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Pham C, Koopmann TT, Vinocur JM, Blom NA, Nogueira Silbiger V, Mittal K, Bootsma M, Palm KCA, Clur SAB, Barge-Schaapveld DQCM, Hamilton RM, Lodder EM. Reduced kinase function in two ultra-rare TNNI3K variants in families with congenital junctional ectopic tachycardia. Clin Genet 2024. [PMID: 38424693 DOI: 10.1111/cge.14504] [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: 12/04/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
Genetic missense variants in TNNI3K, encoding troponin-I interacting kinase, have been associated with dilated cardiomyopathy (DCM) and observed in families with supraventricular tachycardias (SVT). Previously, a family harboring the TNNI3K-c.1615A > G (p.Thr539Ala) variant presented with congenital junctional ectopic tachycardia (CJET), an arrhythmia that arises from the atrioventricular (AV) node and His bundle. However, this was a relatively small four-generational family with limited genetic testing (N = 3). We here describe a multigenerational family with CJET harboring a novel ultra-rare TNNI3K variant: TNNI3K-c.1729C > T (p.Leu577Phe). Of all 18 variant carriers, 13 individuals presented with CJET, resulting in a genetic penetrance of 72%. In addition, CJET is reported in another small family harboring TNNI3K-c.2225C > T (p.Pro742Leu). Similar to the previously published CJET family, both TNNI3K variants demonstrate a substantial reduction of kinase activity. Our study contributes novel evidence supporting the involvement of TNNI3K genetic variants as significant contributors to CJET, shedding light on potential mechanisms underlying this cardiac arrhythmia.
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Affiliation(s)
- Caroline Pham
- Department of Experimental Cardiology Heart Center, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart failure & Arrhythmias, Amsterdam, The Netherlands
| | - Tamara T Koopmann
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Physiology and Experimental Medicine, The Hospital for Sick Children & Research Institute, Toronto, Canada
| | - Jeffrey M Vinocur
- Division of Pediatric Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nico A Blom
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Vivian Nogueira Silbiger
- Physiology and Experimental Medicine, The Hospital for Sick Children & Research Institute, Toronto, Canada
- Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Kirti Mittal
- Department of Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kaylin C A Palm
- Department of Experimental Cardiology Heart Center, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart failure & Arrhythmias, Amsterdam, The Netherlands
| | - Sally-Ann B Clur
- Department of Paediatric Cardiology, Emma Children's Hospital, University Medical Center Amsterdam, Amsterdam, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart - ERN GUARD-Heart, Amsterdam, The Netherlands
| | | | - Robert M Hamilton
- Labatt Family Heart Centre, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Elisabeth M Lodder
- Department of Experimental Cardiology Heart Center, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart failure & Arrhythmias, Amsterdam, The Netherlands
- Department of Human Genetics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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2
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Nabil D, Samuel M, Levesque S, Zaidi A, Cohen S, Opotowsky AR, Mongeon FP, Mondésert B, Kay J, Ibrahim R, Hamilton RM, Fournier A, Jameson SM, Dore A, Cook SC, Cohen S, Chaix MA, Broberg CS, Aboulhosn J, Poirier N, Khairy P. Impact of Fontan fenestration on adverse cardiovascular outcomes: a multicenter study. Can J Cardiol 2024:S0828-282X(24)00079-5. [PMID: 38309467 DOI: 10.1016/j.cjca.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Fenestrating a Fontan baffle has been associated with improved peri-operative outcomes in patients with univentricular hearts. However, longer-term potential adverse effects remain debated. We sought to assess the impact of a fenestrated Fontan baffle on adverse cardiovascular events including all-cause mortality, cardiac transplantation, atrial arrhythmias, and thromboemboli. METHODS A multicenter North American retrospective cohort study was conducted on patients with a total cavopulmonary connection Fontan baffle, with and without fenestration. All components of the composite outcome were independently adjudicated. Potential static and time-varying confounders were taken into consideration, along with competing risks. RESULTS A total of 407 patients were followed for 10.4 (7.1-14.4) years, 70.0% of whom had fenestration of their Fontan baffle. The fenestration spontaneously closed or was deliberately sealed in 79.9% of patients a median of 2.0 years after Fontan completion. In multivariable analysis in which a persistent fenestration was modelled as a time-dependent variable, an open fenestration did not confer a higher risk of the composite outcome [hazard ratio 1.18, 95% confidence interval (0.71 to 1.97), P=0.521]. In secondary analyses, an open fenestration was not significantly associated with components of the primary outcome, i.e., mortality or transplantation, atrial arrhythmias, or thromboemboli. However, sensitivity analyses to assess the possible range of error resulting from imprecise dates for spontaneous fenestration closures could not rule-out significant associations between an open fenestration and atrial arrhythmias or thromboemboli. CONCLUSION In this multicenter study, no significant association was identified between an open fenestration in the Fontan baffle and major adverse cardiovascular events.
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Affiliation(s)
- Dib Nabil
- Montreal Heart Institute, Université de Montréal, Quebec, Canada
| | - Michelle Samuel
- Montreal Heart Institute, Université de Montréal, Quebec, Canada
| | - Sylvie Levesque
- Montreal Health Innovations Coordinating Center, Quebec, Canada
| | - Ali Zaidi
- Nationwide Children's Hospital, Ohio State University, Columbus, USA
| | - Sarah Cohen
- Hôpital Marie-Lannelongue, Groupe Hospitalier Saint-Joseph, Le Plessis Robinson, Paris, France
| | - Alexander R Opotowsky
- Boston Adult Congenital Heart Service, Boston Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, USA; The Cincinnati Adult Congenital Heart Disease Program, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | | | | | - Joseph Kay
- University of Colorado Denver, Aurora, USA
| | - Reda Ibrahim
- Montreal Heart Institute, Université de Montréal, Quebec, Canada
| | - Robert M Hamilton
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Anne Fournier
- Hôpital Sainte-Justine, Université de Montréal, Montreal, Canada
| | - Susan M Jameson
- Stanford Adult Congenital Heart Program, Lucile Packard Children's Hospital Stanford and Stanford Health Care, Stanford University School of Medicine, Palo Alto, USA
| | - Annie Dore
- Montreal Heart Institute, Université de Montréal, Quebec, Canada
| | | | - Scott Cohen
- The Wisconsin Adult Congenital Heart (WAtCH) Program, Medical College of Wisconsin, Milwaukee, USA
| | - Marie-A Chaix
- Montreal Heart Institute, Université de Montréal, Quebec, Canada
| | | | - Jamil Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Program, University of California, Los Angeles, USA
| | - Nancy Poirier
- Montreal Heart Institute, Université de Montréal, Quebec, Canada
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Quebec, Canada.
