
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (V.N.P., E.A.A.)
| | - Adam S. Helms
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.S.H., S.S., M.W.R.)
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and University of New South Wales, Sydney, Australia (J.I.)
| | - Rachel Lampert
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.C.S.)
| | - Neal K. Lakdawala
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (M.M.)
| | - Anjali T. Owens
- Division of Cardiology, University of Pennsylvania, Philadelphia (A.T.O., S.M.D.)
| | - Joseph W. Rossano
- Division of Cardiology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (J.W.R.)
| | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.S.H., S.S., M.W.R.)
| | - Dominic J. Abrams
- Center for Cardiovascular Genetics, Department of Cardiology, Boston Children’s Hospital & Harvard Medical School, MA (D.J.A.)
| | - Euan A. Ashley
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (V.N.P., E.A.A.)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Australia (C.S.)
| | - John C. Stendahl
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.C.S.)
| | - James S. Ware
- Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK (J.S.W.)
| | - Erin Miller
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (E.M., T.D.R.)
- Division of Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (E.M., T.D.R.)
| | - Thomas D. Ryan
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (E.M., T.D.R.)
- Division of Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (E.M., T.D.R.)
| | - Mark W. Russell
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.S.H., S.S., M.W.R.)
| | - Sharlene M. Day
- Division of Cardiology, University of Pennsylvania, Philadelphia (A.T.O., S.M.D.)
| | - Iacopo Olivotto
- Meyer Children Hospital, Department of Experimental and Clinical Medicine, University of Florence, Italy (I.O.)
| | - Christoffer R. Vissing
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (C.R.V.)
| | - Carolyn Y. Ho
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
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Gross R, Thaweethai T, Rosenzweig EB, Chan J, Chibnik LB, Cicek MS, Elliott AJ, Flaherman VJ, Foulkes AS, Witvliet MG, Gallagher R, Gennaro ML, Jernigan TL, Karlson EW, Katz SD, Kinser PA, Kleinman LC, Lamendola-Essel MF, Milner JD, Mohandas S, Mudumbi PC, Newburger JW, Rhee KE, Salisbury AL, Snowden JN, Stein CR, Stockwell MS, Tantisira KG, Thomason ME, Truong DT, Warburton D, Wood JC, Ahmed S, Akerlundh A, Alshawabkeh AN, Anderson BR, Aschner JL, Atz AM, Aupperle RL, Baker FC, Balaraman V, Banerjee D, Barch DM, Baskin-Sommers A, Bhuiyan S, Bind MAC, Bogie AL, Buchbinder NC, Bueler E, Bükülmez H, Casey B, Chang L, Clark DB, Clifton RG, Clouser KN, Cottrell L, Cowan K, D’Sa V, Dapretto M, Dasgupta S, Dehority W, Dummer KB, Elias MD, Esquenazi-Karonika S, Evans DN, Faustino EVS, Fiks AG, Forsha D, Foxe JJ, Friedman NP, Fry G, Gaur S, Gee DG, Gray KM, Harahsheh AS, Heath AC, Heitzeg MM, Hester CM, Hill S, Hobart-Porter L, Hong TK, Horowitz CR, Hsia DS, Huentelman M, Hummel KD, Iacono WG, Irby K, Jacobus J, Jacoby VL, Jone PN, Kaelber DC, Kasmarcak TJ, Kluko MJ, Kosut JS, Laird AR, Landeo-Gutierrez J, Lang SM, Larson CL, Lim PPC, Lisdahl KM, McCrindle BW, McCulloh RJ, Mendelsohn AL, Metz TD, Morgan LM, Müller-Oehring EM, Nahin ER, Neale MC, Ness-Cochinwala M, Nolan SM, Oliveira CR, Oster ME, Payne RM, Raissy H, Randall IG, Rao S, Reeder HT, Rosas JM, Russell MW, Sabati AA, Sanil Y, Sato AI, Schechter MS, Selvarangan R, Shakti D, Sharma K, Squeglia LM, Stevenson MD, Szmuszkovicz J, Talavera-Barber MM, Teufel RJ, Thacker D, Udosen MM, Warner MR, Watson SE, Werzberger A, Weyer JC, Wood MJ, Yin HS, Zempsky WT, Zimmerman E, Dreyer BP. Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design. medRxiv 2023:2023.04.27.23289228. [PMID: 37214806 PMCID: PMC10197716 DOI: 10.1101/2023.04.27.23289228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Importance The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. Observations We describe the protocol for the Pediatric Observational Cohort Study of the NIH's RE searching COV ID to E nhance R ecovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of five cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study ( n =10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n=6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n=6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n=600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. Conclusions and Relevance RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions. Clinical Trialsgov Identifier Clinical Trial Registration: http://www.clinicaltrials.gov . Unique identifier: NCT05172011.
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Affiliation(s)
- Rachel Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Erika B. Rosenzweig
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Lori B. Chibnik
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Mine S. Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Rochester, MN, USA
| | - Amy J. Elliott
- Avera Research Institute, Avera Health, Sioux Falls, SD, USA
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | | | - Richard Gallagher
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Maria Laura Gennaro
- Public Health Research Institute and Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Terry L. Jernigan
- Center for Human Development, Cognitive Science, Psychiatry, Radiology, University of California San Diego, La Jolla, CA, USA
| | | | - Stuart D. Katz
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Patricia A. Kinser
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Lawrence C. Kleinman
- Department of Pediatrics, Division of Population Health, Quality, and Implementation Sciences (POPQuIS), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Joshua D. Milner
- Department of Pediatrics, Columbia University Medical Center: Columbia University Irving Medical Center, New York, NY, USA
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children’s Hospital Los Angeles and the Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Praveen C. Mudumbi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - Kyung E. Rhee
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Amy L. Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica N. Snowden
- Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cheryl R. Stein
- Department of Child and Adolescent Psychiatry, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, USA
| | - Melissa S. Stockwell
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY, USA
| | - Kelan G. Tantisira
- Division of Pediatric Respiratory Medicine, University of California San Diego, San Diego, CA, USA
| | - Moriah E. Thomason
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Dongngan T. Truong
- Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
| | - David Warburton
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Shifa Ahmed
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Almary Akerlundh
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | | | - Brett R. Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Andrew M. Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Robin L. Aupperle
- Oxley College of Health Sciences, Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Venkataraman Balaraman
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Dithi Banerjee
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, Saint Louis, MO, USA
| | | | - Sultana Bhuiyan
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Marie-Abele C. Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda L. Bogie
- Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Natalie C. Buchbinder
- Center for Human Development, University of California San Diego, San Diego, CA, USA
| | - Elliott Bueler
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Hülya Bükülmez
- Department of Pediatrics, Division of Rheumatology, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - B.J. Casey
- Department of Neuroscience and Behavior, Barnard College - Columbia University, New York, NY, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Duncan B. Clark
- Departments of Psychiatry and Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Katharine N. Clouser
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA
| | - Kelly Cowan
- Department of Pediatrics, Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Viren D’Sa
- Department of Pediatrics, Rhode Island Hospital, Providence, RI, USA
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Soham Dasgupta
- Department of Pediatrics, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - Walter Dehority
- Department of Pediatrics, Division of Infectious Diseases, University of New Mexico, Albuquerque, NM, USA
| | - Kirsten B. Dummer
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Matthew D. Elias
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shari Esquenazi-Karonika
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Danielle N. Evans
- Arkansas Children’s Research Institute, Arkansas Children’s Hospital, Little Rock, AR, USA
| | | | - Alexander G. Fiks
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel Forsha
- Department of Cardiology, Children’s Mercy Kansas City, Ward Family Heart Center, Kansas City, MO, USA, Kansas City, MO, USA
| | - John J. Foxe
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Naomi P. Friedman
- Institute for Behavioral Genetics and Department of Psychology and Neuroscience, University of Colorado Boulder, Bolder, CO, USA
| | - Greta Fry
- Pennington Biomedical Research Center Clinic, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Sunanda Gaur
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dylan G. Gee
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ashraf S. Harahsheh
- Department of Pediatrics, Division of Cardiology, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Andrew C. Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Mary M. Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Christina M. Hester
- Division of Practice-Based Research, Innovation, & Evaluation, American Academy of Family Physicians, Leawood, KS, USA
| | - Sophia Hill
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Laura Hobart-Porter
- Departments of Pediatrics and Physical Medicine & Rehabilitation, Section of Pediatric Rehabilitation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Travis K.F. Hong
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Carol R. Horowitz
- Center for Health Equity and Community Engaged Research and Department of Population Health Science and Policy, New York, NY, USA
| | - Daniel S. Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Matthew Huentelman
- Division of Neurogenomics, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Kathy D. Hummel
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - William G. Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Irby
- Department of Pediatrics, Arkansas Children’s Hospital, University of Arkansas Medical School, Little Rock, AR, USA
| | - Joanna Jacobus
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Pei-Ni Jone
- Department of Pediatrics, Pediatric Cardiology, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David C. Kaelber
- Departments of Pediatrics, Internal Medicine, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Tyler J. Kasmarcak
- Department of Pediatric Clinical Research, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J. Kluko
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Jessica S. Kosut
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Angela R. Laird
- Department of Physics, Florida International University, Miami, FL, USA
| | - Jeremy Landeo-Gutierrez
- Department of Pediatrics, Respiratory Medicine Division, University of California San Diego, San Diego, CA, USA
| | - Sean M. Lang
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Peter Paul C. Lim
- Department of Pediatric Infectious Disease, Avera McKennan University Health Center, University of South Dakota, Sioux Falls, SD, USA
| | - Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, Canada
| | - Russell J. McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alan L. Mendelsohn
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Lerraughn M. Morgan
- Department of Pediatrics, Valley Children’s Healthcare, Department of Pediatrics, Madera, CA, Madera, CA, USA
| | | | - Erica R. Nahin
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Michael C. Neale
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Manette Ness-Cochinwala
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sheila M. Nolan
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Carlos R. Oliveira
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew E. Oster
- Department of Pediatric Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - R. Mark Payne
- Department of Pediatrics, Division of Pediatric Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hengameh Raissy
- Department of Pediatrics, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA
| | - Isabelle G. Randall
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Suchitra Rao
- Department of Pediatrics, Division of Infectious Diseases, Epidemiology and Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Harrison T. Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Johana M. Rosas
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Mark W. Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA
| | - Arash A. Sabati
- Department of Pediatric Cardiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Yamuna Sanil
- Division of Pediatric Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Alice I. Sato
- Department of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael S. Schechter
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Divya Shakti
- Department of Pediatrics, Pediatric Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kavita Sharma
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle D. Stevenson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Maria M. Talavera-Barber
- Department of Pediatrics, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA
| | - Ronald J. Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Childrens Health, Delaware, Wilmington, DE, USA
| | - Mmekom M. Udosen
- RECOVER Neurocognitive and Wellbeing/Mental Health Team, NYU Grossman School of Medicine, New York, NY, USA
| | - Megan R. Warner
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | - Sara E. Watson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Alan Werzberger
- Department of Pediatrics, Columbia University Medical Center: Columbia University Irving Medical Center, New York, NY, USA
| | - Jordan C. Weyer
- Center for Individualized Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Marion J. Wood
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - H. Shonna Yin
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - William T. Zempsky
- Department of Pediatrics, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, Boston, MA, USA
| | - Benard P. Dreyer
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
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Kim Y, Mastali M, Van Eyk JE, Orav EJ, Vissing CR, Day SM, Raja AA, Russell MW, Zahka K, Lever HM, Pereira AC, Murphy AM, Canter C, Bach RG, Wheeler MT, Rossano JW, Owens AT, Bundgaard H, Benson L, Mestroni L, Taylor MRG, Patel AR, Wilmot I, Thrush P, Soslow JH, Becker JR, Seidman CE, Ho CY. Transforming Growth Factor-β Analysis of the VANISH Trial Cohort. Circ Heart Fail 2023; 16:e010314. [PMID: 36999957 PMCID: PMC10121916 DOI: 10.1161/circheartfailure.122.010314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Yuri Kim
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA, USA
| | - Mitra Mastali
- Advanced Clinical Biosystems Research Institute, The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer E. Van Eyk
- Advanced Clinical Biosystems Research Institute, The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - E. John Orav
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Christoffer R. Vissing
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA, USA
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sharlene M. Day
- Division of Cardiovascular Medicine Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Anna Axelsson Raja
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mark W. Russell
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Kenneth Zahka
- Department of Pediatric Cardiology, Cleveland Clinic Children’s, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Harry M. Lever
- Department of Pediatric Cardiology, Cleveland Clinic Children’s, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Anne M. Murphy
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Canter
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard G. Bach
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph W. Rossano
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anjali T. Owens
- Division of Cardiovascular Medicine Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lee Benson
- The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Luisa Mestroni
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew R. G. Taylor
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amit R. Patel
- Division of Cardiology, University of Virginia, Charlottesville, VA, USA
| | - Ivan Wilmot
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Philip Thrush
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Jonathan H. Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason R. Becker
- Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christine E. Seidman
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | | | - Carolyn Y. Ho
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA, USA
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Puckelwartz MJ, Pesce LL, Hernandez EJ, Webster G, Dellefave-Castillo LM, Russell MW, Geisler SS, Kearns SD, Etheridge FK, Etheridge SP, Monroe TO, Pottinger TD, Kannankeril PJ, Shoemaker MB, Fountain D, Roden DM, MacLeod H, Burns KM, Yandell M, Tristani-Firouzi M, George AL, McNally EM. The impact of damaging epilepsy and cardiac genetic variant burden in sudden death in the young. medRxiv 2023:2023.03.27.23287711. [PMID: 37034657 PMCID: PMC10081419 DOI: 10.1101/2023.03.27.23287711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background Sudden unexpected death in children is a tragic event. Understanding the genetics of sudden death in the young (SDY) enables family counseling and cascade screening. The objective of this study was to characterize genetic variation in an SDY cohort using whole genome sequencing. Methods The SDY Case Registry is a National Institutes of Health/Centers for Disease Control surveillance effort to discern the prevalence, causes, and risk factors for SDY. The SDY Case Registry prospectively collected clinical data and DNA biospecimens from SDY cases <20 years of age. SDY cases were collected from medical examiner and coroner offices spanning 13 US jurisdictions from 2015-2019. The cohort included 211 children (mean age 1 year; range 0-20 years), determined to have died suddenly and unexpectedly and in whom DNA biospecimens and next-of-kin consent were ascertained. A control cohort consisted of 211 randomly sampled, sex-and ancestry-matched individuals from the 1000 Genomes Project. Genetic variation was evaluated in epilepsy, cardiomyopathy and arrhythmia genes in the SDY and control cohorts. American College of Medical Genetics/Genomics guidelines were used to classify variants as pathogenic or likely pathogenic. Additionally, genetic variation predicted to be damaging was identified using a Bayesian-based artificial intelligence (AI) tool. Results The SDY cohort was 42% European, 30% African, 17% Hispanic, and 11% with mixed ancestries, and 39% female. Six percent of the cohort was found to harbor a pathogenic or likely pathogenic genetic variant in an epilepsy, cardiomyopathy or arrhythmia gene. The genomes of SDY cases, but not controls, were enriched for rare, damaging variants in epilepsy, cardiomyopathy and arrhythmia-related genes. A greater number of rare epilepsy genetic variants correlated with younger age at death. Conclusions While damaging cardiomyopathy and arrhythmia genes are recognized contributors to SDY, we also observed an enrichment in epilepsy-related genes in the SDY cohort, and a correlation between rare epilepsy variation and younger age at death. These findings emphasize the importance of considering epilepsy genes when evaluating SDY.
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Lynch A, Tatangelo M, Ahuja S, Steve Fan CP, Min S, Lafreniere-Roula M, Papaz T, Zhou V, Armstrong K, Aziz PF, Benson LN, Butts R, Dragulescu A, Gardin L, Godown J, Jeewa A, Kantor PF, Kaufman BD, Lal AK, Parent JJ, Richmond M, Russell MW, Balaji S, Stephenson EA, Villa C, Jefferies JL, Whitehill R, Conway J, Howard TS, Nakano SJ, Rossano J, Weintraub RG, Mital S. Risk of Sudden Death in Patients With RASopathy Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2023; 81:1035-1045. [PMID: 36922089 DOI: 10.1016/j.jacc.2023.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/29/2022] [Accepted: 01/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Genetic defects in the RAS/mitogen-activated protein kinase pathway are an important cause of hypertrophic cardiomyopathy (RAS-HCM). Unlike primary HCM (P-HCM), the risk of sudden cardiac death (SCD) and long-term survival in RAS-HCM are poorly understood. OBJECTIVES The study's objective was to compare transplant-free survival, incidence of SCD, and implantable cardioverter-defibrillator (ICD) use between RAS-HCM and P-HCM patients. METHODS In an international, 21-center cohort study, we analyzed phenotype-positive pediatric RAS-HCM (n = 188) and P-HCM (n = 567) patients. The between-group differences in cumulative incidence of all outcomes from first evaluation were compared using Gray's tests, and age-related hazard of all-cause mortality was determined. RESULTS RAS-HCM patients had a lower median age at diagnosis compared to P-HCM (0.9 years [IQR: 0.2-5.0 years] vs 9.8 years [IQR: 2.0-13.9 years], respectively) (P < 0.001). The 10-year cumulative incidence of SCD from first evaluation was not different between RAS-HCM and P-HCM (4.7% vs 4.2%, respectively; P = 0.59). The 10-year cumulative incidence of nonarrhythmic deaths or transplant was higher in RAS-HCM compared with P-HCM (11.0% vs 5.4%, respectively; P = 0.011). The 10-year cumulative incidence of ICD insertions, however, was 5-fold lower in RAS-HCM compared with P-HCM (6.9% vs 36.6%; P < 0.001). Nonarrhythmic deaths occurred primarily in infancy and SCD primarily in adolescence. CONCLUSIONS RAS-HCM was associated with a higher incidence of nonarrhythmic death or transplant but similar incidence of SCD as P-HCM. However, ICDs were used less frequently in RAS-HCM compared to P-HCM. In addition to monitoring for heart failure and timely consideration of advanced heart failure therapies, better risk stratification is needed to guide ICD practices in RAS-HCM.
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Affiliation(s)
- Aine Lynch
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada
| | - Mark Tatangelo
- Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Sachin Ahuja
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Chun-Po Steve Fan
- Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Sandar Min
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Myriam Lafreniere-Roula
- Applied Health Research Centre, St Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada
| | - Tanya Papaz
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
| | - Vivian Zhou
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathryn Armstrong
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Peter F Aziz
- Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Lee N Benson
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada
| | - Ryan Butts
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Andreea Dragulescu
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada
| | - Letizia Gardin
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Justin Godown
- Department of Pediatrics, Monroe Carrell Jr Children's Hospital at Vanderbilt University, Nashville, Tennessee, USA
| | - Aamir Jeewa
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada
| | - Paul F Kantor
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Beth D Kaufman
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Ashwin K Lal
- Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
| | - John J Parent
- Department of Pediatrics, Riley Children's Hospital, Indianapolis, Indiana, USA
| | - Marc Richmond
- Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Mark W Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Seshadri Balaji
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - Elizabeth A Stephenson
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada
| | - Chet Villa
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - John L Jefferies
- Department of Pediatrics, University of Tennessee Health Sciences Centre, Memphis, Tennessee, USA
| | - Robert Whitehill
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jennifer Conway
- Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Taylor S Howard
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Stephanie J Nakano
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Joseph Rossano
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert G Weintraub
- Department of Cardiology, The Royal Children's Hospital of Melbourne, Melbourne, Victoria, Australia
| | - Seema Mital
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada; Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada.
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10
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Conway J, Min S, Villa C, Weintraub RG, Nakano S, Godown J, Tatangelo M, Armstrong K, Richmond M, Kaufman B, Lal AK, Balaji S, Power A, Baez Hernandez N, Gardin L, Kantor PF, Parent JJ, Aziz PF, Jefferies JL, Dragulescu A, Jeewa A, Benson L, Russell MW, Whitehill R, Rossano J, Howard T, Mital S. The Prevalence and Association of Exercise Test Abnormalities With Sudden Cardiac Death and Transplant-Free Survival in Childhood Hypertrophic Cardiomyopathy. Circulation 2023; 147:718-727. [PMID: 36335467 PMCID: PMC9977414 DOI: 10.1161/circulationaha.122.062699] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) can be associated with an abnormal exercise response. In adults with HCM, abnormal results on exercise stress testing are predictive of heart failure outcomes. Our goal was to determine whether an abnormal exercise response is associated with adverse outcomes in pediatric patients with HCM. METHODS In an international cohort study including 20 centers, phenotype-positive patients with primary HCM who were <18 years of age at diagnosis were included. Abnormal exercise response was defined as a blunted blood pressure response and new or worsened ST- or T-wave segment changes or complex ventricular ectopy. Sudden cardiac death (SCD) events were defined as a composite of SCD and aborted sudden cardiac arrest. Using Kaplan-Meier survival, competing outcomes, and Cox regression analyses, we analyzed the association of abnormal exercise test results with transplant and SCD event-free survival. RESULTS Of 724 eligible patients, 630 underwent at least 1 exercise test. There were no major differences in clinical characteristics between those with or without an exercise test. The median age at exercise testing was 13.8 years (interquartile range, 4.7 years); 78% were male and 39% were receiving beta-blockers. A total of 175 (28%) had abnormal test results. Patients with abnormal test results had more severe septal hypertrophy, higher left atrial diameter z scores, higher resting left ventricular outflow tract gradient, and higher frequency of myectomy compared with participants with normal test results (P<0.05). Compared with normal test results, abnormal test results were independently associated with lower 5-year transplant-free survival (97% versus 88%, respectively; P=0.005). Patients with exercise-induced ischemia were most likely to experience all-cause death or transplant (hazard ratio, 4.86 [95% CI, 1.69-13.99]), followed by those with an abnormal blood pressure response (hazard ratio, 3.19 [95% CI, 1.32-7.71]). Exercise-induced ischemia was also independently associated with lower SCD event-free survival (hazard ratio, 3.32 [95% CI, 1.27-8.70]). Exercise-induced ectopy was not associated with survival. CONCLUSIONS Exercise abnormalities are common in childhood HCM. An abnormal exercise test result was independently associated with lower transplant-free survival, especially in those with an ischemic or abnormal blood pressure response with exercise. Exercise-induced ischemia was also independently associated with SCD events. These findings argue for routine exercise testing in childhood HCM as part of ongoing risk assessment.
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Affiliation(s)
- Jennifer Conway
- Department of Pediatrics, Stollery Children’s Hospital, Edmonton, Canada (J.C.)
| | - Sandar Min
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Canada (S. Min, S. Mital)
| | - Chet Villa
- Department of Pediatrics, Cincinnati Children’s Hospital, OH (C.V.)
| | - Robert G. Weintraub
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, Australia (R.G.W.)
| | - Stephanie Nakano
- Department of Pediatrics, Children’s Hospital Colorado, Aurora (S.N.)
| | - Justin Godown
- Department of Pediatrics, Monroe Carrell Jr Children’s Hospital at Vanderbilt, Nashville, TN (J.G.)
| | - Mark Tatangelo
- Ted Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (M.T.)
| | - Kathryn Armstrong
- Department of Pediatrics, BC Children’s Hospital, Vancouver, British Columbia, Canada (K.A.)
| | - Marc Richmond
- Department of Pediatrics, Morgan Stanley Children’s Hospital, Columbia University Medical Centre, New York, NY (M.R.)
| | - Beth Kaufman
- Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (B.K.)
| | - Ashwin K. Lal
- Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City (A.K.L.)
| | - Seshadri Balaji
- Department of Pediatrics, Oregon Health and Science University, Portland (S.B.)
| | - Alyssa Power
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.P., N.B.H.)
| | - Nathanya Baez Hernandez
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.P., N.B.H.)
| | - Letizia Gardin
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Canada (L.G.)
| | - Paul F. Kantor
- Department of Pediatrics, Children’s Hospital of Los Angeles, CA (P.F.K.)
| | - John J. Parent
- Department of Pediatrics, Riley Children’s Hospital, Indianapolis, IN (J.J.P.)
| | - Peter F. Aziz
- Department of Pediatrics, Cleveland Clinic Children’s Hospital, OH (P.F.A.)
| | - John L. Jefferies
- Department of Pediatrics, University of Tennessee Health Sciences Centre, Memphis (J.L.J.)
| | - Andreea Dragulescu
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada (A.D., A.J., L.B., S. Mital)
| | - Aamir Jeewa
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada (A.D., A.J., L.B., S. Mital)
| | - Lee Benson
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada (A.D., A.J., L.B., S. Mital)
| | - Mark W. Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor (M.W.R.)
| | - Robert Whitehill
- Department of Pediatrics, Children’s Healthcare of Atlanta, GA (R.W.)
| | - Joseph Rossano
- Department of Pediatrics, Children’s Hospital of Philadelphia, PA (J.R.)
| | - Taylor Howard
- Department of Pediatrics, Texas Children’s Hospital, Houston (T.H.)
| | - Seema Mital
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Canada (S. Min, S. Mital).,Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada (A.D., A.J., L.B., S. Mital).,Ted Rogers Centre for Heart Research, Toronto, Canada (S. Mital)
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11
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Morton SU, Norris-Brilliant A, Cunningham S, King E, Goldmuntz E, Brueckner M, Miller TA, Thomas NH, Liu C, Adams HR, Bellinger DC, Cleveland J, Cnota JF, Dale AM, Frommelt M, Gelb BD, Grant PE, Goldberg CS, Huang H, Kuperman JM, Li JS, McQuillen PS, Panigrahy A, Porter GA, Roberts AE, Russell MW, Seidman CE, Tivarus ME, Anagnoustou E, Hagler DJ, Chung WK, Newburger JW. Association of Potentially Damaging De Novo Gene Variants With Neurologic Outcomes in Congenital Heart Disease. JAMA Netw Open 2023; 6:e2253191. [PMID: 36701153 PMCID: PMC9880793 DOI: 10.1001/jamanetworkopen.2022.53191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/01/2022] [Indexed: 01/27/2023] Open
Abstract
Importance Neurodevelopmental disabilities are commonly associated with congenital heart disease (CHD), but medical and sociodemographic factors explain only one-third of the variance in outcomes. Objective To examine whether potentially damaging de novo variants (dDNVs) in genes not previously linked to neurodevelopmental disability are associated with neurologic outcomes in CHD and, post hoc, whether some dDNVs or rare putative loss-of-function variants (pLOFs) in specific gene categories are associated with outcomes. Design, Setting, and Participants This cross-sectional study was conducted from September 2017 to June 2020 in 8 US centers. Inclusion criteria were CHD, age 8 years or older, and available exome sequencing data. Individuals with pathogenic gene variants in known CHD- or neurodevelopment-related genes were excluded. Cases and controls were frequency-matched for CHD class, age group, and sex. Exposures Heterozygous for (cases) or lacking (controls) dDNVs in genes not previously associated with neurodevelopmental disability. Participants were separately stratified as heterozygous or not heterozygous for dDNVs and/or pLOFs in 4 gene categories: chromatin modifying, constrained, high level of brain expression, and neurodevelopmental risk. Main Outcomes and Measures Main outcomes were neurodevelopmental assessments of academic achievement, intelligence, fine motor skills, executive function, attention, memory, social cognition, language, adaptive functioning, and anxiety and depression, as well as 7 structural, diffusion, and functional brain magnetic resonance imaging metrics. Results The study cohort included 221 participants in the post hoc analysis and 219 in the case-control analysis (109 cases [49.8%] and 110 controls [50.2%]). Of those 219 participants (median age, 15.0 years [IQR, 10.0-21.2 years]), 120 (54.8%) were male. Cases and controls had similar primary outcomes (reading composite, spelling, and math computation on the Wide Range Achievement Test, Fourth Edition) and secondary outcomes. dDNVs and/or pLOFs in chromatin-modifying genes were associated with lower mean (SD) verbal comprehension index scores (91.4 [20.4] vs 103.4 [17.8]; P = .01), Social Responsiveness Scale, Second Edition, scores (57.3 [17.2] vs 49.4 [11.2]; P = .03), and Wechsler Adult Intelligence Scale, Fourth Edition, working memory scores (73.8 [16.4] vs 97.2 [15.7]; P = .03), as well as higher likelihood of autism spectrum disorder (28.6% vs 5.2%; P = .01). dDNVs and/or pLOFs in constrained genes were associated with lower mean (SD) scores on the Wide Range Assessment of Memory and Learning, Second Edition (immediate story memory: 9.7 [3.7] vs 10.7 [3.0]; P = .03; immediate picture memory: 7.8 [3.1] vs 9.0 [2.9]; P = .008). Adults with dDNVs and/or pLOFs in genes with a high level of brain expression had greater Conners adult attention-deficit hyperactivity disorder rating scale scores (mean [SD], 55.5 [15.4] vs 46.6 [12.3]; P = .007). Conclusions and Relevance The study findings suggest neurodevelopmental outcomes are not associated with dDNVs as a group but may be worse in individuals with dDNVs and/or pLOFs in some gene sets, such as chromatin-modifying genes. Future studies should confirm the importance of specific gene variants to brain function and structure.