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3
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Jaeggi E, Kulasingam V, Chen J, Fan CPS, Laskin C, Hamilton RM, Hiraki LT, Silverman ED, Sepiashvili L. Maternal Anti-Ro Antibody Titers Obtained With Commercially Available Immunoassays Are Strongly Associated With Immune-Mediated Fetal Heart Disease. Arthritis Rheumatol 2023; 75:1556-1565. [PMID: 36996277 DOI: 10.1002/art.42513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE Anti-Ro antibody-positive mothers are frequently referred for serial echocardiography due to the fetal risk of developing heart block and endocardial fibroelastosis. Little is known why only some and not all offspring develop these cardiac manifestations of neonatal lupus (CNL). This prospective study examined associations between anti-Ro antibody titers and fetal CNL. METHODS Antibody-positive mothers referred since 2018 for fetal echocardiography at risk of CNL (group 1; n = 240) or with CNL (group 2; n = 18) were included. Maternal antibody titers were measured with a chemiluminescent immunoassay (CIA). Additional testing on diluted serum samples was used to quantify anti-Ro 60 antibody titers above the analytical measuring range (AMR) of the standard CIA (≥1,375 chemiluminescent units [CU]). RESULTS Among 27 total mothers with a fetal diagnosis of CNL, all displayed anti-Ro 60 antibody titers that exceeded the AMR of the CIA at least 10-fold. Of 122 mothers in group 1 who underwent additional anti-Ro 60 antibody testing, event rates of CNL (n = 9) were 0% (0 of 45) among mothers with anti-Ro 60 antibody titers from 1,375-10,000 CU, 5% (3 of 56) among mothers with titers from 10,000-50,000 CU, but 29% (6 of 21) among mothers with titers >50,000 CU (odds ratio 13.1, P = 0.0008). Of mothers in group 2 with a primary diagnosis of CNL, 0% (0 of 18 mothers) had anti-Ro 60 antibody titers <10,000 CU, 44% (8 of 18 mothers) had titers from 10,000-50,000 CU, and 56% (10 of 18 mothers) had titers >50,000 CU. CONCLUSION CNL is associated with substantially higher anti-Ro antibody titers than are obtained using a standard CIA. Enhancing the assay measuring range allows an improved specificity of identifying pregnancies at risk of CNL.
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Affiliation(s)
- Edgar Jaeggi
- Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Vathany Kulasingam
- Division of Clinical Biochemistry, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jack Chen
- Department of Laboratory Medicine & Pathobiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Chun-Po Steve Fan
- Rogers Computational Program, Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Carl Laskin
- Department of Medicine, Mount Sinai Hospital, New York, New York
| | - Robert M Hamilton
- Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Linda T Hiraki
- Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Earl D Silverman
- Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lusia Sepiashvili
- Department of Laboratory Medicine & Pathobiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Dorobantu DM, Riding N, McClean G, de la Garza MS, Abuli-Lluch M, Sharma C, Duarte N, Adamuz MC, Watt V, Hamilton RM, Ryding D, Perry D, McNally S, Stuart AG, Sitges M, Oxborough DL, Wilson M, Friedberg M, Williams C, Pieles GE. The use of 2-D speckle tracking echocardiography in differentiating healthy adolescent athletes with right ventricular outflow tract dilation from patients with arrhythmogenic cardiomyopathy. Int J Cardiol 2023; 382:98-105. [PMID: 37030404 DOI: 10.1016/j.ijcard.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/01/2023] [Accepted: 04/03/2023] [Indexed: 04/10/2023]
Abstract
AIMS Echocardiographic assessment of adolescent athletes for arrhythmogenic cardiomyopathy (ACM) can be challenging owing to right ventricular (RV) exercise-related remodelling, particularly RV outflow tract (RVOT) dilation. The aim of this study is to evaluate the role of RV 2-D speckle tracking echocardiography (STE) in comparing healthy adolescent athletes with and without RVOT dilation to patients with ACM. METHODS AND RESULTS A total of 391 adolescent athletes, mean age 14.5 ± 1.7 years, evaluated at three sports academies between 2014 and 2019 were included, and compared to previously reported ACM patients (n = 38 definite and n = 39 borderline). Peak systolic RV free wall (RVFW-Sl), global and segmental strain (Sl), and corresponding strain rates (SRl) were calculated. The participants meeting the major modified Task Force Criteria (mTFC) for RVOT dilation were defined as mTFC+ (n = 58, 14.8%), and the rest as mTFC- (n = 333, 85.2%). Mean RVFW-Sl was -27.6 ± 3.4% overall, -28.2 ± 4.1% in the mTFC+ group and - 27.5 ± 3.3% in the mTFC- group. mTFC+ athletes had normal RV-FW-Sl when compared to definite (-29% vs -19%, p < 0.001) and borderline ACM (-29% vs -21%, p < 0.001) cohorts. In addition, all mean global and regional Sl and SRl values were no worse in the mTFC+ group compared to the mTFC- (p values range < 0.0001 to 0.1, inferiority margin of 2% and 0.1 s-1 respectively). CONCLUSIONS In athletes with RVOT dilation meeting the major mTFC, STE evaluation of the RV can demostrate normal function and differentiate physiological remodelling from pathological changes found in ACM, improving screening in grey-area cases.
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Affiliation(s)
- Dan M Dorobantu
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK; Population Health Sciences and Medical Schools, University of Bristol, Bristol, UK; Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, UK
| | - Nathan Riding
- Population Health Sciences and Medical Schools, University of Bristol, Bristol, UK; Sports Medicine Department and the Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Institute of Sport Exercise and Health, University College London, London, UK
| | - Gavin McClean
- Sports Medicine Department and the Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Institute of Sport Exercise and Health, University College London, London, UK; Echocardiography Laboratory, St. Bartholomew's Hospital, Barts Health National Health System Foundation Trust and University College London, London, UK
| | - María-Sanz de la Garza
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Marc Abuli-Lluch
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Chetanya Sharma
- Population Health Sciences and Medical Schools, University of Bristol, Bristol, UK
| | - Nuno Duarte
- Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, UK
| | - Maria Carmen Adamuz
- Sports Medicine Department and the Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Victoria Watt
- Sports Medicine Department and the Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Cardiovascular Institute, Hospital Clinic de Barcelona and Barcelona Football Club Medical Services, Barcelona, Spain
| | - Robert M Hamilton
- Cardiology Department, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Diane Ryding
- Labatt Family Heart Centre, Department of Pediatrics, Hospital for Sick Children, University of Toronto, ON, Canada
| | - Dave Perry
- Manchester Metropolitan University, Manchester, UK
| | | | - A Graham Stuart
- Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, UK; Manchester United Football Club, Football Medicine & Science Department, Manchester, UK
| | - Marta Sitges
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David L Oxborough
- Echocardiography Laboratory, St. Bartholomew's Hospital, Barts Health National Health System Foundation Trust and University College London, London, UK
| | - Mathew Wilson
- Sports Medicine Department and the Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Institute of Sport Exercise and Health, University College London, London, UK
| | - Mark Friedberg
- Cardiology Department, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Craig Williams
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK.
| | - Guido E Pieles
- Sports Medicine Department and the Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Institute of Sport Exercise and Health, University College London, London, UK; National Institute for Health Research Cardiovascular Biomedical Research Centre, Bristol Heart Institute, UK
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5
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Basmaji S, Samuel M, Shohoudi A, Hamilton RM, Aboulhosn J, Broberg CS, Chaix MA, Cohen S, Cook S, Dore A, Fernandes SM, Fortier A, Fournier A, Guertin MC, Kay J, Mondésert B, Mongeon FP, Opotowsky AR, Proietti A, Ting J, Zaidi A, Khairy P. Time in Therapeutic Range With Vitamin K Antagonists in Congenital Heart Disease: A Multicentre Study. Can J Cardiol 2022; 38:1751-1758. [PMID: 35964887 DOI: 10.1016/j.cjca.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vitamin K antagonists (VKAs) are frequently prescribed to patients with congenital heart disease (CHD) for atrial arrhythmias or Fontan palliation, but there is a paucity of data regarding time spent in the therapeutic range (TTR). We sought to determine the TTR in patients with CHD and atrial arrhythmias or Fontan palliation prescribed VKAs and explore associations with thromboembolic and bleeding events. METHODS A multicentre North American cohort study was conducted on patients with CHD who received VKAs for sustained atrial arrhythmia or Fontan palliation. TTR was calculated using the Rosendaal linear interpolation method. Generalized estimating equations were used to explore factors associated with time outside the therapeutic range. RESULTS A total of 567 patients, aged 33 ± 17 years, 56% female, received VKAs for 11.5 ± 8.4 years for atrial arrhythmias (63.0%) or Fontan palliation (58.0%). CHD was simple, moderate, and complex in 10.8%, 20.3%, and 69.0%, respectively. Site investigators perceived good control over international normalized ratio (INR) levels in most patients (75.3%), with no or minor compliance or adherence issues (85.6%). The mean TTR was 41.9% (95% confidence interval [CI], 39.0%-44.8%). Forty-seven (8.3%) and 34 (6.0%) patients had thromboembolic and bleeding events, respectively. Thromboembolic events were associated with a higher proportion of time below the therapeutic range (31.3% vs 19.1%, P = 0.003) and bleeding complications with a higher proportion of time above the therapeutic range (32.5% vs 19.5%, P = 0.006). CONCLUSIONS Patients with CHD who receive VKAs spend < 42% of their time with INR levels in the therapeutic range, with repercussions regarding thromboembolic and bleeding complications.