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Affiliation(s)
- Sarah U. Morton
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Genetics, Harvard Medical School, Boston, Massachusetts
| | - Ami Norris-Brilliant
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sean Cunningham
- Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City
| | - Eileen King
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Elizabeth Goldmuntz
- Division of Cardiology, Children’s Hospital of Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Martina Brueckner
- Departments of Genetics and Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Thomas A. Miller
- Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City
- Division of Pediatric Cardiology, Maine Medical Center, Portland
| | - Nina H. Thomas
- Department of Child and Adolescent Psychiatry and Behavioral Sciences and Center for Human Phenomic Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Heather R. Adams
- Departments of Neurology and Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - David C. Bellinger
- Departments of Neurology and Psychiatry, Boston Children’s Hospital, Boston, Massachusetts
- Departments of Neurology and Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - John Cleveland
- Departments of Surgery and Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles
| | - James F. Cnota
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Anders M. Dale
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla
- Departments of Cognitive Science and Neuroscience, University of California San Diego, La Jolla
| | - Michele Frommelt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Bruce D. Gelb
- Mindich Child Health and Development Institute and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - P. Ellen Grant
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Caren S. Goldberg
- Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor
| | - Hao Huang
- Department of Radiology, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia
| | - Joshua M. Kuperman
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla
- Departments of Cognitive Science and Neuroscience, University of California San Diego, La Jolla
| | - Jennifer S. Li
- Division of Pediatric Cardiology, Duke University, Durham, North Carolina
| | - Patrick S. McQuillen
- Departments of Pediatrics and Neurology, University of California, San Francisco
| | - Ashok Panigrahy
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - George A. Porter
- Departments of Neurology and Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Amy E. Roberts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts
| | - Mark W. Russell
- Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor
| | - Christine E. Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
- Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Madalina E. Tivarus
- Departments of Imaging Sciences and Neuroscience, University of Rochester Medical Center, Rochester, New York
| | - Evdokia Anagnoustou
- Department of Pediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Donald J. Hagler
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla
- Departments of Cognitive Science and Neuroscience, University of California San Diego, La Jolla
| | - Wendy K. Chung
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, New York
| | - Jane W. Newburger
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
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12
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Russell MW. JAHA Spotlight on Pregnancy and Its Impact on Maternal and Offspring Cardiovascular Health. J Am Heart Assoc 2022; 11:e025167. [PMID: 35016536 PMCID: PMC9238538 DOI: 10.1161/jaha.121.025167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mark W Russell
- Division of Pediatric Cardiology University of Michigan Ann Arbor MI
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13
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Truong DT, Trachtenberg FL, Pearson GD, Dionne A, Elias MD, Friedman K, Hayes KH, Mahony L, McCrindle BW, Oster ME, Pemberton V, Powell AJ, Russell MW, Shekerdemian LS, Son MB, Taylor M, Newburger JW. The NHLBI Study on Long-terM OUtcomes after the Multisystem Inflammatory Syndrome In Children (MUSIC): Design and Objectives. Am Heart J 2022; 243:43-53. [PMID: 34418362 PMCID: PMC8710361 DOI: 10.1016/j.ahj.2021.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/06/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The Long-terM OUtcomes after the Multisystem Inflammatory Syndrome In Children (MUSIC) study aims to characterize the frequency and time course of acute and long-term cardiac and non-cardiac sequelae in multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C), which are currently poorly understood. METHODS This multicenter observational cohort study will enroll at least 600 patients <21 years old who meet the Centers for Disease Control and Prevention case definition of MIS-C across multiple North American centers over 2 years. The study will collect detailed hospital and follow-up data for up to 5 years, and optional genetic testing. Cardiac imaging at specific time points includes standardized echocardiographic assessment (all participants) and cardiac magnetic resonance imaging (CMR) in those with left ventricular ejection fraction (LVEF) <45% during the acute illness. The primary outcomes are the worst LVEF and the highest coronary artery z-score of the left anterior descending or right coronary artery. Other outcomes include occurrence and course of non-cardiac organ dysfunction, inflammation, and major medical events. Independent adjudication of cases will classify participants as definite, possible, or not MIS-C. Analysis of the outcomes will include descriptive statistics and regression analysis with stratification by definite or possible MIS-C. The MUSIC study will provide phenotypic data to support basic and translational research studies. CONCLUSION The MUSIC study, with the largest cohort of MIS-C patients and the longest follow-up period to date, will make an important contribution to our understanding of the acute cardiac and non-cardiac manifestations of MIS-C and the long-term effects of this public health emergency.
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Affiliation(s)
- Dongngan T Truong
- Department of Pediatrics, Dvision of Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA.
| | | | - Gail D Pearson
- National Heart, Lung, and Blood Institute/NIH, Bethesda, MD, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Matthew D Elias
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kevin Friedman
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | - Lynn Mahony
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, TX, USA
| | - Brian W McCrindle
- The Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Matthew E Oster
- Children's Heart Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory Unviersity School of Medicine, Atlanta, GA, USA
| | | | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mark W Russell
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Lara S Shekerdemian
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Mary Beth Son
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michael Taylor
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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14
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Meisner JK, Bradley DJ, Russell MW. Molecular Management of Multifocal Atrial Tachycardia in Noonan's Syndrome With MEK1/2 Inhibitor Trametinib. Circ Genom Precis Med 2021; 14:e003327. [PMID: 34463117 DOI: 10.1161/circgen.121.003327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joshua K Meisner
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor
| | - David J Bradley
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor
| | - Mark W Russell
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor
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15
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Ho CY, Day SM, Axelsson A, Russell MW, Zahka K, Lever HM, Pereira AC, Colan SD, Margossian R, Murphy AM, Canter C, Bach RG, Wheeler MT, Rossano JW, Owens AT, Bundgaard H, Benson L, Mestroni L, Taylor MRG, Patel AR, Wilmot I, Thrush P, Vargas JD, Soslow JH, Becker JR, Seidman CE, Lakdawala NK, Cirino AL, Burns KM, McMurray JJV, MacRae CA, Solomon SD, Orav EJ, Braunwald E. Valsartan in early-stage hypertrophic cardiomyopathy: a randomized phase 2 trial. Nat Med 2021; 27:1818-1824. [PMID: 34556856 DOI: 10.1038/s41591-021-01505-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/13/2021] [Indexed: 12/13/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is often caused by pathogenic variants in sarcomeric genes and characterized by left ventricular (LV) hypertrophy, myocardial fibrosis and increased risk of heart failure and arrhythmias. There are no existing therapies to modify disease progression. In this study, we conducted a multi-center, double-blind, placebo-controlled phase 2 clinical trial to assess the safety and efficacy of the angiotensin II receptor blocker valsartan in attenuating disease evolution in early HCM. In total, 178 participants with early-stage sarcomeric HCM were randomized (1:1) to receive valsartan (320 mg daily in adults; 80-160 mg daily in children) or placebo for 2 years ( NCT01912534 ). Standardized changes from baseline to year 2 in LV wall thickness, mass and volumes; left atrial volume; tissue Doppler diastolic and systolic velocities; and serum levels of high-sensitivity troponin T and N-terminal pro-B-type natriuretic protein were integrated into a single composite z-score as the primary outcome. Valsartan (n = 88) improved cardiac structure and function compared to placebo (n = 90), as reflected by an increase in the composite z-score (between-group difference +0.231, 95% confidence interval (+0.098, +0.364); P = 0.001), which met the primary endpoint of the study. Treatment was well-tolerated. These results indicate a key opportunity to attenuate disease progression in early-stage sarcomeric HCM with an accessible and safe medication.
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Affiliation(s)
- Carolyn Y Ho
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sharlene M Day
- University of Michigan, Ann Arbor, MI, USA.,Division of Cardiovascular Medicine Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Anna Axelsson
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Renee Margossian
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Anne M Murphy
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Canter
- Washington University School of Medicine, St. Louis, MO, USA
| | - Richard G Bach
- Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew T Wheeler
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Anjali T Owens
- Division of Cardiovascular Medicine Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lee Benson
- Toronto Hospital for Sick Children, Toronto, ON, Canada
| | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Amit R Patel
- Departments of Medicine and Radiology, University of Chicago, Chicago, IL, USA
| | - Ivan Wilmot
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Philip Thrush
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jose D Vargas
- MedStar Heart and Vascular Institute, Washington, USA
| | | | - Jason R Becker
- Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Cardiology, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Christine E Seidman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Neal K Lakdawala
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Allison L Cirino
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Kristin M Burns
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Calum A MacRae
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott D Solomon
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - E John Orav
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eugene Braunwald
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Mital S, Armstrong KR, Butts RJ, Conway J, Fan S, Gardin L, Kantor PF, Kaufman B, Lafreniere-Roula M, Miron A, Richmond ME, Rossano JW, Russell MW, Villa C, Weintraub RG. Response by Mital et al to Letter Regarding Article, "A Validated Model for Sudden Cardiac Death Risk Prediction in Pediatric Hypertrophic Cardiomyopathy". Circulation 2021; 143:e788-e789. [PMID: 33720772 DOI: 10.1161/circulationaha.120.051632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Seema Mital
- Department of Pediatrics and Genetics and Genome Biology Program (S.M.), Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Katey R Armstrong
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada (K.R.A.)
| | - Ryan J Butts
- Department of Pediatrics, Children's Medical Center of Dallas, TX (R.J.B.)
| | - Jennifer Conway
- Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada (J.C.)
| | - Steve Fan
- Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada (S.F., M.L.-R.)
| | - Letizia Gardin
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada (L.G.)
| | - Paul F Kantor
- Department of Pediatrics, Children's Hospital of Los Angeles, CA (P.F.K.)
| | - Beth Kaufman
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford, Palo Alto, CA (B.K.)
| | - Myriam Lafreniere-Roula
- Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada (S.F., M.L.-R.).,Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, NY (M.E.R.)
| | | | | | - Joseph W Rossano
- Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.)
| | - Mark W Russell
- Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI (M.W.R.)
| | - Chet Villa
- The Heart Institute, Cincinnati Children's Hospital, OH (C.V.)
| | - Robert G Weintraub
- Department of Cardiology, The Royal Children's Hospital, Melbourne, Victoria, Australia (R.G.W.).,Murdoch Children's Research Institute, University of Melbourne, Victoria, Australia (R.G.W.)
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17
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Miron A, Lafreniere-Roula M, Steve Fan CP, Armstrong KR, Dragulescu A, Papaz T, Manlhiot C, Kaufman B, Butts RJ, Gardin L, Stephenson EA, Howard TS, Aziz PF, Balaji S, Ladouceur VB, Benson LN, Colan SD, Godown J, Henderson HT, Ingles J, Jeewa A, Jefferies JL, Lal AK, Mathew J, Jean-St-Michel E, Michels M, Nakano SJ, Olivotto I, Parent JJ, Pereira AC, Semsarian C, Whitehill RD, Wittekind SG, Russell MW, Conway J, Richmond ME, Villa C, Weintraub RG, Rossano JW, Kantor PF, Ho CY, Mital S. A Validated Model for Sudden Cardiac Death Risk Prediction in Pediatric Hypertrophic Cardiomyopathy. Circulation 2020; 142:217-229. [PMID: 32418493 PMCID: PMC7365676 DOI: 10.1161/circulationaha.120.047235] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death (SCD) in children and young adults. Our objective was to develop and validate a SCD risk prediction model in pediatric hypertrophic cardiomyopathy to guide SCD prevention strategies. METHODS In an international multicenter observational cohort study, phenotype-positive patients with isolated hypertrophic cardiomyopathy <18 years of age at diagnosis were eligible. The primary outcome variable was the time from diagnosis to a composite of SCD events at 5-year follow-up: SCD, resuscitated sudden cardiac arrest, and aborted SCD, that is, appropriate shock following primary prevention implantable cardioverter defibrillators. Competing risk models with cause-specific hazard regression were used to identify and quantify clinical and genetic factors associated with SCD. The cause-specific regression model was implemented using boosting, and tuned with 10 repeated 4-fold cross-validations. The final model was fitted using all data with the tuned hyperparameter value that maximizes the c-statistic, and its performance was characterized by using the c-statistic for competing risk models. The final model was validated in an independent external cohort (SHaRe [Sarcomeric Human Cardiomyopathy Registry], n=285). RESULTS Overall, 572 patients met eligibility criteria with 2855 patient-years of follow-up. The 5-year cumulative proportion of SCD events was 9.1% (14 SCD, 25 resuscitated sudden cardiac arrests, and 14 aborted SCD). Risk predictors included age at diagnosis, documented nonsustained ventricular tachycardia, unexplained syncope, septal diameter z-score, left ventricular posterior wall diameter z score, left atrial diameter z score, peak left ventricular outflow tract gradient, and presence of a pathogenic variant. Unlike in adults, left ventricular outflow tract gradient had an inverse association, and family history of SCD had no association with SCD. Clinical and clinical/genetic models were developed to predict 5-year freedom from SCD. Both models adequately discriminated between patients with and without SCD events with a c-statistic of 0.75 and 0.76, respectively, and demonstrated good agreement between predicted and observed events in the primary and validation cohorts (validation c-statistic 0.71 and 0.72, respectively). CONCLUSION Our study provides a validated SCD risk prediction model with >70% prediction accuracy and incorporates risk factors that are unique to pediatric hypertrophic cardiomyopathy. An individualized risk prediction model has the potential to improve the application of clinical practice guidelines and shared decision making for implantable cardioverter defibrillator insertion. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT0403679.
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Affiliation(s)
- Anastasia Miron
- Division of Cardiology (A.M., T.P., S.M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Myriam Lafreniere-Roula
- Ted Rogers Computational Program, Ted Rogers Center for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada (M.L.-R., C.-P, S.F.)
| | - Chun-Po Steve Fan
- Ted Rogers Computational Program, Ted Rogers Center for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada (M.L.-R., C.-P, S.F.)
| | - Katey R. Armstrong
- Division of Pediatric Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, Canada (K.R.A.)
| | - Andreea Dragulescu
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tanya Papaz
- Division of Cardiology (A.M., T.P., S.M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cedric Manlhiot
- Department of Pediatrics, Johns Hopkins Medical Center, Baltimore, MD (C.M.)
| | - Beth Kaufman
- Department of Pediatrics, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA (B.K.)
| | - Ryan J. Butts
- Division of Pediatric Cardiology, Department of Pediatrics, Children’s Medical Center of Dallas, TX (R.J.B.)
| | - Letizia Gardin
- Department of Cardiology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada (L.G.)
| | - Elizabeth A. Stephenson
- Department of Cardiology, Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Ontario, Canada (E.A.S., S.M.)
| | - Taylor S. Howard
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children’s Hospital (T.S.H.)
| | - Pete F. Aziz
- Center for Pediatric and Congenital Heart Disease, Pediatric Electrophysiology and Pacing, Cleveland Clinic Children’s Hospital, OH (P.F.A.)
| | - Seshadri Balaji
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, OHSU Doernbecher Children’s Hospital, Portland (S.B.)
| | - Virginie Beauséjour Ladouceur
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lee N. Benson
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven D. Colan
- Department of Cardiology, Boston Children’s Hospital, MA (S.D.C.)
| | - Justin Godown
- Department of Pediatrics, Division of Pediatric Cardiology, Monroe Carrell Jr Children’s Hospital at Vanderbilt, Nashville, TN (J.G.)
| | | | - Jodie Ingles
- Agnes Ginges Center for Molecular Cardiology at Centenary Institute, The University of Sydney, New South Wales, Australia (J.I., C.S.)
| | - Aamir Jeewa
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - John L. Jefferies
- Division of Adult Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis (J.L.J.)
| | - Ashwin K. Lal
- Division of Pediatric Cardiology, University of Utah Primary Children’s Hospital, Salt Lake City (A.K.L.)
| | - Jacob Mathew
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, Victoria, Australia (J.M., R.G.W.)
| | - Emilie Jean-St-Michel
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, South Holland, Netherlands (M.M.)
| | - Stephanie J. Nakano
- Department of Pediatrics, Division of Cardiology, Children’s Hospital Colorado, Aurora (S.J.N.)
| | - Iacopo Olivotto
- Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O.)
| | - John J. Parent
- Department of Pediatrics, Riley Children’s Hospital, Indianapolis, IN (J.J.P.)
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (A.C.P.)
| | - Christopher Semsarian
- Agnes Ginges Center for Molecular Cardiology at Centenary Institute, The University of Sydney, New South Wales, Australia (J.I., C.S.)
| | | | | | - Mark W. Russell
- Pediatrics, C.S. Mott Children’s Hospital, Ann Arbor, MI (M.W.R.)
| | - Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada (J.C.)
| | - Marc E. Richmond
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons/Morgan Stanley Children’s Hospital, New York, NY (M.E.R.)
| | - Chet Villa
- The Heart Institute, Cincinnati Children’s Hospital, OH (S.G.W., C.V.)
| | - Robert G. Weintraub
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, Victoria, Australia (J.M., R.G.W.)
- Murdoch Children’s Research Institute, University of Melbourne, Victoria, Australia (R.G.W.)
| | - Joseph W. Rossano
- Division of Cardiology, Children’s Hospital of Philadelphia, PA (J.W.R.)
| | - Paul F. Kantor
- Division of Cardiology, Children’s Hospital of Los Angeles, CA (P.F.K.)
| | - Carolyn Y. Ho
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (C.Y.H.)
| | - Seema Mital
- Division of Cardiology (A.M., T.P., S.M.), Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Cardiology, Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Ontario, Canada (E.A.S., S.M.)
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18
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Fattahi F, Grailer JJ, Parlett M, Lu H, Malan EA, Abe E, Russell MW, Frydrych LM, Delano MJ, Zetoune FS, Ward PA. Requirement of Complement C6 for Intact Innate Immune Responses in Mice. J Immunol 2020; 205:251-260. [PMID: 32444389 DOI: 10.4049/jimmunol.1900801] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 04/01/2020] [Indexed: 12/11/2022]
Abstract
Over the first days of polymicrobial sepsis, there is robust activation of the innate immune system, causing the appearance of proinflammatory cytokines and chemokines, along with the appearance of extracellular histones, which are highly proinflammatory and prothrombotic. In the current study, we studied different innate immune responses in mice with knockout (KO) of complement protein 6 (C6). Polymorphonuclear neutrophils (PMNs) from these KO mice had defective innate immune responses, including defective expression of surface adhesion molecules, generation of superoxide anion, and appearance of reactive oxygen species and histone release after activation of PMNs, along with defective phagocytosis. In addition, in C6-/- mice, the NLRP3 inflammasome was defective both in PMNs and in macrophages. When these KO mice were subjected to polymicrobial sepsis, their survival was improved, associated with reduced levels in the plasma of proinflammatory cytokines and chemokines and lower levels of histones in plasma. In addition, sepsis-induced cardiac dysfunction was attenuated in these KO mice. In a model of acute lung injury induced by LPS, C6-/- mice showed reduced PMN buildup and less lung epithelial/endothelial cell dysfunction (edema and hemorrhage). These data indicate that C6-/- mice have reduced innate immune responses that result in less organ injury and improved survival after polymicrobial sepsis.
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Affiliation(s)
- Fatemeh Fattahi
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Jamison J Grailer
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Michella Parlett
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Hope Lu
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Elizabeth A Malan
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Elizabeth Abe
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Mark W Russell
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109; and
| | - Lynn M Frydrych
- Department of Surgery, University of Michigan School Medical School, Ann Arbor, MI 48109
| | - Matthew J Delano
- Department of Surgery, University of Michigan School Medical School, Ann Arbor, MI 48109
| | - Firas S Zetoune
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Peter A Ward
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109;
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Burns KM, Cottengim C, Dykstra H, Faulkner M, Lambert ABE, MacLeod H, Novak A, Parks SE, Russell MW, Shapiro-Mendoza CK, Shaw E, Tian N, Whittemore V, Kaltman JR. Epidemiology of Sudden Death in a Population-Based Study of Infants and Children. J Pediatr X 2020; 2. [PMID: 32743542 PMCID: PMC7394394 DOI: 10.1016/j.ympdx.2020.100023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective To describe epidemiologic data from the Sudden Death in the Young (SDY) Case Registry. Understanding the scope of SDY may optimize prevention efforts. Study design We analyzed sudden, unexpected deaths of infants (<365 days) and children (1–17 years) from a population-based registry of 8 states/jurisdictions in 2015 and 9 in 2016. Natural deaths and injury deaths from drowning, motor vehicle accident drivers, and infant suffocation were included; other injury deaths, homicide, suicide, intentional overdose, and terminal illness were excluded. Cases were categorized using a standardized algorithm. Descriptive statistics were used to characterize deaths, and mortality rates were calculated. Results Of 1319 cases identified, 92% had an autopsy. We removed incomplete cases, leaving 1132 analyzable deaths (889 infants, 243 children). The SDY rate for infants was 120/100 000 live births and for children was 1.9/100 000 children. Explained Cardiac rates were greater for infants (2.7/100 000 live births) than children (0.3/100 000 children). The pediatric Sudden Unexpected Death in Epilepsy (SUDEP) mortality rate was 0.2/100 000 live births and children. Blacks comprised 42% of infant and 43% of child deaths but only 23% of the population. In all ages, myocarditis/endocarditis was the most common Explained Cardiac cause; respiratory illness was the most common Explained Other cause. SDY occurred during activity in 13% of childhood cases. Conclusions Prevention strategies include optimizing identification and treatment of respiratory and cardiac diseases.
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Affiliation(s)
- Kristin M. Burns
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Carri Cottengim
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Heather Dykstra
- National Center for Fatality Review and Prevention, Michigan Public Health Institute. Okemos, MI
| | - Meghan Faulkner
- National Center for Fatality Review and Prevention, Michigan Public Health Institute. Okemos, MI
| | | | - Heather MacLeod
- National Center for Fatality Review and Prevention, Michigan Public Health Institute. Okemos, MI
| | - Alissa Novak
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, MI
| | - Sharyn E. Parks
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mark W. Russell
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, MI
| | - Carrie K. Shapiro-Mendoza
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Esther Shaw
- National Center for Fatality Review and Prevention, Michigan Public Health Institute. Okemos, MI
| | - Niu Tian
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Vicky Whittemore
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Jonathan R. Kaltman
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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20
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Goldberg DJ, Zak V, Goldstein BH, Schumacher KR, Rhodes J, Penny DJ, Petit CJ, Ginde S, Menon SC, Kim SH, Kim GB, Nowlen TT, DiMaria MV, Frischhertz BP, Wagner JB, McHugh KE, McCrindle BW, Shillingford AJ, Sabati AA, Yetman AT, John AS, Richmond ME, Files MD, Payne RM, Mackie AS, Davis CK, Shahanavaz S, Hill KD, Garg R, Jacobs JP, Hamstra MS, Woyciechowski S, Rathge KA, McBride MG, Frommelt PC, Russell MW, Urbina EM, Yeager JL, Pemberton VL, Stylianou MP, Pearson GD, Paridon SM. Results of the FUEL Trial. Circulation 2019; 141:641-651. [PMID: 31736357 DOI: 10.1161/circulationaha.119.044352] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Fontan operation creates a total cavopulmonary connection, a circulation in which the importance of pulmonary vascular resistance is magnified. Over time, this circulation leads to deterioration of cardiovascular efficiency associated with a decline in exercise performance. Rigorous clinical trials aimed at improving physiology and guiding pharmacotherapy are lacking. METHODS The FUEL trial (Fontan Udenafil Exercise Longitudinal) was a phase III clinical trial conducted at 30 centers. Participants were randomly assigned udenafil, 87.5 mg twice daily, or placebo in a 1:1 ratio. The primary outcome was the between-group difference in change in oxygen consumption at peak exercise. Secondary outcomes included between-group differences in changes in submaximal exercise at the ventilatory anaerobic threshold, the myocardial performance index, the natural log of the reactive hyperemia index, and serum brain-type natriuretic peptide. RESULTS Between 2017 and 2019, 30 clinical sites in North America and the Republic of Korea randomly assigned 400 participants with Fontan physiology. The mean age at randomization was 15.5±2 years; 60% of participants were male, and 81% were white. All 400 participants were included in the primary analysis with imputation of the 26-week end point for 21 participants with missing data (11 randomly assigned to udenafil and 10 to placebo). Among randomly assigned participants, peak oxygen consumption increased by 44±245 mL/min (2.8%) in the udenafil group and declined by 3.7±228 mL/min (-0.2%) in the placebo group (P=0.071). Analysis at ventilatory anaerobic threshold demonstrated improvements in the udenafil group versus the placebo group in oxygen consumption (+33±185 [3.2%] versus -9±193 [-0.9%] mL/min, P=0.012), ventilatory equivalents of carbon dioxide (-0.8 versus -0.06, P=0.014), and work rate (+3.8 versus +0.34 W, P=0.021). There was no difference in change of myocardial performance index, the natural log of the reactive hyperemia index, or serum brain-type natriuretic peptide level. CONCLUSIONS In the FUEL trial, treatment with udenafil (87.5 mg twice daily) was not associated with an improvement in oxygen consumption at peak exercise but was associated with improvements in multiple measures of exercise performance at the ventilatory anaerobic threshold. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02741115.
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Affiliation(s)
- David J Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, PA (D.J.G., S.W., M.G.M., S.M.P.)
| | - Victor Zak
- New England Research Institutes, Watertown, MA (V.Z.)
| | - Bryan H Goldstein
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, OH (B.H.G., M.S.H., K.A.R., E.M.U.)
| | - Kurt R Schumacher
- Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI (K.R.S., M.W.R.)
| | - Jonathan Rhodes
- Department of Cardiology, Children's Hospital Boston, MA (J.R.)
| | - Daniel J Penny
- Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX (D.J.P.)
| | - Christopher J Petit
- Emory University School of Medicine, Children's Healthcare of Atlanta, GA (C.J.P.)
| | - Salil Ginde
- Division of Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee (S.G., P.C.F.)
| | - Shaji C Menon
- Division of Pediatric Cardiology, University of Utah, Salt Lake City (S.C.M.)
| | - Seong-Ho Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon-Si, South Korea (S.-H.K.)
| | - Gi Beom Kim
- Seoul National University School of Medicine, Seoul National University Children's Hospital, South Korea (G.B.K.)
| | - Todd T Nowlen
- Heart Center, Phoenix Children's Hospital, AZ (T.T.N.)
| | - Michael V DiMaria
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (M.V.D.)
| | - Benjamin P Frischhertz
- Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN (B.P.F.)
| | - Jonathan B Wagner
- Divisions of Cardiology and Clinical Pharmacology, Children's Mercy Kansas City, MO (J.B.W.)
| | - Kimberly E McHugh
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston (K.E.M.)
| | - Brian W McCrindle
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Ontario (B.W.M.)
| | - Amanda J Shillingford
- Nemours Cardiac Center, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE (A.J.S.)
| | - Arash A Sabati
- Los Angeles Children's Hospital, Division of Cardiology, CA (A.A.S.)
| | - Anji T Yetman
- Children's Hospital and Medical Center, University of Nebraska, Omaha (A.T.Y.)
| | - Anitha S John
- Division of Cardiology, Children's National Health System, Washington, DC (A.S.J.)
| | - Marc E Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY (M.E.R.)
| | - Matthew D Files
- Division of Cardiology, Seattle Children's Hospital, WA (M.D.F.)
| | - R Mark Payne
- Division of Cardiology, Riley Hospital for Children, Indianapolis, IN (R.M.P.)
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada (A.S.M.)
| | | | | | - Kevin D Hill
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC (K.D.H.)
| | - Ruchira Garg
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (R.G.)
| | - Jeffrey P Jacobs
- Johns Hopkins All Children's Hospital, Department of Surgery, St Petersburg, FL (J.P.J.)
| | - Michelle S Hamstra
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, OH (B.H.G., M.S.H., K.A.R., E.M.U.)
| | - Stacy Woyciechowski
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, PA (D.J.G., S.W., M.G.M., S.M.P.)
| | - Kathleen A Rathge
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, OH (B.H.G., M.S.H., K.A.R., E.M.U.)
| | - Michael G McBride
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, PA (D.J.G., S.W., M.G.M., S.M.P.)
| | - Peter C Frommelt
- Division of Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee (S.G., P.C.F.)
| | - Mark W Russell
- Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI (K.R.S., M.W.R.)
| | - Elaine M Urbina
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, OH (B.H.G., M.S.H., K.A.R., E.M.U.)
| | - James L Yeager
- Consultant to Mezzion Pharma Co Ltd, Mezzion Pharma Co Ltd, Seoul, South Korea (J.L.Y.)
| | - Victoria L Pemberton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.P., M.P.S., G.D.P.)
| | - Mario P Stylianou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.P., M.P.S., G.D.P.)
| | - Gail D Pearson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.P., M.P.S., G.D.P.)
| | - Stephen M Paridon
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, PA (D.J.G., S.W., M.G.M., S.M.P.)
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21
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Russell MW, Moldenhauer JS, Rychik J, Burnham NB, Zullo E, Parry SI, Simmons RA, Elovitz MA, Nicolson SC, Linn RL, Johnson MP, Yu S, Sampson MG, Hakonarson H, Gaynor JW. Damaging Variants in Proangiogenic Genes Impair Growth in Fetuses with Cardiac Defects. J Pediatr 2019; 213:103-109. [PMID: 31227283 PMCID: PMC6765419 DOI: 10.1016/j.jpeds.2019.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine the impact of damaging genetic variation in proangiogenic pathways on placental function, complications of pregnancy, fetal growth, and clinical outcomes in pregnancies with fetal congenital heart defect. STUDY DESIGN Families delivering a baby with a congenital heart defect requiring surgical repair in infancy were recruited. The placenta and neonate were weighed and measured. Hemodynamic variables were recorded from a third trimester (36.4 ± 1.7 weeks) fetal echocardiogram. Exome sequencing was performed on the probands (N = 133) and consented parents (114 parent-child trios, and 15 parent-child duos) and the GeneVetter analysis tool used to identify damaging coding sequence variants in 163 genes associated with the positive regulation of angiogenesis (PRA) (GO:0045766). RESULTS In total, 117 damaging variants were identified in PRA genes in 133 congenital heart defect probands with 73 subjects having at least 1 variant. Presence of a damaging PRA variant was associated with increased umbilical artery pulsatility index (mean 1.11 with variant vs 1.00 without; P = .01). The presence of a damaging PRA variant was also associated with lower neonatal length and head circumference for age z score at birth (mean -0.44 and -0.47 with variant vs 0.23 and -0.05 without; P = .01 and .04, respectively). During median 3.1 years (IQR 2.0-4.1 years) of follow-up, deaths occurred in 2 of 60 (3.3%) subjects with no PRA variant and in 9 of 73 (12.3%) subjects with 1 or more PRA variants (P = .06). CONCLUSIONS Damaging variants in proangiogenic genes may impact placental function and are associated with impaired fetal growth in pregnancies involving a fetus with congenital heart defect.
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Affiliation(s)
- Mark W Russell
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI.
| | - Julie S Moldenhauer
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jack Rychik
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Nancy B Burnham
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Erin Zullo
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Samuel I Parry
- Division of Maternal Fetal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA
| | - Rebecca A Simmons
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michal A Elovitz
- Division of Maternal Fetal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA
| | - Susan C Nicolson
- Division of Cardiothoracic Anesthesiology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Rebecca L Linn
- Division of Anatomic Pathology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mark P Johnson
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sunkyung Yu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Matthew G Sampson
- Division of Pediatric Nephrology, Department of Pediatrics, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
| | - Hakon Hakonarson
- The Center for Applied Genomics, The Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - J William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
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22
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Balaji S, DiLorenzo MP, Fish FA, Etheridge SP, Aziz PF, Russell MW, Tisma S, Pflaumer A, Sreeram N, Kubus P, Law IH, Kantoch MJ, Kertesz NJ, Strieper M, Erickson CC, Moore JP, Nakano SJ, Singh HR, Chang P, Cohen M, Fournier A, Ilina MV, Smith RT, Zimmerman F, Horndasch M, Li W, Batra A, Liberman L, Hamilton R, Janson CM, Sanatani S, Zeltser I, McDaniel G, Blaufox AD, Garnreiter JM, Katcoff H, Shah M. Risk factors for lethal arrhythmic events in children and adolescents with hypertrophic cardiomyopathy and an implantable defibrillator: An international multicenter study. Heart Rhythm 2019; 16:1462-1467. [DOI: 10.1016/j.hrthm.2019.04.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Indexed: 11/16/2022]
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23
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Pierpont ME, Brueckner M, Chung WK, Garg V, Lacro RV, McGuire AL, Mital S, Priest JR, Pu WT, Roberts A, Ware SM, Gelb BD, Russell MW. Genetic Basis for Congenital Heart Disease: Revisited: A Scientific Statement From the American Heart Association. Circulation 2019; 138:e653-e711. [PMID: 30571578 DOI: 10.1161/cir.0000000000000606] [Citation(s) in RCA: 314] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This review provides an updated summary of the state of our knowledge of the genetic contributions to the pathogenesis of congenital heart disease. Since 2007, when the initial American Heart Association scientific statement on the genetic basis of congenital heart disease was published, new genomic techniques have become widely available that have dramatically changed our understanding of the causes of congenital heart disease and, clinically, have allowed more accurate definition of the pathogeneses of congenital heart disease in patients of all ages and even prenatally. Information is presented on new molecular testing techniques and their application to congenital heart disease, both isolated and associated with other congenital anomalies or syndromes. Recent advances in the understanding of copy number variants, syndromes, RASopathies, and heterotaxy/ciliopathies are provided. Insights into new research with congenital heart disease models, including genetically manipulated animals such as mice, chicks, and zebrafish, as well as human induced pluripotent stem cell-based approaches are provided to allow an understanding of how future research breakthroughs for congenital heart disease are likely to happen. It is anticipated that this review will provide a large range of health care-related personnel, including pediatric cardiologists, pediatricians, adult cardiologists, thoracic surgeons, obstetricians, geneticists, genetic counselors, and other related clinicians, timely information on the genetic aspects of congenital heart disease. The objective is to provide a comprehensive basis for interdisciplinary care for those with congenital heart disease.