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Affiliation(s)
- Samir Basmaji
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Michelle Samuel
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Azadeh Shohoudi
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Robert M Hamilton
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Marie-A Chaix
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Scott Cohen
- The Wisconsin Adult Congenital Heart (WAtCH) Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephen Cook
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Annie Dore
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Annik Fortier
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Anne Fournier
- Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | | | - Joseph Kay
- University of Colorado Denver, Aurora, Colorado, USA
| | - Blandine Mondésert
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Alexander R Opotowsky
- Boston Adult Congenital Heart Service, Boston Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Proietti
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Jennifer Ting
- Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Ali Zaidi
- Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
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6
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Teng ACT, Gu L, Di Paola M, Lakin R, Williams ZJ, Au A, Chen W, Callaghan NI, Zadeh FH, Zhou YQ, Fatah M, Chatterjee D, Jourdan LJ, Liu J, Simmons CA, Kislinger T, Yip CM, Backx PH, Gourdie RG, Hamilton RM, Gramolini AO. Tmem65 is critical for the structure and function of the intercalated discs in mouse hearts. Nat Commun 2022; 13:6166. [PMID: 36257954 PMCID: PMC9579145 DOI: 10.1038/s41467-022-33303-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/07/2022] [Indexed: 12/24/2022] Open
Abstract
The intercalated disc (ICD) is a unique membrane structure that is indispensable to normal heart function, yet its structural organization is not completely understood. Previously, we showed that the ICD-bound transmembrane protein 65 (Tmem65) was required for connexin43 (Cx43) localization and function in cultured mouse neonatal cardiomyocytes. Here, we investigate the functional and cellular effects of Tmem65 reductions on the myocardium in a mouse model by injecting CD1 mouse pups (3-7 days after birth) with recombinant adeno-associated virus 9 (rAAV9) harboring Tmem65 shRNA, which reduces Tmem65 expression by 90% in mouse ventricles compared to scrambled shRNA injection. Tmem65 knockdown (KD) results in increased mortality which is accompanied by eccentric hypertrophic cardiomyopathy within 3 weeks of injection and progression to dilated cardiomyopathy with severe cardiac fibrosis by 7 weeks post-injection. Tmem65 KD hearts display depressed hemodynamics as measured echocardiographically as well as slowed conduction in optical recording accompanied by prolonged PR intervals and QRS duration in electrocardiograms. Immunoprecipitation and super-resolution microscopy demonstrate a physical interaction between Tmem65 and sodium channel β subunit (β1) in mouse hearts and this interaction appears to be required for both the establishment of perinexal nanodomain structure and the localization of both voltage-gated sodium channel 1.5 (NaV1.5) and Cx43 to ICDs. Despite the loss of NaV1.5 at ICDs, whole-cell patch clamp electrophysiology did not reveal reductions in Na+ currents but did show reduced Ca2+ and K+ currents in Tmem65 KD cardiomyocytes in comparison to control cells. We conclude that disrupting Tmem65 function results in impaired ICD structure, abnormal cardiac electrophysiology, and ultimately cardiomyopathy.
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Affiliation(s)
- Allen C T Teng
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada.
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, ON, M5G 1M1, Canada.
| | - Liyang Gu
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, ON, M5G 1M1, Canada
| | - Michelle Di Paola
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, ON, M5G 1M1, Canada
| | - Robert Lakin
- Department of Biology, York University, Toronto, ON, M3J 1P3, Canada
| | - Zachary J Williams
- The Center for Heart and Reparative Medicine, Fralin Biomedical Research Institute at Virginia Tech. Carilion, Roanoke, VA, 24016, USA
- Translational Biology Medicine and Health Graduate Program, Virginia Tech, Roanoke, VA, 24016, USA
| | - Aaron Au
- Institute of Biomedical Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
- Donnelly Centre, University of Toronto, Toronto, ON, M5S 3E1, Canada
| | - Wenliang Chen
- Department of Biology, York University, Toronto, ON, M3J 1P3, Canada
| | - Neal I Callaghan
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, ON, M5G 1M1, Canada
- Institute of Biomedical Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Farigol Hakem Zadeh
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, ON, M5G 1M1, Canada
| | - Yu-Qing Zhou
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, ON, M5G 1M1, Canada
- Institute of Biomedical Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Meena Fatah
- The Labatt Family Heart Centre (Dept. of Pediatrics) and Translational Medicine, The Hospital for Sick Children & Research Institute, University of Toronto, Toronto, ON., M5G 1X8, Canada
| | - Diptendu Chatterjee
- The Labatt Family Heart Centre (Dept. of Pediatrics) and Translational Medicine, The Hospital for Sick Children & Research Institute, University of Toronto, Toronto, ON., M5G 1X8, Canada
| | - L Jane Jourdan
- The Center for Heart and Reparative Medicine, Fralin Biomedical Research Institute at Virginia Tech. Carilion, Roanoke, VA, 24016, USA
- Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016, USA
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24060, USA
| | - Jack Liu
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Craig A Simmons
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, ON, M5G 1M1, Canada
- Institute of Biomedical Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Thomas Kislinger
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, M5G 1L7, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, M5G 1L7, Canada
| | - Christopher M Yip
- Institute of Biomedical Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
- Donnelly Centre, University of Toronto, Toronto, ON, M5S 3E1, Canada
| | - Peter H Backx
- Department of Biology, York University, Toronto, ON, M3J 1P3, Canada
| | - Robert G Gourdie
- The Center for Heart and Reparative Medicine, Fralin Biomedical Research Institute at Virginia Tech. Carilion, Roanoke, VA, 24016, USA
- Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016, USA
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24060, USA
| | - Robert M Hamilton
- The Labatt Family Heart Centre (Dept. of Pediatrics) and Translational Medicine, The Hospital for Sick Children & Research Institute, University of Toronto, Toronto, ON., M5G 1X8, Canada
| | - Anthony O Gramolini
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada.
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, ON, M5G 1M1, Canada.