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24
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Musunuru K, Arora P, Cooke JP, Ferguson JF, Hershberger RE, Hickey KT, Lee JM, Lima JAC, Loscalzo J, Pereira NL, Russell MW, Shah SH, Sheikh F, Wang TJ, MacRae CA. Interdisciplinary Models for Research and Clinical Endeavors in Genomic Medicine: A Scientific Statement From the American Heart Association. Circ Genom Precis Med 2019; 11:e000046. [PMID: 29844141 DOI: 10.1161/hcg.0000000000000046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The completion of the Human Genome Project has unleashed a wealth of human genomics information, but it remains unclear how best to implement this information for the benefit of patients. The standard approach of biomedical research, with researchers pursuing advances in knowledge in the laboratory and, separately, clinicians translating research findings into the clinic as much as decades later, will need to give way to new interdisciplinary models for research in genomic medicine. These models should include scientists and clinicians actively working as teams to study patients and populations recruited in clinical settings and communities to make genomics discoveries-through the combined efforts of data scientists, clinical researchers, epidemiologists, and basic scientists-and to rapidly apply these discoveries in the clinic for the prediction, prevention, diagnosis, prognosis, and treatment of cardiovascular diseases and stroke. The highly publicized US Precision Medicine Initiative, also known as All of Us, is a large-scale program funded by the US National Institutes of Health that will energize these efforts, but several ongoing studies such as the UK Biobank Initiative; the Million Veteran Program; the Electronic Medical Records and Genomics Network; the Kaiser Permanente Research Program on Genes, Environment and Health; and the DiscovEHR collaboration are already providing exemplary models of this kind of interdisciplinary work. In this statement, we outline the opportunities and challenges in broadly implementing new interdisciplinary models in academic medical centers and community settings and bringing the promise of genomics to fruition.
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25
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Balaji S, DiLorenzo MP, Fish FA, Etheridge SP, Aziz PF, Russell MW, Tisma S, Pflaumer A, Sreeram N, Kubus P, Law IH, Kantoch MJ, Kertesz NJ, Strieper M, Erickson CC, Moore JP, Nakano SJ, Singh HR, Chang P, Cohen M, Fournier A, Ilina MV, Smith RT, Zimmerman F, Horndasch M, Li W, Batra A, Liberman L, Hamilton R, Janson CM, Sanatani S, Zeltser I, McDaniel G, Blaufox AD, Garnreiter JM, Katcoff H, Shah M. Impact of Obesity on Left Ventricular Thickness in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol 2019; 40:1253-1257. [PMID: 31263917 DOI: 10.1007/s00246-019-02145-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/19/2019] [Indexed: 01/23/2023]
Abstract
Obesity is associated with additional left ventricular hypertrophy (LVH) in adults with hypertrophic cardiomyopathy (HCM). It is not known whether obesity can lead to further LVH in children with HCM. Echocardiographic LV dimensions were determined in 504 children with HCM. Measurements of interventricular septal thickness (IVST) and posterior wall thickness (PWT), and patients' weight and height were recorded. Obesity was defined as a body mass index (BMI) ≥ 99th percentile for age and sex. IVST data was available for 498 and PWT data for 484 patients. Patient age ranged from 2 to 20 years (mean ± SD, 12.5 ± 3.9) and 340 (68%) were males. Overall, patient BMI ranged from 7 to 50 (22.7 ± 6.1). Obesity (BMI 18-50, mean 29.1) was present in 140 children aged 2-19.6 (11.3 ± 4.1). The overall mean IVST was 20.5 ± 9.6 mm and the overall mean PWT was 11.0 ± 8.4 mm. The mean IVST in the obese patients was 21.6 ± 10.0 mm and mean PWT was 13.3 ± 14.7 mm. The mean IVST in the non-obese patients was 20.1 ± 9.5 mm and mean PWT was 10.4 ± 4.3 mm. Obesity was not significantly associated with IVST (p = 0.12), but was associated with increased PWT (0.0011). Obesity is associated with increased PWT but not IVST in children with HCM. Whether obesity and its impact on LVH influences clinical outcomes in children with HCM needs to be studied.
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Affiliation(s)
- Seshadri Balaji
- Division of Cardiology, Department of Pediatrics, Oregon Health & Science University, 707, SW Gaines Street, Mailcode: CDRC-P, Portland, OR, 97239, USA.
| | | | | | | | | | | | | | | | | | | | - Ian H Law
- University of Iowa, Iowa City, IA, USA
| | | | | | | | | | | | | | - Harinder R Singh
- Children's Hospital of Michigan, Detroit, MI, USA
- Children's Hospital of San Antonio, San Antonio, TX, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hannah Katcoff
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maully Shah
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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26
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Russell MW, Moldenhauer JS, Rychik J, Burnham NB, Zullo E, Parry SI, Simmons RA, Elovitz MA, Nicolson SC, Linn RL, Johnson MP, Yu S, Sampson MG, Hakonarson H, Gaynor JW. Effect of parental origin of damaging variants in pro-angiogenic genes on fetal growth in patients with congenital heart defects: Data and analyses. Data Brief 2019; 25:104311. [PMID: 31453292 PMCID: PMC6700409 DOI: 10.1016/j.dib.2019.104311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/14/2019] [Accepted: 07/17/2019] [Indexed: 11/03/2022] Open
Abstract
The placenta is a highly vascular structure composed of both maternal and fetal elements. We have determined that damaging variants in genes responsible for the positive regulation of angiogenesis (PRA) (GO:0045766) that are inherited by the fetus impair fetal growth and placental function in pregnancies involving critical congenital cardiac defects (Russell et al., 2019). In this dataset, we present the specific genetic variants identified, describe the parental origin of each variant where possible and present the analyses regarding the potential effects of parental origin of the variant on placental function and fetal growth. The data presented are related to the research article "Damaging variants in pro-angiogenic genes impair growth in fetuses with cardiac defects" (Russell et al., 2019).
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Affiliation(s)
- Mark W. Russell
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Julie S. Moldenhauer
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jack Rychik
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nancy B. Burnham
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Zullo
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel I. Parry
- Division of Maternal Fetal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca A. Simmons
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michal A. Elovitz
- Division of Maternal Fetal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Susan C. Nicolson
- Division of Cardiothoracic Anesthesiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca L. Linn
- Division of Anatomic Pathology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark P. Johnson
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sunkyung Yu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthew G. Sampson
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Hakon Hakonarson
- The Center for Applied Genomics, The Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J. William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Kim DS, Newburger JW, Bellinger DC, Russell MW, Goldberg CS, Jarvik GP, Gaynor JW. Failure to validate association of mannose-binding lectin deficiency with adverse neurodevelopmental outcomes after cardiac surgery in infants. J Thorac Cardiovasc Surg 2019; 157:e397-e398. [PMID: 31307150 DOI: 10.1016/j.jtcvs.2018.10.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/07/2018] [Accepted: 10/21/2018] [Indexed: 10/26/2022]
Affiliation(s)
- Daniel Seung Kim
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Mich
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - David C Bellinger
- Department of Pediatrics, Harvard Medical School, Boston, Mass; Division of Neurology, Boston Children's Hospital, Boston, Mass
| | - Mark W Russell
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Mich
| | - Caren S Goldberg
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Mich
| | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, Wash
| | - J William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
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28
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Ho CY, Day SM, Colan SD, Russell MW, Towbin JA, Sherrid MV, Canter CE, Jefferies JL, Murphy AM, Cirino AL, Abraham TP, Taylor M, Mestroni L, Bluemke DA, Jarolim P, Shi L, Sleeper LA, Seidman CE, Orav EJ. The Burden of Early Phenotypes and the Influence of Wall Thickness in Hypertrophic Cardiomyopathy Mutation Carriers: Findings From the HCMNet Study. JAMA Cardiol 2019; 2:419-428. [PMID: 28241245 DOI: 10.1001/jamacardio.2016.5670] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Sarcomere mutations and left ventricular (LV) hypertrophy (LVH) are cardinal features of hypertrophic cardiomyopathy (HCM). However, little is known about the full spectrum of phenotypic manifestations or how LVH influences disease expression. Objectives (1) To characterize and assess phenotypic burden in sarcomere mutation carriers (genotype positive [G+]) and (2) to investigate the correlation between LV wall thickness (LVWT) and other disease features in mutation carriers. Design, Setting, and Participants This investigation was a cross-sectional, multicenter observational study in the setting of the HCMNet network of HCM clinical centers. Mutation carriers with LVH (G+/LVH+), mutation carriers without LVH (G+/LVH-), and healthy related control individuals (G-/LVH-) were enrolled through HCMNet sites. A total of 193 participants were enrolled and underwent study procedures. Participants were enrolled between April 9, 2010, and January 30, 2012. Study analysis was performed between June 2015 and May 2016. Exposures The primary stratifying variables were the presence of a sarcomere mutation and measures of LVWT. Main Outcomes and Measures Variables from standardized exercise testing, echocardiography, cardiac magnetic resonance imaging, serum biomarker measurement, and electrocardiography were compared across study cohorts. Results Analyses were performed in 178 participants, including 81 G+/LVH+ (mean [SD] age at baseline, 27 [14] years), 55 G+/LVH- (20 [10] years), and 42 G-/LVH- (18 [8] years). All mutation carriers had smaller LV cavity, higher ratio of LVWT to diastolic diameter, and higher echocardiographic LV ejection fraction than controls. A phenotypic burden score was evaluated as the cumulative number of 7 traits (changes on electrocardiography; decreased LV systolic, diastolic diameter, or septal E' velocity; higher ratio of LVWT to diastolic diameter; serum troponin level; and natriuretic peptide level) in each individual. The mean (SE) phenotypic burden was 4.9 (0.2) phenotypes per individual in G+/LVH+, 2.4 (0.2) in G+/LVH-, and 1.3 (0.2) in controls (P < .001). Classification and regression tree analysis identified an LV end-diastolic dimension z score less than -1.85 or the combination of an LV end-diastolic dimension z score of -1.85 or higher and a septal E' velocity z score less than -0.52 as having 74% accuracy in discriminating G+/LVH- participants from controls. In mutation carriers, clinical variables demonstrated a continuous correlation with LVWT, generally without a clear cutoff signifying pathologic transition. Conclusions and Relevance G+/LVH- individuals demonstrated altered cardiac dimensions and function and a higher burden of early phenotypes than healthy G- controls. Two methods discriminated phenotypic subgroups, namely, a sum across 7 traits and a regression tree-based rule that identifies constellations of distinguishing factors. Greater LVWT is associated with more prominent cardiac abnormalities in a continuous, although not always linear, manner. A single value of LVWT could not dichotomize the presence or absence of disease.
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Affiliation(s)
- Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sharlene M Day
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Mark W Russell
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Jeffrey A Towbin
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark V Sherrid
- Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, New York
| | - Charles E Canter
- Department of Pediatrics, Washington University School of Medicine in St Louis, Missouri
| | - John L Jefferies
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anne M Murphy
- Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allison L Cirino
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Theodore P Abraham
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - David A Bluemke
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ling Shi
- New England Research Institutes, Watertown, Massachusetts
| | | | - Christine E Seidman
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts14Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - E John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Russell MW, Moldenhauer JS, Rychik J, Burnham N, Parry SI, Simmons R, Elovitz M, Nicolson S, Linn R, Johnson MP, Yu S, Sampson M, Hakonarson H, Gaynor JW. DAMAGING GENETIC VARIANTS IN PRO-ANGIOGENIC GENES IMPAIR GROWTH IN FETUSES WITH CRITICAL CONGENITAL CARDIAC DEFECTS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31193-3] [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: 10/27/2022]
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30
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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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Affiliation(s)
- Mark W Russell
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, NY
| | - Jonathan R Kaltman
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Thomas A Miller
- Department of Pediatrics, University of Utah, Salt Lake City, UT
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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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Ho JE, Shi L, Day SM, Colan SD, Russell MW, Towbin JA, Sherrid MV, Canter CE, Jefferies JL, Murphy A, Taylor M, Mestroni L, Cirino AL, Sleeper LA, Jarolim P, Lopez B, Gonzalez A, Diez J, Orav EJ, Ho CY. Biomarkers of cardiovascular stress and fibrosis in preclinical hypertrophic cardiomyopathy. Open Heart 2017; 4:e000615. [PMID: 29177058 PMCID: PMC5687543 DOI: 10.1136/openhrt-2017-000615] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/09/2017] [Accepted: 06/13/2017] [Indexed: 11/04/2022] Open
Abstract
Objective Sarcomeric gene mutation carriers without overt left ventricular hypertrophy (G+/LVH-) can harbour subclinical changes in cardiovascular structure and function that precede the development of hypertrophic cardiomyopathy (HCM). We sought to investigate if circulating biomarkers of cardiovascular stress and collagen metabolism among G+/LVH- individuals, measured at rest and following exercise provocation, yield further insights into the underlying biology of HCM. Methods We studied 76 individuals with overt HCM, 50 G+/LVH- individuals and 41 genotype-negative related controls enrolled in a cross-sectional, multicentre observational study (HCMNet). Biomarkers of cardiac stress (N-terminal pro-B-type natriuretic peptide, NT-proBNP; high-sensitivity troponin I, hsTnI; soluble ST2) and fibrosis (carboxy-terminal propeptide of procollagen type I; C-terminal telopeptide of type I collagen; galectin-3; periostin) were measured. Results Individuals with overt HCM had elevated NT-proBNP and hsTnI compared with G+/LVH- subjects and controls at rest, along with an exaggerated increase in NT-proBNP and hsTnI in response to exercise. We found no detectable differences in resting or exercise-provoked biomarker profiles of cardiovascular stress and fibrosis among G+/LVH- individuals compared with healthy controls despite subtle echocardiographic differences in cardiac structure and function. Conclusion Dynamic exercise testing exaggerated resting differences in natriuretic peptides and troponin elevations among individuals with overt HCM. In contrast, we found no differences in biomarker profiles of cardiovascular stress and fibrosis among G+/LVH- individuals compared with controls even after maximal exercise provocation. Our findings highlight the need for continued investigation into early phenotypes of sarcomeric gene mutations and the evolution of HCM.