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7
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Teng A, Gu L, Di Paola M, Lakin R, Williams Z, Au A, CHEN WENLIANG, Callaghan NI, Hakem Zadeh F, ZHOU YUQING, Fatah M, Chatterjee D, Jourdan J, Jack L, Simmons CA, Kislinger T, Yip C, Backx P, Gourdie RG, Hamilton RM, Gramolini A. Abstract P2018: Tmem65 Is Critical For The Structure And Function Of The Intercalated Discs In Mouse Hearts. Circ Res 2022. [DOI: 10.1161/res.131.suppl_1.p2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The intercalated disc (ICD) is unique membrane structure that is indispensable to normal heart function, yet its structural organization is not completely understood. Previously, we showed that the ICD-bound transmembrane protein 65 (Tmem65) was required for connexin 43 (Cx43) localization and function in cultured mouse neonatal cardiomyocytes. Here, we investigated the role of Tmem65 in ICD organization
in vivo
. A mouse model was established by injecting CD1 mouse pups (3-7 days after birth) with recombinant adeno-associated virus 9 (rAAV9) harboring Tmem65 shRNA which resulted in a 90% reduction of Tmem65 expression in mouse ventricles compared to mice injected with scrambled shRNA. Tmem65 knockdown (KD) resulted in increased mortality which was accompanied by eccentric hypertrophic cardiomyopathy within 3 weeks of injection, progressing to dilated cardiomyopathy with severe cardiac fibrosis by 7 weeks post-injection. Tmem65 KD hearts displayed depressed hemodynamics, measured echocardiographically, accompanied by electrocardiogram changes (prolonged PR intervals and QRS duration) consistent with impaired conduction, which was confirmed with optical mapping of isolated hearts. Immunoprecipitation and super-resolution microscopy demonstrated a physical interaction between Tmem65 and sodium channel β subunit (β1) in mouse hearts and this interaction appeared to be required for both the establishment of perinexal nanodomain structure and the localization of both voltage-gated sodium channel 1.5 (NaV1.5) and Cx43 to ICDs. Despite the loss of NaV1.5 at the ICDs, whole-cell patch clamp electrophysiology did not reveal reductions in Na
+
currents but did show reduced Ca
2+
and K
+
currents in Tmem65 KD cardiomyocytes in comparison to control cells. We conclude that disrupting Tmem65 function results in impaired ICD structure, abnormal cardiac electrophysiology, and ultimately cardiomyopathy.
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Affiliation(s)
| | | | | | | | | | - Aaron Au
- Univ of Toronto, Toronto, Canada
| | | | | | | | | | | | | | | | - Liu Jack
- Univ of Toronto, Toronto, Canada
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8
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Guimier A, Achleitner MT, Moreau de Bellaing A, Edwards M, de Pontual L, Mittal K, Dunn KE, Grove ME, Tysoe CJ, Dimartino C, Cameron J, Kanthi A, Shukla A, van den Broek F, Chatterjee D, Alston CL, Knowles CV, Brett L, Till JA, Homfray T, French P, Spentzou G, Elserafy NA, Lichkus KS, Sankaran BP, Kennedy HL, George PM, Kidd A, Wortmann SB, Fisk DG, Koopmann TT, Rafiq MA, Merker JD, Parikh S, Ahimaz P, Weintraub RG, Ma AS, Turner C, Ellaway CJ, Phillips LK, Thorburn DR, Chung WK, Kana SL, Faye-Petersen OM, Thompson ML, Janin A, McLeod K, McGowan R, McFarland R, Girisha KM, Morris-Rosendahl DJ, Hurst ACE, Turner CLS, Hamilton RM, Taylor RW, Bajolle F, Gordon CT, Amiel J, Mayr JA, Doudney K. PPA2-associated sudden cardiac death: extending the clinical and allelic spectrum in 20 new families. Genet Med 2022; 24:967. [PMID: 35394429 DOI: 10.1016/j.gim.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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9
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Dorian D, Chatterjee D, Connelly KA, Goodman JM, Yan AT, Bentley RF, Banks L, Hamilton RM, Dorian P. A Novel Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) Biomarker—Anti-DSG2—Is Absent in Athletes With Right Ventricular Enlargement. CJC Open 2021; 3:1413-1418. [PMID: 34993452 PMCID: PMC8712542 DOI: 10.1016/j.cjco.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022] Open
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10
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Fridman MD, Tofighi T, Fan CPS, Hamilton RM. Resting ECG measurements can identify abnormalities in children with catecholaminergic polymorphic ventricular tachycardia. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is a rare inherited disease characterized by exercise- or emotionally-triggered life-threatening ventricular arrhythmias. The resting ECG is considered to be normal and diagnosis has depended on exercise testing that is difficult acutely post-arrest or in young children.
Purpose
To identify resting ECG abnormalities in children with CPVT through assessment of measurement matrix parameters compared to a cohort of normal children.
Methods
A discovery cohort of 65 CPVT patients from the Electrophysiology program were identified. After excluding those on antiarrhythmics or in an arrhythmia at the time of their baseline ECG, 31 cases were matched 3:1 by age and sex with 93 healthy controls. Each individual had baseline ECG parameters and 180 machine-derived ECG amplitudes and durations (measurement matrix) measured. Statistical differences between ECG measures were assessed using Student's T-Test adjusted with a False Detection Rate of 1%. Significant measures were processed in a machine-learning algorithm to derive a Tree Model to differentiate individuals with and without CPVT.
Results
No significant differences were detected between CPVT patients who had and did not have a cardiac arrest. Comparing the CPVT and control cohorts, significant repolarization differences were seen in the amplitudes of lateral (I, negative aVR, V5, V6) and anterior leads (V2, V3, V4) at the J-point, ST midpoint, ST endpoint, and T-wave. Specifically, individuals with CPVT had significantly lower mean amplitudes in all aforementioned leads except aVR where the mean amplitudes were higher. These data were then used to create a Tree Model of the discovery cohort displayed in Figure 1 with a resulting R2 of 0.74, sensitivity of 0.81, and specificity of 0.98.
Conclusions
Baseline differences in repolarization are detectable in the left and anterior chest leads using machine-derived measurements of baseline ECGs in patients with CPVT, which may guide clinical suspicion when evaluating the resting ECG. These results warrant further analysis including testing of the Tree Model with a validation cohort.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Scholar Award from the Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada to Trainee Dr. Taraneh TofighiCanadian Institute for Health Research Figure 1. CPVT Tree Model
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Affiliation(s)
- M D Fridman
- Hospital for Sick Children, Pediatrics, Division of Cardiology, Toronto, Canada
| | - T Tofighi
- University of Toronto, Toronto, Canada
| | - C P S Fan
- University Health Network, Toronto, Canada
| | - R M Hamilton
- Hospital for Sick Children, Pediatrics, Division of Cardiology, Toronto, Canada
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11
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Teng AC, Gu L, Di Paola M, Williams Z, Au A, Callaghan N, Hakem Zadeh F, Zhao YQ, Fatah M, Chatterjee D, Jourdan JJ, Simmons CA, Kislinger T, Yip C, Gourdie RG, Hamilton RM, Gramolini A. Abstract P361: Reduced Cardiac Tmem65 In Mouse Hearts Results In Intercalated Disc Defects And Eventual Dilated Cardiomyopathy With Cardiac Fibrosis. Circ Res 2021. [DOI: 10.1161/res.129.suppl_1.p361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The intercalated disc (ICD) is unique membrane structure that is indispensable to normal heart function. However, its structural organization is not well understood. Previously, we showed that the ICD-bound transmembrane protein 65 (Tmem65) was required for connexin 43 (Cx43) localization in cultured mouse neonatal cardiomyocytes. Here, we investigated the role of Tmem65 in ICD organization
in vivo
. A mouse model was established by injecting CD1 mouse pups (3-7 days after birth) with recombinant adeno-associated virus 9 (rAAV9) harboring Tmem65 (or scrambled) shRNA. Quantitative polymerase chain reaction (qPCR) and immunoblots confirmed greater than 85% reduction in Tmem65 expression (7.1±0.7% remained for Tmem65 proteins; 14.4±2.5% remained for Tmem65 transcripts,
n
=4) in mouse ventricles compared to control hearts. Tmem65 knockdown (KD) mice exhibited heart failure-like symptoms as early as 3 weeks post viral administration. Specifically, Tmem65 KD mice developed eccentric hypertrophic cardiomyopathy in 3 weeks and dilated cardiomyopathy with severe cardiac fibrosis in 7 weeks, as confirmed by H&E and Masson’s Trichrome staining. Echocardiography and electrocardiography, respectively, showed depressed hemodynamics (19.27±1.46ml/min for cardiac output in control hearts vs. 6.63±0.52ml/min for Tmem65 KD hearts,
n
=6) and impaired conduction, including prolonged PR (22.7±1.85ms in control hearts vs. 28.89±3.85ms in Tmem65 KD hearts, n≥8), QRS intervals (10.47±0.42ms in control hearts vs. 16.35±0.36ms in Tmem65 KD hearts, n≥8), and slowed heart rate (415±10bpm in control hearts vs. 347±16bpm in Tmem65 KD hearts, n≥8) in Tmem65 KD mouse hearts.