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Affiliation(s)
- Jennifer E Ho
- Division of Cardiology, Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital, Ann Arbor, Michigan, USA
| | - Ling Shi
- New England Research Institutes, Watertown, Massachusetts, USA
| | - Sharlene M Day
- Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mark W Russell
- Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey A Towbin
- The Heart Institute and Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mark V Sherrid
- Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Charles E Canter
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - John Lynn Jefferies
- The Heart Institute and Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anne Murphy
- Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew Taylor
- Department of Medicine, University of Colorado Denver CU-Cardiovascular Institute, Aurora, Colorado, USA
| | - Luisa Mestroni
- Department of Medicine, University of Colorado Denver CU-Cardiovascular Institute, Aurora, Colorado, USA
| | - Allison L Cirino
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lynn A Sleeper
- New England Research Institutes, Watertown, Massachusetts, USA
| | - Peter Jarolim
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Begoña Lopez
- Program of Cardiovascular Diseases, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Arantxa Gonzalez
- Program of Cardiovascular Diseases, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Javier Diez
- Program of Cardiovascular Diseases, Center for Applied Medical Research, University of Navarra, Pamplona, Spain.,Department for Cardiology and Cardiac Surgery, University Clinic, University of Navarra, Pamplona, Spain
| | - E John Orav
- Department of Biostatistics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Carolyn Y Ho
- Division of Cardiology, Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital, Ann Arbor, Michigan, USA
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34
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Jin SC, Homsy J, Zaidi S, Lu Q, Morton S, DePalma SR, Zeng X, Qi H, Chang W, Sierant MC, Hung WC, Haider S, Zhang J, Knight J, Bjornson RD, Castaldi C, Tikhonoa IR, Bilguvar K, Mane SM, Sanders SJ, Mital S, Russell MW, Gaynor JW, Deanfield J, Giardini A, Porter GA, Srivastava D, Lo CW, Shen Y, Watkins WS, Yandell M, Yost HJ, Tristani-Firouzi M, Newburger JW, Roberts AE, Kim R, Zhao H, Kaltman JR, Goldmuntz E, Chung WK, Seidman JG, Gelb BD, Seidman CE, Lifton RP, Brueckner M. Contribution of rare inherited and de novo variants in 2,871 congenital heart disease probands. Nat Genet 2017; 49:1593-1601. [PMID: 28991257 PMCID: PMC5675000 DOI: 10.1038/ng.3970] [Citation(s) in RCA: 486] [Impact Index Per Article: 69.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/15/2017] [Indexed: 12/17/2022]
Abstract
Congenital heart disease (CHD) is the leading cause of mortality from birth defects. Exome sequencing of a single cohort of 2,871 CHD probands including 2,645 parent-offspring trios implicated rare inherited mutations in 1.8%, including a recessive founder mutation in GDF1 accounting for ~5% of severe CHD in Ashkenazim, recessive genotypes in MYH6 accounting for ~11% of Shone complex, and dominant FLT4 mutations accounting for 2.3% of Tetralogy of Fallot. De novo mutations (DNMs) accounted for 8% of cases, including ~3% of isolated CHD patients and ~28% with both neurodevelopmental and extra-cardiac congenital anomalies. Seven genes surpassed thresholds for genome-wide significance and 12 genes not previously implicated in CHD had > 70% probability of being disease-related; DNMs in ~440 genes are inferred to contribute to CHD. There was striking overlap between genes with damaging DNMs in probands with CHD and autism.
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Affiliation(s)
- Sheng Chih Jin
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jason Homsy
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Samir Zaidi
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Qiongshi Lu
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Sarah Morton
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Steven R DePalma
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Xue Zeng
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Hongjian Qi
- Department of Applied Physics and Applied Mathematics, Columbia University, New York, New York, USA
| | - Weni Chang
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
| | - Michael C Sierant
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Wei-Chien Hung
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Shozeb Haider
- Department of Computational Chemistry, University College London School of Pharmacy, London, UK
| | - Junhui Zhang
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James Knight
- Yale Center for Genome Analysis, Yale University, New Haven, Connecticut, USA
| | - Robert D Bjornson
- Yale Center for Genome Analysis, Yale University, New Haven, Connecticut, USA
| | | | - Irina R Tikhonoa
- Yale Center for Genome Analysis, Yale University, New Haven, Connecticut, USA
| | - Kaya Bilguvar
- Yale Center for Genome Analysis, Yale University, New Haven, Connecticut, USA
| | - Shrikant M Mane
- Yale Center for Genome Analysis, Yale University, New Haven, Connecticut, USA
| | - Stephan J Sanders
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Seema Mital
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mark W Russell
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - J William Gaynor
- Department of Pediatric Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John Deanfield
- Department of Cardiology, University College London and Great Ormond Street Hospital, London, UK
| | - Alessandro Giardini
- Department of Cardiology, University College London and Great Ormond Street Hospital, London, UK
| | - George A Porter
- Department of Pediatrics, University of Rochester Medical Center, The School of Medicine and Dentistry, Rochester, New York, USA
| | - Deepak Srivastava
- Gladstone Institute of Cardiovascular Disease, San Francisco, California, USA.,Roddenberry Stem Cell Center at Gladstone, San Francisco, California, USA.,Departments of Pediatrics and Biochemistry & Biophysics, University of California, San Francisco, San Francisco, California, USA
| | - Cecelia W Lo
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yufeng Shen
- Departments of Systems Biology and Biomedical Informatics, Columbia University Medical Center, New York, New York, USA
| | - W Scott Watkins
- Department of Human Genetics, Eccles Institute of Human Genetics, University of Utah and School of Medicine, Salt Lake City, Utah, USA
| | - Mark Yandell
- Department of Human Genetics, Eccles Institute of Human Genetics, University of Utah and School of Medicine, Salt Lake City, Utah, USA.,USTAR Center for Genetic Discovery, University of Utah, Salt Lake City, Utah, USA
| | - H Joseph Yost
- Department of Human Genetics, Eccles Institute of Human Genetics, University of Utah and School of Medicine, Salt Lake City, Utah, USA
| | | | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Amy E Roberts
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Richard Kim
- Pediatric Cardiac Surgery, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Hongyu Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jonathan R Kaltman
- Heart Development and Structural Diseases Branch, Division of Cardiovascular Sciences, NHLBI/NIH, Bethesda, Maryland, USA
| | - Elizabeth Goldmuntz
- Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jonathan G Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce D Gelb
- Mindich Child Health and Development Institute and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Howard Hughes Medical Institute, Harvard University, Boston, Massachusetts, USA
| | - Richard P Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA.,Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, New York, USA
| | - Martina Brueckner
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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35
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Ramroop R, Manase G, Lu D, Manase D, Chen S, Kim R, Lee T, Mahle WT, McHugh K, Mitchell M, Tristani-Firouzi M, Wechsler SB, Wilder NS, Zak V, Lafreniere-Roula M, Newburger JW, Gaynor JW, Russell MW, Mital S. Adrenergic receptor genotypes influence postoperative outcomes in infants in the Single-Ventricle Reconstruction Trial. J Thorac Cardiovasc Surg 2017; 154:1703-1710.e3. [PMID: 28734628 DOI: 10.1016/j.jtcvs.2017.06.041] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 06/06/2017] [Accepted: 06/20/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Adrenergic receptor (ADR) genotypes have been associated with adverse outcomes in heart failure. Our objective was to evaluate the association of ADR genotypes with post-Norwood outcomes in infants with hypoplastic left heart syndrome (HLHS). METHODS Infants with HLHS participating in the Pediatric Heart Network Single-Ventricle Reconstruction Trial underwent genotyping for 4 single-nucleotide polymorphisms in 3 ADR genes: ADRB1_231A/G, ADRB1_1165G/C, ADRB2_5318C/G, and ADRA2A_2790C/T. The association of genotype with freedom from serious adverse events (SAEs) (death, transplant, extracorporeal membrane oxygenation, cardiopulmonary resuscitation, acute shunt failure, unplanned reoperations, or necrotizing enterocolitis) during 14 months' follow-up was assessed with Cox regression and the association with post-Norwood complications was assessed with Poisson regression. Models were adjusted for clinical and surgical factors. RESULTS The study included 351 eligible patients (62% male; 83% white). The mean age at Norwood procedure was 5.6 ± 3.6 days. A total of 152 patients had SAEs during 14-month follow-up including 84 deaths and 10 transplants. ADRA2A_2790CC genotype had lower SAE-free survival compared with CT/TT genotypes during follow-up (Log rank test, P = .02), and this association was independent of clinical and surgical risk factors (adjusted Cox regression, hazard ratio 1.54 [95% confidence interval 1.04, 2.30] P = .033). Post-Norwood complication rate did not differ by genotype. CONCLUSIONS Infants with HLHS harboring ADR genotypes that are associated with greater catecholamine release or sensitivity had lower event-free survival after staged palliation. Excess catecholamine activation may adversely affect cardiovascular adaptation after the Norwood procedure. Future studies should explore whether targeting adrenergic activation in those harboring risk genotypes can improve outcomes. (ClinicalTrials.gov number NCT00115934).
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Affiliation(s)
- Ronand Ramroop
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George Manase
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Danny Lu
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Dorin Manase
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shan Chen
- New England Research Institute, Watertown, Mass
| | - Richard Kim
- Children's Hospital of Los Angeles, Los Angeles, Calif
| | - Teresa Lee
- Columbia University Medical Center, New York, NY
| | | | | | | | | | | | | | - Victor Zak
- New England Research Institute, Watertown, Mass
| | | | | | | | | | - Seema Mital
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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36
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Fattahi F, Kalbitz M, Malan EA, Abe E, Jajou L, Huber-Lang MS, Bosmann M, Russell MW, Zetoune FS, Ward PA. Complement-induced activation of MAPKs and Akt during sepsis: role in cardiac dysfunction. FASEB J 2017; 31:4129-4139. [PMID: 28572445 DOI: 10.1096/fj.201700140r] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/15/2017] [Indexed: 01/27/2023]
Abstract
Polymicrobial sepsis in mice causes myocardial dysfunction after generation of the complement anaphylatoxin, complement component 5a (C5a). C5a interacts with its receptors on cardiomyocytes (CMs), resulting in redox imbalance and cardiac dysfunction that can be functionally measured and quantitated using Doppler echocardiography. In this report we have evaluated activation of MAPKs and Akt in CMs exposed to C5a in vitro and after cecal ligation and puncture (CLP) in vivo In both cases, C5a in vitro caused activation (phosphorylation) of MAPKs and Akt in CMs, which required availability of both C5a receptors. Using immunofluorescence technology, activation of MAPKs and Akt occurred in left ventricular (LV) CMs, requiring both C5a receptors, C5aR1 and -2. Use of a water-soluble p38 inhibitor curtailed activation in vivo of MAPKs and Akt in LV CMs as well as the appearance of cytokines and histones in plasma from CLP mice. When mouse macrophages were exposed in vitro to LPS, activation of MAPKs and Akt also occurred. The copresence of the p38 inhibitor blocked these activation responses. Finally, the presence of the p38 inhibitor in CLP mice reduced the development of cardiac dysfunction. These data suggest that polymicrobial sepsis causes cardiac dysfunction that appears to be linked to activation of MAPKs and Akt in heart.-Fattahi, F., Kalbitz, M., Malan, E. A., Abe, E., Jajou, L., Huber-Lang, M. S., Bosmann, M., Russell, M. W., Zetoune, F. S., Ward, P. A. Complement-induced activation of MAPKs and Akt during sepsis: role in cardiac dysfunction.
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Affiliation(s)
- Fatemeh Fattahi
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Miriam Kalbitz
- Department of Orthopaedic Trauma, Hand, Plastic, and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany
| | - Elizabeth A Malan
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Elizabeth Abe
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lawrence Jajou
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Markus S Huber-Lang
- Department of Orthopaedic Trauma, Hand, Plastic, and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany
| | - Markus Bosmann
- Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
| | - Mark W Russell
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Firas S Zetoune
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Peter A Ward
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA;
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37
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Burns KM, Bienemann L, Camperlengo L, Cottengim C, Covington TM, Dykstra H, Faulkner M, Kobau R, Erck Lambert AB, MacLeod H, Parks SE, Rosenberg E, Russell MW, Shapiro-Mendoza CK, Shaw E, Tian N, Whittemore V, Kaltman JR. The Sudden Death in the Young Case Registry: Collaborating to Understand and Reduce Mortality. Pediatrics 2017; 139:e20162757. [PMID: 28228502 PMCID: PMC5330401 DOI: 10.1542/peds.2016-2757] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 12/13/2022] Open
Abstract
Knowledge gaps persist about the incidence of and risk factors for sudden death in the young (SDY). The SDY Case Registry is a collaborative effort between the National Institutes of Health, the Centers for Disease Control and Prevention, and the Michigan Public Health Institute. Its goals are to: (1) describe the incidence of SDY in the United States by using population-based surveillance; (2) compile data from SDY cases to create a resource of information and DNA samples for research; (3) encourage standardized approaches to investigation, autopsy, and categorization of SDY cases; (4) develop partnerships between local, state, and federal stakeholders toward a common goal of understanding and preventing SDY; and (5) support families who have lost loved ones to SDY by providing resources on bereavement and medical evaluation of surviving family members. Built on existing Child Death Review programs and as an expansion of the Sudden Unexpected Infant Death Case Registry, the SDY Case Registry achieves its goals by identifying SDY cases, providing guidance to medical examiners/coroners in conducting comprehensive autopsies, evaluating cases through child death review and an advanced review by clinical specialists, and classifying cases according to a standardized algorithm. The SDY Case Registry also includes a process to obtain informed consent from next-of-kin to save DNA for research, banking, and, in some cases, diagnostic genetic testing. The SDY Case Registry will provide valuable incidence data and will enhance understanding of the characteristics of SDY cases to inform the development of targeted prevention efforts.
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Affiliation(s)
- Kristin M Burns
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute and
| | - Lauren Bienemann
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Carri Cottengim
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Theresa M Covington
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, Michigan; and
| | - Heather Dykstra
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, Michigan; and
| | - Meghan Faulkner
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, Michigan; and
| | - Rosemarie Kobau
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Heather MacLeod
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, Michigan; and
| | - Sharyn E Parks
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ellen Rosenberg
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute and
| | - Mark W Russell
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Esther Shaw
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, Michigan; and
| | - Niu Tian
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vicky Whittemore
- National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Jonathan R Kaltman
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute and
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38
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Hajishengallis G, Arce S, Gockel CM, Connell TD, Russell MW. Immunomodulation with Enterotoxins for the Generation of Secretory Immunity or Tolerance: Applications for Oral Infections. J Dent Res 2016; 84:1104-16. [PMID: 16304439 DOI: 10.1177/154405910508401205] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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: 01/04/2023] Open
Abstract
The heat-labile enterotoxins, such as cholera toxin (CT), and the labile toxins types I and II (LT-I and LT-II) of Escherichia coli have been extensively studied for their immunomodulatory properties, which result in the enhancement of immune responses. Despite superficial similarity in structure, in which a toxic A subunit is coupled to a pentameric binding B subunit, different toxins have different immunological properties. Administration of appropriate antigens admixed with or coupled to these toxins by oral, intranasal, or other routes in experimental animals induces mucosal IgA and circulating IgG antibodies that have protective potential against a variety of enteric, respiratory, or genital infections. These include the generation of salivary antibodies that may protect against colonization with mutans streptococci and the development of dental caries. However, exploitation of these adjuvants for human use requires an understanding of their mode of action and the separation of their desirable immunomodulatory properties from their toxicity. Recent findings have revealed that adjuvant action is not critically dependent upon the enzymic activity of the A subunits, and that the isolated B subunits may exert different effects on cells of the immune system than do the intact toxins. Interaction of the toxins with immunocompetent cells is not exclusively dependent upon their conventional ganglioside receptors. Immunomodulatory effects have been observed on dendritic cells, macrophages, CD4+ and CD8+ T-cells, and B-cells. Numerous factors—including the precise form of the toxin adjuvant, properties of the antigen, whether and how they are coupled, route of administration, and species of animal model—affect the outcome, whether this is enhanced humoral and cellular immunity, or specific induced tolerance toward the antigen.