Immunoprecipitation and super-resolution microscopy confirmed the physical interaction and localization between Tmem65 and voltage-gated sodium channel β subunit (β1) at the ICD and this interaction was evidently required for the establishment of perinexal nanodomains and voltage-gated sodium channel 1.5 (NaV1.5) localization to the ICD. Disrupting Tmem65 function, thus, impaired perinexal structure, reduced conduction velocity, and ultimately resulted in cardiomyopathy
in vivo
.
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Affiliation(s)
| | | | | | | | - Aaron Au
- Univ of Toronto, Toronto, Canada
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12
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Kallas D, Ghadiry-Tavi R, Roston TM, Franciosi S, Fischbach PS, Knight LM, Kannankeril PJ, Krahn AD, Kwok SY, LaPage MJ, Tisma-Dupanovic S, Atallah J, Kean AC, Etheridge SP, Hill AC, Law IH, Balaji S, Johnsrude CL, Backhoff D, Dhillon SS, Perry JC, Kubuš P, Kovach JR, Fournier A, Kamp AN, Kron J, Lau YR, Brugada GS, Hamilton RM, Sanatani S. B-PO05-167 ATRIAL TACHYARRHYTHMIAS IN CATECHOLAMINERGIC POLYMORPHIC VENTRICULAR TACHYCARDIA: A REPORT FROM THE INTERNATIONAL PEDIATRIC CPVT REGISTRY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1086] [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: 11/26/2022]
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13
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Cheung CC, Davies B, Roberts JD, Tadros R, Green MS, Healey JS, Simpson CS, Sanatani S, Steinberg C, Gardner MJ, MacIntyre C, Angaran P, Duff HJ, Talajic M, Hamilton RM, Arbour L, Leather RA, Seifer CM, Anne Fournier, Joza JE, Klein GJ, Laksman Z, Krahn AD. B-PO01-020 MACHINE LEARNING TO PREDICT RECURRENT EVENTS FOLLOWING UNEXPLAINED CARDIAC ARREST. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.166] [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: 11/25/2022]
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14
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Malik A, Marshall ME, Shah MJ, Fish FA, Etheridge SP, Aziz PF, Russell M, Tisma-Dupanovic S, Pflaumer A, Sreeram N, Kubuš P, Law IH, Kantoch M, Kertesz NJ, Strieper MJ, Erickson CC, Moore JP, Nakano S, Singh HR, Chang PM, Cohen MI, Fournier A, Ilina MV, Smith RT, Zimmermann F, Horndasch M, Li WL, Batra AS, Liberman L, Hamilton RM, Janson CM, Sanatani S, Zeltser I, McDaniel GM, Blaufox AD, Garnreiter JM, Balaji S. B-PO02-197 PATTERNS OF ELECTROCARDIOGRAPH ABNORMALITIES IN CHILDREN WITH HYPERTROPHIC CARDIOMYOPATHY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.449] [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: 11/15/2022]
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15
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Landry CH, Fatah M, Connelly KA, Angaran P, Hamilton RM, Dorian P. Evaluating the 12-Lead Electrocardiogram for Diagnosing ARVC in Young Populations: Implications for Preparticipation Screening of Athletes. CJC Open 2021; 3:498-503. [PMID: 34027353 PMCID: PMC8129442 DOI: 10.1016/j.cjco.2020.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 10/24/2022] Open
Abstract
Background Arrhythmogenic right-ventricular cardiomyopathy (ARVC) is an identified cause of sport-related sudden cardiac arrest (SCA). Identifying athletes with ARVC and restricting them from exercise is believed to reduce the risk of SCA. The electrocardiogram (ECG) is considered to be an important component of screening for ARVC; however, the sensitivity of the 12-lead ECG to identify ARVC in young asymptomatic persons is unknown. Methods In this retrospective study, we identified 70 patients (49 ARVC-positive, based on Task Force Criteria, and 21 age-matched ARVC-negative persons from a paediatric arrhythmia database (<18 years of age); ECGs were analyzed for abnormalities, based on International Criteria for Interpretation of ECGs in Athletes, and ECG findings were adjudicated by group consensus. Results Of the 49 ARVC-positive patients (median age: 17 [interquartile range: 16-18], 65% male), 22% were found to have abnormal ECGs; the most common ECG findings were T-wave inversions. Patients with symptoms were more likely to have abnormal ECGs than asymptomatic patients (28% compared with 17%, respectively; P = 0.002). Of 16 gene-positive patients, 31% had abnormal ECGs. Patients with abnormal ECGs had larger right-ventricular end-diastolic volume indexes on magnetic resonance imaging than those with normal ECGs (P = 0.03). Conclusions The ECG was insensitive for detecting ARVC in young (age <18 years), asymptomatic patients, and is unlikely to provide significant diagnostic value for identifying ARVC on routine preparticipation screening of adolescent athletes.
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Affiliation(s)
- Cameron H Landry
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Meena Fatah
- Department of Paediatrics (Cardiology) and the Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute and the Keenan Research Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Paul Angaran
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Robert M Hamilton
- Department of Paediatrics (Cardiology) and the Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Dorian
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
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16
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Suna G, Kolios A, Chatterjee D, Fatah M, Gasperetti A, Casella M, Sommariva E, Franzen D, Manka R, Pazhenkottil A, Ruschitzka F, Boyman O, Duru F, Hamilton RM, Saguner AM. Anti-desmoglein2 autoantibodies are present in patients with cardiac sarcoidosis and correlate with cardiac inflammation. Europace 2021. [DOI: 10.1093/europace/euab116.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Zurich ACM Program is supported by generous grants from the Georg and Bertha Schwyzer-Winniker Foundation, the Baugarten Foundation, Swiss National Science Foundation, Swiss Heart Foundation and Wild Foundation. This work is also supported by a Canadian Institutes of Health Research grant (FRN: 162402) and the Labatt Heart Centre and Waugh Family Innovation Funds, Caitlin Elizabeth Morris Memorial Fund, Alex Corrance Memorial Foundation and Meredith Cartwright.
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) has several phenocopies such as cardiac sarcoidosis (CS), idiopathic outflow tract ventricular tachycardia (OT-VT) and myocarditis. Differentiation between these entities can be challenging. Recently, we have identified diagnostic anti-desmoglein-2 autoantibodies (anti-DSG2 Abs) in patients with ARVC.
PURPOSE We sought to examine whether anti-DSG2 Abs are also present in clinical phenocopies of ARVC.
METHODS Anti-DSG2 Abs in sera of 25, 19 and 22 patients with sarcoidosis, OT-VT and myocarditis, respectively, were assessed by western blots and ELISA. Clinical and imaging parameters, as well as conventional biomarkers were correlated to detected anti-DSG2 Ab intensity levels.
RESULTS Anti-DSG2 Abs, at various intensities, were identified in 6/25 (24%) patients with sarcoidosis, all presenting with CS, but were absent in patients with OT-VT and myocarditis. Cardiac 18F- fluorodeoxyglucose positron emission tomography (18F-FDG PET) was positive in all sarcoidosis patients with positive anti-DSG2 Abs, corresponding to a median PET maximum standardized uptake value (SUVmax) of 5.65 [IQR: 5.15 – 10.9]. In sarcoidosis patients without anti-DSG2 Abs, the SUVmax values were significantly lower with a median of 0 [IQR: 0 – 4] (p = 0.011). The Pearson correlation coefficient (R) was 0.188 (p = 0.039) indicating a positive correlation between cardiac 18F-FDG uptake and anti-DSG2 Abs. No significant correlation was detected for any of the other clinical parameters and biomarkers.
CONCLUSIONS In addition to being present in ARVC, anti-DSG2 Abs are also found in CS, a common phenocopy of ARVC; conversely, anti-DSG2 Abs are absent in idiopathic OT-VT and myocarditis. Anti-DSG2 Ab levels positively correlate with myocardial disease activity in CS as indicated by cardiac 18F-FDG PET scanning. Abstract Figure. Central illustration
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Affiliation(s)
- G Suna
- University Hospital Zurich, Zurich, Switzerland
| | - A Kolios
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, United States of America
| | - D Chatterjee
- University of Toronto, The Labatt Family Heart Centre and Translational Medicine, The Hospital for Sick Children, Toronto, Canada
| | - M Fatah
- University of Toronto, The Labatt Family Heart Centre and Translational Medicine, The Hospital for Sick Children, Toronto, Canada
| | | | - M Casella
- Marche Polytechnic University of Ancona, Ancona, Italy
| | - E Sommariva
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - D Franzen
- University Hospital Zurich, Zurich, Switzerland
| | - R Manka
- University Hospital Zurich, Zurich, Switzerland
| | | | | | - O Boyman
- University Hospital Zurich, Zurich, Switzerland
| | - F Duru
- University Hospital Zurich, Zurich, Switzerland
| | - RM Hamilton
- University of Toronto, The Labatt Family Heart Centre and Translational Medicine, The Hospital for Sick Children, Toronto, Canada
| | - AM Saguner
- University Hospital Zurich, Zurich, Switzerland
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17
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Chatterjee D, Pieroni M, Fatah M, Charpentier F, Cunningham KS, Spears DA, Chatterjee D, Suna G, Bos JM, Ackerman MJ, Schulze-Bahr E, Dittmann S, Notarstefano PG, Bolognese L, Duru F, Saguner AM, Hamilton RM. An autoantibody profile detects Brugada syndrome and identifies abnormally expressed myocardial proteins. Eur Heart J 2021; 41:2878-2890. [PMID: 32533187 DOI: 10.1093/eurheartj/ehaa383] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/23/2020] [Accepted: 04/24/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS Brugada syndrome (BrS) is characterized by a unique electrocardiogram (ECG) pattern and life-threatening arrhythmias. However, the Type 1 Brugada ECG pattern is often transient, and a genetic cause is only identified in <25% of patients. We sought to identify an additional biomarker for this rare condition. As myocardial inflammation may be present in BrS, we evaluated whether myocardial autoantibodies can be detected in these patients. METHODS AND RESULTS For antibody (Ab) discovery, normal human ventricular myocardial proteins were solubilized and separated by isoelectric focusing (IEF) and molecular weight on two-dimensional (2D) gels and used to discover Abs by plating with sera from patients with BrS and control subjects. Target proteins were identified by mass spectrometry (MS). Brugada syndrome subjects were defined based on a consensus clinical scoring system. We assessed discovery and validation cohorts by 2D gels, western blots, and ELISA. We performed immunohistochemistry on myocardium from BrS subjects (vs. control). All (3/3) 2D gels exposed to sera from BrS patients demonstrated specific Abs to four proteins, confirmed by MS to be α-cardiac actin, α-skeletal actin, keratin, and connexin-43, vs. 0/8 control subjects. All (18/18) BrS subjects from our validation cohorts demonstrated the same Abs, confirmed by western blots, vs. 0/24 additional controls. ELISA optical densities for all Abs were elevated in all BrS subjects compared to controls. In myocardium obtained from BrS subjects, each protein, as well as SCN5A, demonstrated abnormal protein expression in aggregates. CONCLUSION A biomarker profile of autoantibodies against four cardiac proteins, namely α-cardiac actin, α-skeletal actin, keratin, and connexin-43, can be identified from sera of BrS patients and is highly sensitive and specific, irrespective of genetic cause for BrS. The four involved proteins, along with the SCN5A-encoded Nav1.5 alpha subunit are expressed abnormally in the myocardium of patients with BrS.
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Affiliation(s)
- Diptendu Chatterjee
- Department of Pediatrics, The Labatt Family Heart Centre and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Room 1725D, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Maurizio Pieroni
- Cardiovascular Department, San Donato Hospital, Via Curtatone 54 - 52100 Arezzo, Italy
| | - Meena Fatah
- Department of Pediatrics, The Labatt Family Heart Centre and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Room 1725D, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Flavien Charpentier
- L'Institut du Thorax, INSERM, CNRS, UNIV Nantes, 8 quai Moncousu, 44007 Nantes, France
| | - Kristopher S Cunningham
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada
| | - Danna A Spears
- Department of Medicine, University Health Network-Toronto General Hospital, 200 Elizabeth Street 4NU-492, Toronto, Ontario M5G 2C4, Canada
| | - Dipashree Chatterjee
- Department of Psychology, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada
| | - Gonca Suna
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - J Martjin Bos
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA.,Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Michael J Ackerman
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA.,Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Eric Schulze-Bahr
- Institute for Genetics of Heart Diseases, Department für Kardiologie und Angiologie, Zentrum für Innere Medizin, Universitätsklinikum Münster Albert-Schweitzer-Campus 1, Gebäude D3 48149 Münster, Germany
| | - Sven Dittmann
- Institute for Genetics of Heart Diseases, Department für Kardiologie und Angiologie, Zentrum für Innere Medizin, Universitätsklinikum Münster Albert-Schweitzer-Campus 1, Gebäude D3 48149 Münster, Germany
| | | | - Leonardo Bolognese
- Cardiovascular Department, San Donato Hospital, Via Curtatone 54 - 52100 Arezzo, Italy
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Robert M Hamilton
- Department of Pediatrics, The Labatt Family Heart Centre and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Room 1725D, 555 University Avenue, Toronto, ON M5G 1X8, Canada
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18
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Corrado D, van Tintelen PJ, McKenna WJ, Hauer RNW, Anastastakis A, Asimaki A, Basso C, Bauce B, Brunckhorst C, Bucciarelli-Ducci C, Duru F, Elliott P, Hamilton RM, Haugaa KH, James CA, Judge D, Link MS, Marchlinski FE, Mazzanti A, Mestroni L, Pantazis A, Pelliccia A, Marra MP, Pilichou K, Platonov PGA, Protonotarios A, Rampazzo A, Saffitz JE, Saguner AM, Schmied C, Sharma S, Tandri H, Te Riele ASJM, Thiene G, Tsatsopoulou A, Zareba W, Zorzi A, Wichter T, Marcus FI, Calkins H. Arrhythmogenic right ventricular cardiomyopathy: evaluation of the current diagnostic criteria and differential diagnosis. Eur Heart J 2021; 41:1414-1429. [PMID: 31637441 PMCID: PMC7138528 DOI: 10.1093/eurheartj/ehz669] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/04/2019] [Accepted: 09/05/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Peter J van Tintelen
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands.,Department of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
| | - William J McKenna
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, 7GR5+RW Doha, Qatar.,Institute of Cardiovascular Science, University College London, 62 Huntley St, Fitzrovia, London WC1E 6DD, UK