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Affiliation(s)
- G Hajishengallis
- Department of Microbiology, Immunology, and Parasitology, and Center of Excellence in Oral and Craniofacial Biology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Helms AS, Alvarado FJ, Yob J, Tang VT, Pagani F, Russell MW, Valdivia HH, Day SM. Genotype-Dependent and -Independent Calcium Signaling Dysregulation in Human Hypertrophic Cardiomyopathy. Circulation 2016; 134:1738-1748. [PMID: 27688314 PMCID: PMC5127749 DOI: 10.1161/circulationaha.115.020086] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 08/05/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Aberrant calcium signaling may contribute to arrhythmias and adverse remodeling in hypertrophic cardiomyopathy (HCM). Mutations in sarcomere genes may distinctly alter calcium handling pathways. METHODS We analyzed gene expression, protein levels, and functional assays for calcium regulatory pathways in human HCM surgical samples with (n=25) and without (n=10) sarcomere mutations compared with control hearts (n=8). RESULTS Gene expression and protein levels for calsequestrin, L-type calcium channel, sodium-calcium exchanger, phospholamban, calcineurin, and calcium/calmodulin-dependent protein kinase type II (CaMKII) were similar in HCM samples compared with controls. CaMKII protein abundance was increased only in sarcomere-mutation HCM (P<0.001). The CaMKII target pT17-phospholamban was 5.5-fold increased only in sarcomere-mutation HCM (P=0.01), as was autophosphorylated CaMKII (P<0.01), suggestive of constitutive activation. Calcineurin (PPP3CB) mRNA was not increased, nor was RCAN1 mRNA level, indicating a lack of calcineurin activation. Furthermore, myocyte enhancer factor 2 and nuclear factor of activated T cell transcription factor activity was not increased in HCM, suggesting that calcineurin pathway activation is not an upstream cause of increased CAMKII protein abundance or activation. SERCA2A mRNA transcript levels were reduced in HCM regardless of genotype, as was sarcoplasmic endoplasmic reticular calcium ATPase 2/phospholamban protein ratio (45% reduced; P=0.03). 45Ca sarcoplasmic endoplasmic reticular calcium ATPaseuptake assay showed reduced uptake velocity in HCM regardless of genotype (P=0.01). The cardiac ryanodine receptor was not altered in transcript, protein, or phosphorylated (pS2808, pS2814) protein abundance, and [3H]ryanodine binding was not different in HCM, consistent with no major modification of the ryanodine receptor. CONCLUSIONS Human HCM demonstrates calcium mishandling through both genotype-specific and common pathways. Posttranslational activation of the CaMKII pathway is specific to sarcomere mutation-positive HCM, whereas sarcoplasmic endoplasmic reticular calcium ATPase 2 abundance and sarcoplasmic reticulum Ca uptake are depressed in both sarcomere mutation-positive and -negative HCM.
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Affiliation(s)
- Adam S Helms
- From Departments of Internal Medicine (A.S.H., J.Y., V.T.T., H.H.V., S.M.D.), Molecular and Integrative Physiology (F.J.A., H.H.V., S.M.D.), Cardiac Surgery (F.P.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor.
| | - Francisco J Alvarado
- From Departments of Internal Medicine (A.S.H., J.Y., V.T.T., H.H.V., S.M.D.), Molecular and Integrative Physiology (F.J.A., H.H.V., S.M.D.), Cardiac Surgery (F.P.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor
| | - Jaime Yob
- From Departments of Internal Medicine (A.S.H., J.Y., V.T.T., H.H.V., S.M.D.), Molecular and Integrative Physiology (F.J.A., H.H.V., S.M.D.), Cardiac Surgery (F.P.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor
| | - Vi T Tang
- From Departments of Internal Medicine (A.S.H., J.Y., V.T.T., H.H.V., S.M.D.), Molecular and Integrative Physiology (F.J.A., H.H.V., S.M.D.), Cardiac Surgery (F.P.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor
| | - Francis Pagani
- From Departments of Internal Medicine (A.S.H., J.Y., V.T.T., H.H.V., S.M.D.), Molecular and Integrative Physiology (F.J.A., H.H.V., S.M.D.), Cardiac Surgery (F.P.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor
| | - Mark W Russell
- From Departments of Internal Medicine (A.S.H., J.Y., V.T.T., H.H.V., S.M.D.), Molecular and Integrative Physiology (F.J.A., H.H.V., S.M.D.), Cardiac Surgery (F.P.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor
| | - Héctor H Valdivia
- From Departments of Internal Medicine (A.S.H., J.Y., V.T.T., H.H.V., S.M.D.), Molecular and Integrative Physiology (F.J.A., H.H.V., S.M.D.), Cardiac Surgery (F.P.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor
| | - Sharlene M Day
- From Departments of Internal Medicine (A.S.H., J.Y., V.T.T., H.H.V., S.M.D.), Molecular and Integrative Physiology (F.J.A., H.H.V., S.M.D.), Cardiac Surgery (F.P.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor
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Mital S, Musunuru K, Garg V, Russell MW, Lanfear DE, Gupta RM, Hickey KT, Ackerman MJ, Perez MV, Roden DM, Woo D, Fox CS, Ware S. Enhancing Literacy in Cardiovascular Genetics: A Scientific Statement From the American Heart Association. ACTA ACUST UNITED AC 2016; 9:448-467. [PMID: 27672144 DOI: 10.1161/hcg.0000000000000031] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Advances in genomics are enhancing our understanding of the genetic basis of cardiovascular diseases, both congenital and acquired, and stroke. These advances include finding genes that cause or increase the risk for childhood and adult-onset diseases, finding genes that influence how patients respond to medications, and the development of genetics-guided therapies for diseases. However, the ability of cardiovascular and stroke clinicians to fully understand and apply this knowledge to the care of their patients has lagged. This statement addresses what the specialist caring for patients with cardiovascular diseases and stroke should know about genetics; how they can gain this knowledge; how they can keep up-to-date with advances in genetics, genomics, and pharmacogenetics; and how they can apply this knowledge to improve the care of patients and families with cardiovascular diseases and stroke.
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Kalbitz M, Fattahi F, Grailer JJ, Jajou L, Malan EA, Zetoune FS, Huber-Lang M, Russell MW, Ward PA. Complement-induced activation of the cardiac NLRP3 inflammasome in sepsis. FASEB J 2016; 30:3997-4006. [PMID: 27543123 DOI: 10.1096/fj.201600728r] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [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: 06/09/2016] [Accepted: 08/08/2016] [Indexed: 01/02/2023]
Abstract
Cardiac dysfunction develops during sepsis in humans and rodents. In the model of polymicrobial sepsis induced by cecal ligation and puncture (CLP), we investigated the role of the NLRP3 inflammasome in the heart. Mouse heart homogenates from sham-procedure mice contained high mRNA levels of NLRP3 and IL-1β. Using the inflammasome protocol, exposure of cardiomyocytes (CMs) to LPS followed by ATP or nigericin caused release of mature IL-1β. Immunostaining of left ventricular frozen sections before and 8 h after CLP revealed the presence of NLRP3 and IL-1β proteins in CMs. CLP caused substantial increases in mRNAs for IL-1β and NLRP3 in CMs which are reduced in the absence of either C5aR1 or C5aR2. After CLP, NLRP3-/- mice showed reduced plasma levels of IL-1β and IL-6. In vitro exposure of wild-type CMs to recombinant C5a (rC5a) caused elevations in both cytosolic and nuclear/mitochondrial reactive oxygen species (ROS), which were C5a-receptor dependent. Use of a selective NOX2 inhibitor prevented increased cytosolic and nuclear/mitochondrial ROS levels and release of IL-1β. Finally, NLRP3-/- mice had reduced defects in echo/Doppler parameters in heart after CLP. These studies establish that the NLRP3 inflammasome contributes to the cardiomyopathy of polymicrobial sepsis.-Kalbitz, M., Fattahi, F., Grailer, J. J., Jajou, L., Malan, E. A., Zetoune, F. S., Huber-Lang, M., Russell, M. W., Ward, P. A. Complement-induced activation of the cardiac NLRP3 inflammasome in sepsis.
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Affiliation(s)
- Miriam Kalbitz
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Orthopaedic Trauma, Hand, Plastic, and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; and
| | - Fatemeh Fattahi
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jamison J Grailer
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lawrence Jajou
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Elizabeth A Malan
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Firas S Zetoune
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Markus Huber-Lang
- Department of Orthopaedic Trauma, Hand, Plastic, and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; and
| | - Mark W Russell
- Department of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Peter A Ward
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA;
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Kalbitz M, Fattahi F, Herron TJ, Grailer JJ, Jajou L, Lu H, Huber-Lang M, Zetoune FS, Sarma JV, Day SM, Russell MW, Jalife J, Ward PA. Complement Destabilizes Cardiomyocyte Function In Vivo after Polymicrobial Sepsis and In Vitro. J Immunol 2016; 197:2353-61. [PMID: 27521340 DOI: 10.4049/jimmunol.1600091] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 07/06/2016] [Indexed: 01/12/2023]
Abstract
There is accumulating evidence during sepsis that cardiomyocyte (CM) homeostasis is compromised, resulting in cardiac dysfunction. An important role for complement in these outcomes is now demonstrated. Addition of C5a to electrically paced CMs caused prolonged elevations of intracellular Ca(2+) concentrations during diastole, together with the appearance of spontaneous Ca(2+) transients. In polymicrobial sepsis in mice, we found that three key homeostasis-regulating proteins in CMs were reduced: Na(+)/K(+)-ATPase, which is vital for effective action potentials in CMs, and two intracellular Ca(2+) concentration regulatory proteins, that is, sarcoplasmic/endoplasmic reticulum calcium ATPase 2 and the Na(+)/Ca(2+) exchanger. Sepsis caused reduced mRNA levels and reductions in protein concentrations in CMs for all three proteins. The absence of either C5a receptor mitigated sepsis-induced reductions in the three regulatory proteins. Absence of either C5a receptor (C5aR1 or C5aR2) diminished development of defective systolic and diastolic echocardiographic/Doppler parameters developing in the heart (cardiac output, left ventricular stroke volume, isovolumic relaxation, E' septal annulus, E/E' septal annulus, left ventricular diastolic volume). We also found in CMs from septic mice the presence of defective current densities for Ik1, l-type calcium channel, and Na(+)/Ca(2+) exchanger. These defects were accentuated in the copresence of C5a. These data suggest complement-related mechanisms responsible for development of cardiac dysfunction during sepsis.
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Affiliation(s)
- Miriam Kalbitz
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109; Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, 89081 Ulm, Germany
| | - Fatemeh Fattahi
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Todd J Herron
- Division of Cardiovascular Research, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109; Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Jamison J Grailer
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Lawrence Jajou
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Hope Lu
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Markus Huber-Lang
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, 89081 Ulm, Germany
| | - Firas S Zetoune
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - J Vidya Sarma
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Sharlene M Day
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI 48109; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109; Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Mark W Russell
- Department of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, MI 48109; and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109
| | - José Jalife
- Division of Cardiovascular Research, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109; Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Peter A Ward
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109;
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White MJ, Loccoh EC, Goble MM, Yu S, Duquette D, Davis MM, Odetola FO, Russell MW. Availability of Automated External Defibrillators in Public High Schools. J Pediatr 2016; 172:142-146.e1. [PMID: 26935784 DOI: 10.1016/j.jpeds.2016.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 10/17/2015] [Revised: 12/09/2015] [Accepted: 02/03/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess automated external defibrillator (AED) distribution and cardiac emergency preparedness in Michigan secondary schools and investigate for association with school sociodemographic characteristics. STUDY DESIGN Surveys were sent via electronic mail to representatives from all public high schools in 30 randomly selected Michigan counties, stratified by population. Association of AED-related factors with school sociodemographic characteristics were evaluated using Wilcoxon rank sum test and χ(2) test, as appropriate. RESULTS Of 188 schools, 133 (71%) responded to the survey and all had AEDs. Larger student population was associated with fewer AEDs per 100 students (P < .0001) and fewer staff with AED training per AED (P = .02), compared with smaller schools. Schools with >20% students from racial minority groups had significantly fewer AEDs available per 100 students than schools with less racial diversity (P = .03). Schools with more students eligible for free and reduced lunch were less likely to have a cardiac emergency response plan (P = .02) and demonstrated less frequent AED maintenance (P = .03). CONCLUSIONS Although AEDs are available at public high schools across Michigan, the number of AEDs per student varies inversely with minority student population and school size. Unequal distribution of AEDs and lack of cardiac emergency preparedness may contribute to outcomes of sudden cardiac arrest among youth.
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Affiliation(s)
- Michelle J White
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.
| | - Emefah C Loccoh
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Monica M Goble
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Sunkyung Yu
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Deb Duquette
- Genomics and Genetic Disorders Section, Michigan Department of Health and Human Services, Lansing, MI
| | - Matthew M Davis
- Department of Pediatrics and Communicable Diseases, Gerald R. Ford School of Public Policy, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Folafoluwa O Odetola
- Division of Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Mark W Russell
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
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Homsy J, Zaidi S, Shen Y, Ware JS, Samocha KE, Karczewski KJ, DePalma SR, McKean D, Wakimoto H, Gorham J, Jin SC, Deanfield J, Giardini A, Porter GA, Kim R, Bilguvar K, López-Giráldez F, Tikhonova I, Mane S, Romano-Adesman A, Qi H, Vardarajan B, Ma L, Daly M, Roberts AE, Russell MW, Mital S, Newburger JW, Gaynor JW, Breitbart RE, Iossifov I, Ronemus M, Sanders SJ, Kaltman JR, Seidman JG, Brueckner M, Gelb BD, Goldmuntz E, Lifton RP, Seidman CE, Chung WK. De novo mutations in congenital heart disease with neurodevelopmental and other congenital anomalies. Science 2016; 350:1262-6. [PMID: 26785492 DOI: 10.1126/science.aac9396] [Citation(s) in RCA: 516] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Congenital heart disease (CHD) patients have an increased prevalence of extracardiac congenital anomalies (CAs) and risk of neurodevelopmental disabilities (NDDs). Exome sequencing of 1213 CHD parent-offspring trios identified an excess of protein-damaging de novo mutations, especially in genes highly expressed in the developing heart and brain. These mutations accounted for 20% of patients with CHD, NDD, and CA but only 2% of patients with isolated CHD. Mutations altered genes involved in morphogenesis, chromatin modification, and transcriptional regulation, including multiple mutations in RBFOX2, a regulator of mRNA splicing. Genes mutated in other cohorts examined for NDD were enriched in CHD cases, particularly those with coexisting NDD. These findings reveal shared genetic contributions to CHD, NDD, and CA and provide opportunities for improved prognostic assessment and early therapeutic intervention in CHD patients.
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Affiliation(s)
- Jason Homsy
- Department of Genetics, Harvard Medical School, Boston, MA, USA. Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Samir Zaidi
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Yufeng Shen
- Departments of Systems Biology and Biomedical Informatics, Columbia University Medical Center, New York, NY, USA
| | - James S Ware
- Department of Genetics, Harvard Medical School, Boston, MA, USA. NIHR Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield NHS Foundation and Trust and Imperial College London, London, UK. National Heart & Lung Institute, Imperial College London, London, UK
| | - Kaitlin E Samocha
- Department of Genetics, Harvard Medical School, Boston, MA, USA. Analytical and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Konrad J Karczewski
- Department of Genetics, Harvard Medical School, Boston, MA, USA. Analytical and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Steven R DePalma
- Department of Genetics, Harvard Medical School, Boston, MA, USA. Howard Hughes Medical Institute, Harvard University, Boston, MA, USA
| | - David McKean
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Hiroko Wakimoto
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Josh Gorham
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Sheng Chih Jin
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - John Deanfield
- Department of Cardiology, University College London and Great Ormond Street Hospital, London, UK
| | - Alessandro Giardini
- Department of Cardiology, University College London and Great Ormond Street Hospital, London, UK
| | - George A Porter
- Department of Pediatrics, University of Rochester Medical Center, The School of Medicine and Dentistry, Rochester, NY, USA
| | - Richard Kim
- Section of Cardiothoracic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kaya Bilguvar
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA. Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | | | - Irina Tikhonova
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | - Shrikant Mane
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | - Angela Romano-Adesman
- Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Hongjian Qi
- Departments of Systems Biology and Biomedical Informatics, Columbia University Medical Center, New York, NY, USA. Department of Applied Physics and Applied Mathematics, Columbia University, New York, NY, USA
| | - Badri Vardarajan
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Lijiang Ma
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Mark Daly
- Department of Genetics, Harvard Medical School, Boston, MA, USA. Analytical and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Amy E Roberts
- Department of Cardiology, Children's Hospital Boston, Boston, MA, USA
| | - Mark W Russell
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Seema Mital
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - J William Gaynor
- Department of Pediatric Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Roger E Breitbart
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Ivan Iossifov
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | | | - Stephan J Sanders
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Jonathan R Kaltman
- Heart Development and Structural Diseases Branch, Division of Cardiovascular Sciences, NHLBI/NIH, Bethesda, MD, USA
| | | | - Martina Brueckner
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA.
| | - Bruce D Gelb
- Mindich Child Health and Development Institute and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Elizabeth Goldmuntz
- Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Richard P Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA. Howard Hughes Medical Institute, Yale University, New Haven, CT, USA.
| | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, MA, USA. Howard Hughes Medical Institute, Harvard University, Boston, MA, USA. Cardiovascular Division, Brigham & Women's Hospital, Harvard University, Boston, MA, USA.
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY, USA.
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Magdo HS, Stillwell TL, Greenhawt MJ, Stringer KA, Yu S, Fifer CG, Russell MW, Schumacher KR. Immune Abnormalities in Fontan Protein-Losing Enteropathy: A Case-Control Study. J Pediatr 2015; 167:331-7. [PMID: 26009017 DOI: 10.1016/j.jpeds.2015.04.061] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 11/24/2014] [Revised: 03/10/2015] [Accepted: 04/22/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To comprehensively characterize the immunologic characteristics of patients with protein-losing enteropathy (PLE) post-Fontan and compare them with patients without PLE post-Fontan. STUDY DESIGN Patients with PLE post-Fontan and age-matched controls post-Fontan were prospectively studied with laboratory markers of immune function. Infectious history was obtained by interview and chart review. The groups' demographics, cardiac history, immune characteristics, and infection history were compared using appropriate 2-group statistics. RESULTS A total of 16 patients enrolled (8 patients with PLE and 8 controls). All patients with PLE had lymphopenia compared with 25% of controls (P = .01). All patients with PLE had markedly depressed CD4 T cell counts (median 58 cells/μL) compared with controls (median 450 cells/μL, P = .0002); CD4% was also low in the PLE group (12.3%) and normal in control (36.9%, P = .004). Both groups had mildly depressed CD8 T cells and normal to slightly elevated natural killer and B-cell subsets. A majority of patients with PLE (62.5%) had negative titers to measles, mumps, and rubella vaccination, compared with no control Fontan with a negative titer (P = .03). Despite profoundly low CD4 counts, the frequency of infection was not different between groups with no reported opportunistic infections. CONCLUSIONS Patients with Fontan-associated PLE have extensive quantitative immune abnormalities, particularly CD4 deficiency. These immune abnormalities are similar to those found in non-Fontan patients with PLE caused by intestinal lymphangiectasia.
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Affiliation(s)
- H Sonali Magdo
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI.
| | | | | | | | - Sunkyung Yu
- University of Michigan, Michigan Congenital Heart Outcomes Research and Discovery Ann Arbor, MI
| | - Carlen G Fifer
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Mark W Russell
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Kurt R Schumacher
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI
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Schumacher KR, Stringer KA, Donohue JE, Yu S, Shaver A, Caruthers RL, Zikmund-Fisher BJ, Fifer C, Goldberg C, Russell MW. Fontan-associated protein-losing enteropathy and plastic bronchitis. J Pediatr 2015; 166:970-7. [PMID: 25661406 PMCID: PMC4564862 DOI: 10.1016/j.jpeds.2014.12.068] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [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: 09/17/2014] [Revised: 10/29/2014] [Accepted: 12/22/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To characterize the medical history, disease progression, and treatment of current-era patients with the rare diseases Fontan-associated protein-losing enteropathy (PLE) and plastic bronchitis. STUDY DESIGN A novel survey that queried demographics, medical details, and treatment information was piloted and placed online via a Facebook portal, allowing social media to power the study. Participation regardless of PLE or plastic bronchitis diagnosis was allowed. Case control analyses compared patients with PLE and plastic bronchitis with uncomplicated control patients receiving the Fontan procedure. RESULTS The survey was completed by 671 subjects, including 76 with PLE, 46 with plastic bronchitis, and 7 with both. Median PLE diagnosis was 2.5 years post-Fontan. Hospitalization for PLE occurred in 71% with 41% hospitalized ≥ 3 times. Therapy varied significantly. Patients with PLE more commonly had hypoplastic left ventricle (62% vs 44% control; OR 2.81, 95% CI 1.43-5.53), chylothorax (66% vs 41%; OR 2.96, CI 1.65-5.31), and cardiothoracic surgery in addition to staged palliation (17% vs 5%; OR 4.27, CI 1.63-11.20). Median plastic bronchitis diagnosis was 2 years post-Fontan. Hospitalization for plastic bronchitis occurred in 91% with 61% hospitalized ≥ 3 times. Therapy was very diverse. Patients with plastic bronchitis more commonly had chylothorax at any surgery (72% vs 51%; OR 2.47, CI 1.20-5.08) and seasonal allergies (52% vs 36%; OR 1.98, CI 1.01-3.89). CONCLUSIONS Patient-specific factors are associated with diagnoses of PLE or plastic bronchitis. Treatment strategies are diverse without clear patterns. These results provide a foundation upon which to design future therapeutic studies and identify a clear need for forming consensus approaches to treatment.
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Affiliation(s)
- Kurt R. Schumacher
- University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital
| | | | - Janet E. Donohue
- University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital
| | - Sunkyung Yu
- University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital
| | - Ashley Shaver
- University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital
| | - Regine L. Caruthers
- University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital
| | | | - Carlen Fifer
- University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital
| | - Caren Goldberg
- University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital
| | - Mark W. Russell
- University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital
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Kalbitz M, Grailer JJ, Fattahi F, Jajou L, Herron TJ, Campbell KF, Zetoune FS, Bosmann M, Sarma JV, Huber-Lang M, Gebhard F, Loaiza R, Valdivia HH, Jalife J, Russell MW, Ward PA. Role of extracellular histones in the cardiomyopathy of sepsis. FASEB J 2015; 29:2185-93. [PMID: 25681459 DOI: 10.1096/fj.14-268730] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [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: 12/16/2014] [Accepted: 01/14/2015] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to define the relationship in polymicrobial sepsis (in adult male C57BL/6 mice) between heart dysfunction and the appearance in plasma of extracellular histones. Procedures included induction of sepsis by cecal ligation and puncture and measurement of heart function using echocardiogram/Doppler parameters. We assessed the ability of histones to cause disequilibrium in the redox status and intracellular [Ca(2+)]i levels in cardiomyocytes (CMs) (from mice and rats). We also studied the ability of histones to disturb both functional and electrical responses of hearts perfused with histones. Main findings revealed that extracellular histones appearing in septic plasma required C5a receptors, polymorphonuclear leukocytes (PMNs), and the Nacht-, LRR-, and PYD-domains-containing protein 3 (NLRP3) inflammasome. In vitro exposure of CMs to histones caused loss of homeostasis of the redox system and in [Ca(2+)]i, as well as defects in mitochondrial function. Perfusion of hearts with histones caused electrical and functional dysfunction. Finally, in vivo neutralization of histones in septic mice markedly reduced the parameters of heart dysfunction. Histones caused dysfunction in hearts during polymicrobial sepsis. These events could be attenuated by histone neutralization, suggesting that histones may be targets in the setting of sepsis to reduce cardiac dysfunction.
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Affiliation(s)
- Miriam Kalbitz
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Jamison J Grailer
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Fatemeh Fattahi
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Lawrence Jajou
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Todd J Herron
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Katherine F Campbell
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Firas S Zetoune
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Markus Bosmann
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - J Vidya Sarma
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Markus Huber-Lang
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Florian Gebhard
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Randall Loaiza
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Hector H Valdivia
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - José Jalife
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Mark W Russell
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
| | - Peter A Ward
- *Department of Pathology and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany; Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA; and Center for Thrombosis and Hemostasis and Department of Hematology, Oncology and Pneumology, University Medical Center, Mainz, Germany
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Russell MW, Hannibal M. Other Single-Gene Disorders Causing Congenital Heart Disease. CONGENIT HEART DIS 2015. [DOI: 10.1159/000375216] [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: 11/19/2022]
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Gaynor JW, Kim DS, Arrington CB, Atz AM, Bellinger DC, Burt AA, Ghanayem NS, Jacobs JP, Lee TM, Lewis AB, Mahle WT, Marino BS, Miller SG, Newburger JW, Pizarro C, Ravishankar C, Santani AB, Wilder NS, Jarvik GP, Mital S, Russell MW. Validation of association of the apolipoprotein E ε2 allele with neurodevelopmental dysfunction after cardiac surgery in neonates and infants. J Thorac Cardiovasc Surg 2014; 148:2560-6. [PMID: 25282659 DOI: 10.1016/j.jtcvs.2014.07.052] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 04/07/2014] [Revised: 06/27/2014] [Accepted: 07/12/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Apolipoprotein E (APOE) genotype is a determinant of neurologic recovery after brain ischemia and traumatic brain injury. The APOE ε2 allele has been associated with worse neurodevelopmental (ND) outcome after repair of congenital heart defects (CHD) in infancy. Replication of this finding in an independent cohort is essential to validate the observed genotype-phenotype association. METHODS The association of APOE genotype with ND outcomes was assessed in a combined cohort of patients with single-ventricle CHD enrolled in the Single Ventricle Reconstruction and Infant Single Ventricle trials. ND outcome was assessed at 14 months using the Psychomotor Development Index (PDI) and Mental Development Index (MDI) of the Bayley Scales of Infant Development-II. Stepwise multivariable regression was performed to develop predictive models for PDI and MDI scores. RESULTS Complete data were available for 298 of 435 patients. After adjustment for preoperative and postoperative covariates, the APOE ε2 allele was associated with a lower PDI score (P = .038). Patients with the ε2 allele had a PDI score approximately 6 points lower than those without the risk allele, explaining 1.04% of overall PDI variance, because the ε2 allele was present in only 11% of the patients. There was a marginal effect of the ε2 allele on MDI scores (P = .058). CONCLUSIONS These data validate the association of the APOE ε2 allele with adverse early ND outcomes after cardiac surgery in infants, independent of patient and operative factors. Genetic variants that decrease neuroresilience and impair neuronal repair after brain injury are important risk factors for ND dysfunction after surgery for CHD.
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Affiliation(s)
- J William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Daniel Seung Kim
- Departments of Medicine (Division of Medical Genetics) and Genome Sciences, University of Washington School of Medicine, Seattle, Wash
| | | | - Andrew M Atz
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital, Boston, Mass, and Department of Neurology, Harvard Medical School, Boston, Mass
| | - Amber A Burt
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, Wash
| | - Nancy S Ghanayem
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Jeffery P Jacobs
- Johns Hopkins Children's Heart Institute, All Children's Hospital and Florida Hospital for Children, St Petersburg, Fla
| | - Teresa M Lee
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Alan B Lewis
- Children's Hospital Los Angeles, Los Angeles, Calif
| | | | - Bradley S Marino
- Ann and Robert F. Lurie Children's Hospital of Chicago, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephen G Miller
- Division of Pediatric Oncology, Duke University Medical Center, Durham, NC
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Christian Pizarro
- Nemours Cardiac Center, Alfred I. Dupont Hospital for Children, Wilmington, Del
| | - Chitra Ravishankar
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Avni B Santani
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Nicole S Wilder
- Department of Anesthesia, University of Michigan Medical School, Ann Arbor, Mich
| | - Gail P Jarvik
- Departments of Medicine (Division of Medical Genetics) and Genome Sciences, University of Washington School of Medicine, Seattle, Wash
| | - Seema Mital
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mark W Russell
- Department of Pediatrics and Communicable Diseases (Division of Pediatric Cardiology), University of Michigan Medical School, Ann Arbor, Mich
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50
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Helms AS, Davis FM, Coleman D, Bartolone SN, Glazier AA, Pagani F, Yob JM, Sadayappan S, Pedersen E, Lyons R, Westfall MV, Jones R, Russell MW, Day SM. Sarcomere mutation-specific expression patterns in human hypertrophic cardiomyopathy. ACTA ACUST UNITED AC 2014; 7:434-43. [PMID: 25031304 DOI: 10.1161/circgenetics.113.000448] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Heterozygous mutations in sarcomere genes in hypertrophic cardiomyopathy (HCM) are proposed to exert their effect through gain of function for missense mutations or loss of function for truncating mutations. However, allelic expression from individual mutations has not been sufficiently characterized to support this exclusive distinction in human HCM. METHODS AND RESULTS Sarcomere transcript and protein levels were analyzed in septal myectomy and transplant specimens from 46 genotyped HCM patients with or without sarcomere gene mutations and 10 control hearts. For truncating mutations in MYBPC3, the average ratio of mutant:wild-type transcripts was ≈1:5, in contrast to ≈1:1 for all sarcomere missense mutations, confirming that nonsense transcripts are uniquely unstable. However, total MYBPC3 mRNA was significantly increased by 9-fold in HCM samples with MYBPC3 mutations compared with control hearts and with HCM samples without sarcomere gene mutations. Full-length MYBPC3 protein content was not different between MYBPC3 mutant HCM and control samples, and no truncated proteins were detected. By absolute quantification of abundance with multiple reaction monitoring, stoichiometric ratios of mutant sarcomere proteins relative to wild type were strikingly variable in a mutation-specific manner, with the fraction of mutant protein ranging from 30% to 84%. CONCLUSIONS These results challenge the concept that haploinsufficiency is a unifying mechanism for HCM caused by MYBPC3 truncating mutations. The range of allelic imbalance for several missense sarcomere mutations suggests that certain mutant proteins may be more or less stable or incorporate more or less efficiently into the sarcomere than wild-type proteins. These mutation-specific properties may distinctly influence disease phenotypes.
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Affiliation(s)
- Adam S Helms
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - Frank M Davis
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - David Coleman
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - Sarah N Bartolone
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - Amelia A Glazier
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - Francis Pagani
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - Jaime M Yob
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - Sakthivel Sadayappan
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - Ellen Pedersen
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - Robert Lyons
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - Margaret V Westfall
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - Richard Jones
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - Mark W Russell
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.)
| | - Sharlene M Day
- From the Departments of Internal Medicine (A.S.H., F.D., D.C., S.B., J.M.Y., S.M.D.), Molecular and Integrative Physiology (A.A.G., M.V.W.), Cardiac Surgery (F.P., M.V.W.), Sequencing Core (E.P., R.L.), and Pediatrics (M.W.R.), University of Michigan, Ann Arbor; Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S.S.); and MS Bioworks, Ann Arbor, MI (R.J.).
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