| | - Richard N W Hauer
- Department of Cardiology, Netherlands Heart Institute, University Medical Center Utrecht, Moreelsepark 1, 3511 EP Utrecht, Netherlands
| | - Aris Anastastakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Leof. Andrea Siggrou 356, Kallithea 176 74, Greece
| | - Angeliki Asimaki
- Molecular and Clinical Sciences Research Institute, St. George's University of London NHS Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Corinna Brunckhorst
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Chiara Bucciarelli-Ducci
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation, Trust Headquarters, Marlborough St, Bristol BS1 3NU, UK
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London, 62 Huntley St, Fitzrovia, London WC1E 6DD, UK
| | - Robert M Hamilton
- The Labatt Family Heart Centre and Division of Cardiology, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, Canada
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Problemveien 7, 0315 Oslo, Norway
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Daniel Judge
- Department of Medicine, Medical University of South Carolina (MUSC), 30 Courtenay Drive Room 326 Gazes, Charleston, MSC 592, USA
| | - Mark S Link
- Department of Medicine, Division of Cardiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Francis E Marchlinski
- Cardiac Electrophysiology Program, Cardiovascular Division Hospital of the University of Pennsylvania, 9 Founders Pavilion - Cardiology, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Andrea Mazzanti
- Department of Molecular Medicine, University of Pavia, Corso Str. Nuova 25, Pavia, Italy
| | - Luisa Mestroni
- Molecular Genetics, Cardiovascular Institute, University of Colorado, Denver Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Antonis Pantazis
- Inherited Cardiovascular Conditions services, The Royal Brompton and Harefield Hospitals, Sydney St, Chelsea, London SW3 6NP, UK
| | - Antonio Pelliccia
- Department of Cardiology, Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Roma, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Pyotr G A Platonov
- Department of Cardiology, Lund University Arrhythmia Clinic, Skåne University Hospital, Entrégatan 7, 222 42 Lund, Sweden
| | - Alexandros Protonotarios
- Inherited Cardiovascular Disease Unit, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London EC1A 7BE, UK
| | - Alessandra Rampazzo
- Department of Biology, University of Padua, Viale Giuseppe Colombo, 3, 35131 Padova PD, Italy
| | - Jeffry E Saffitz
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Christian Schmied
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK
| | - Hari Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Anneline S J M Te Riele
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.,Netherlands Heart Institute, Utrecht, Moreelsepark 1, 3511 EP Utrecht, Netherlands
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | | | - Wojciech Zareba
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, 150 Lucius Gordon Dr, West Henrietta, NY 14586, USA
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Thomas Wichter
- Heart Center Osnabrück, Bad Rothenfelde Niels-Stensen-Kliniken Marienhospital Osnabrück, Ulmenallee 5 - 11, 49214 Bad Rothenfelde, Germany
| | - Frank I Marcus
- Sarver Heart Center, The University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
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19
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Ghidoni A, Elliott PM, Syrris P, Calkins H, James CA, Judge DP, Murray B, Barc J, Probst V, Schott JJ, Song JP, Hauer RNW, Hoorntje ET, van Tintelen JP, Schulze-Bahr E, Hamilton RM, Mittal K, Semsarian C, Behr ER, Ackerman MJ, Basso C, Parati G, Gentilini D, Kotta MC, Mayosi BM, Schwartz PJ, Crotti L. Cadherin 2-Related Arrhythmogenic Cardiomyopathy: Prevalence and Clinical Features. Circ Genom Precis Med 2021; 14:e003097. [PMID: 33566628 DOI: 10.1161/circgen.120.003097] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiac disease characterized by fibrofatty replacement of the right and left ventricle, often causing ventricular dysfunction and life-threatening arrhythmias. Variants in desmosomal genes account for up to 60% of cases. Our objective was to establish the prevalence and clinical features of ACM stemming from pathogenic variants in the nondesmosomal cadherin 2 (CDH2), a novel genetic substrate of ACM. METHODS A cohort of 500 unrelated patients with a definite diagnosis of ACM and no disease-causing variants in the main ACM genes was assembled. Genetic screening of CDH2 was performed through next-generation or Sanger sequencing. Whenever possible, cascade screening was initiated in the families of CDH2-positive probands, and clinical evaluation was performed. RESULTS Genetic screening of CDH2 led to the identification of 7 rare variants: 5, identified in 6 probands, were classified as pathogenic or likely pathogenic. The previously established p.D407N pathogenic variant was detected in 2 additional probands. Probands and family members with pathogenic/likely pathogenic variants in CDH2 were clinically evaluated, and along with previously published cases, altogether contributed to the identification of gene-specific features (13 cases from this cohort and 11 previously published, for a total of 9 probands and 15 family members). Ventricular arrhythmic events occurred in most CDH2-positive subjects (20/24, 83%), while the occurrence of heart failure was rare (2/24, 8.3%). Among probands, sustained ventricular tachycardia and sudden cardiac death occurred in 5/9 (56%). CONCLUSIONS In this worldwide cohort of previously genotype-negative ACM patients, the prevalence of probands with CDH2 pathogenic/likely pathogenic variants was 1.2% (6/500). Our data show that this cohort of CDH2-ACM patients has a high incidence of ventricular arrhythmias, while evolution toward heart failure is rare.
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Affiliation(s)
- Alice Ghidoni
- Center for Cardiac Arrhythmias of Genetic Origin (A.G., M.-C.K., P.J.S., L.C.), Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Perry M Elliott
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, United Kingdom (P.M.E., P.S.)
| | - Petros Syrris
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, United Kingdom (P.M.E., P.S.)
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (H.C., C.A.J., B.M.)
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (H.C., C.A.J., B.M.)
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, SC (D.P.J.)
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (H.C., C.A.J., B.M.)
| | - Julien Barc
- Université de Nantes (J.B.), CNRS, Inserm, l'Institut du Thorax, France
| | - Vincent Probst
- Université de Nantes, CHU Nantes (V.P., J.J.S.), CNRS, Inserm, l'Institut du Thorax, France.,Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (V.P., E.S.-B., E.R.B., C.B., P.J.S., L.C.)
| | - Jean Jacques Schott
- Université de Nantes, CHU Nantes (V.P., J.J.S.), CNRS, Inserm, l'Institut du Thorax, France
| | - Jiang-Ping Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (J.-P.S.)
| | - Richard N W Hauer
- Netherlands Heart Institute (R.N.W.H., E.T.H., J.P.v.T.), University Medical Center Utrecht.,Department of Cardiology (R.N.W.H.), University Medical Center Utrecht
| | - Edgar T Hoorntje
- Netherlands Heart Institute (R.N.W.H., E.T.H., J.P.v.T.), University Medical Center Utrecht.,Department of Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (E.T.H.)
| | - J Peter van Tintelen
- Netherlands Heart Institute (R.N.W.H., E.T.H., J.P.v.T.), University Medical Center Utrecht.,Department of Genetics (J.P.v.T.), University Medical Center Utrecht
| | - Eric Schulze-Bahr
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (V.P., E.S.-B., E.R.B., C.B., P.J.S., L.C.).,Institute for Genetics of Heart Diseases (IfGH), University Hospital Münster, Germany (E.S.-B.)
| | | | - Kirti Mittal
- Hospital for Sick Children, Toronto, ON, Canada (R.M.H., K.M.)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, NSW, Australia (C.S.)
| | - Elijah R Behr
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (V.P., E.S.-B., E.R.B., C.B., P.J.S., L.C.).,Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, St George's University of London, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (E.R.B.)
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology and Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, MN (M.J.A.)
| | - Cristina Basso
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (V.P., E.S.-B., E.R.B., C.B., P.J.S., L.C.).,Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University and Hospital of Padua, Italy (C.B.)
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Cardiomyopathies Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan (G.P., L.C.).,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., L.C.)
| | - Davide Gentilini
- Bioinformatics and Statistical Genomics Unit (D.G.), Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Italy (D.G.)
| | - Maria-Christina Kotta
- Center for Cardiac Arrhythmias of Genetic Origin (A.G., M.-C.K., P.J.S., L.C.), Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Bongani M Mayosi
- Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, Groote Schuur Hospital and Division of Cardiology, Faculty of Health Sciences, University of Cape Town, South Africa (B.M.M.)
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin (A.G., M.-C.K., P.J.S., L.C.), Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (V.P., E.S.-B., E.R.B., C.B., P.J.S., L.C.)
| | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin (A.G., M.-C.K., P.J.S., L.C.), Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (V.P., E.S.-B., E.R.B., C.B., P.J.S., L.C.).,Istituto Auxologico Italiano, IRCCS, Cardiomyopathies Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan (G.P., L.C.).,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., L.C.)
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Affiliation(s)
- Robert M Hamilton
- Department of Pediatrics (Cardiology), Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Diptendu Chatterjee
- Department of Pediatrics (Cardiology), Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
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21
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Mondal T, Sullivan K, Divakaramenon S, Hamilton RM. Antiepileptic rufinamide and QTc interval shortening in a patient with long QT syndrome: case report. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33442618 PMCID: PMC7793134 DOI: 10.1093/ehjcr/ytaa336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/21/2020] [Accepted: 09/01/2020] [Indexed: 11/24/2022]
Abstract
Background There is limited pharmacologic therapy to reduce the QT interval in hereditary long QT syndrome (LQTS). Case summary We describe a child with Allan–Herndon–Dudley syndrome, Lennox–Gastaut epileptic syndrome (LGS), and LQTS Type 1 (LQTS1). Rufinamide was added to his antiepileptic medications to improve seizure control and was noted to be associated with a marked improvement in electrocardiogram QT interval. To the best of our knowledge, this is the first reported case of successful pharmacologic shortening of the QT interval in LQTS1. Discussion This case report highlights the potential benefits of rufinamide, a drug associated with mild QT shortening in normal individuals, to markedly reduce and normalize QT duration in a subject with LQTS1.
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Affiliation(s)
- Tapas Mondal
- Division of Cardiology, Department of Pediatrics, McMaster University, Health Sciences Centre, 3A 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Kristen Sullivan
- Department of Medicine, McMaster University, Health Sciences Centre, 4V33 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - Syam Divakaramenon
- Division of Electrophysiology, Department of Cardiology, McMaster University, HHSC, Hamilton General Hospital Site, 502, McMaster Clinic, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada
| | - Robert M Hamilton
- Department of Pediatrics (Cardiology), The Hospital for Sick Children, Room 1725D, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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22
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Crotti L, Spazzolini C, Tester DJ, Ghidoni A, Baruteau AE, Beckmann BM, Behr ER, Bennett JS, Bezzina CR, Bhuiyan ZA, Celiker A, Cerrone M, Dagradi F, De Ferrari GM, Etheridge SP, Fatah M, Garcia-Pavia P, Al-Ghamdi S, Hamilton RM, Al-Hassnan ZN, Horie M, Jimenez-Jaimez J, Kanter RJ, Kaski JP, Kotta MC, Lahrouchi N, Makita N, Norrish G, Odland HH, Ohno S, Papagiannis J, Parati G, Sekarski N, Tveten K, Vatta M, Webster G, Wilde AAM, Wojciak J, George AL, Ackerman MJ, Schwartz PJ. Calmodulin mutations and life-threatening cardiac arrhythmias: insights from the International Calmodulinopathy Registry. Eur Heart J 2020; 40:2964-2975. [PMID: 31170290 DOI: 10.1093/eurheartj/ehz311] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/06/2019] [Accepted: 04/29/2019] [Indexed: 12/12/2022] Open
Abstract
AIMS Calmodulinopathies are rare life-threatening arrhythmia syndromes which affect mostly young individuals and are, caused by mutations in any of the three genes (CALM 1-3) that encode identical calmodulin proteins. We established the International Calmodulinopathy Registry (ICalmR) to understand the natural history, clinical features, and response to therapy of patients with a CALM-mediated arrhythmia syndrome. METHODS AND RESULTS A dedicated Case Report File was created to collect demographic, clinical, and genetic information. ICalmR has enrolled 74 subjects, with a variant in the CALM1 (n = 36), CALM2 (n = 23), or CALM3 (n = 15) genes. Sixty-four (86.5%) were symptomatic and the 10-year cumulative mortality was 27%. The two prevalent phenotypes are long QT syndrome (LQTS; CALM-LQTS, n = 36, 49%) and catecholaminergic polymorphic ventricular tachycardia (CPVT; CALM-CPVT, n = 21, 28%). CALM-LQTS patients have extremely prolonged QTc intervals (594 ± 73 ms), high prevalence (78%) of life-threatening arrhythmias with median age at onset of 1.5 years [interquartile range (IQR) 0.1-5.5 years] and poor response to therapies. Most electrocardiograms (ECGs) show late onset peaked T waves. All CALM-CPVT patients were symptomatic with median age of onset of 6.0 years (IQR 3.0-8.5 years). Basal ECG frequently shows prominent U waves. Other CALM-related phenotypes are idiopathic ventricular fibrillation (IVF, n = 7), sudden unexplained death (SUD, n = 4), overlapping features of CPVT/LQTS (n = 3), and predominant neurological phenotype (n = 1). Cardiac structural abnormalities and neurological features were present in 18 and 13 patients, respectively. CONCLUSION Calmodulinopathies are largely characterized by adrenergically-induced life-threatening arrhythmias. Available therapies are disquietingly insufficient, especially in CALM-LQTS. Combination therapy with drugs, sympathectomy, and devices should be considered.
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Affiliation(s)
- Lia Crotti
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Laboratory of Cardiovascular Genetics, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart
| | - Carla Spazzolini
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy.,Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart
| | - David J Tester
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Alice Ghidoni
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Laboratory of Cardiovascular Genetics, Milan, Italy.,Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart
| | - Alban-Elouen Baruteau
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.,L'Institut du Thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France.,Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Britt-Maria Beckmann
- Department of Medicine I, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Elijah R Behr
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.,Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | | | - Connie R Bezzina
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.,Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Zahurul A Bhuiyan
- Unité de Recherche Cardiogénétique, Service de Médecine Génétique, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Alpay Celiker
- Department of Pediatric Cardiology, Koc University School of Medicine, Istanbul, Turkey
| | - Marina Cerrone
- Cardiovascular Genetics Program, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Federica Dagradi
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy.,Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart
| | - Gaetano M De Ferrari
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Italy.,PhD Program in Translational Medicine, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Susan P Etheridge
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - Meena Fatah
- The Labatt Family Heart Centre and Pediatrics (Cardiology), The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Pablo Garcia-Pavia
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.,Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain.,University Francisco de Vitoria (UFV), Pozuelo de Alarcon, Spain
| | - Saleh Al-Ghamdi
- Cardiac Sciences Department, Section of Pediatric Cardiology, King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Robert M Hamilton
- The Labatt Family Heart Centre and Pediatrics (Cardiology), The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Zuhair N Al-Hassnan
- Cardiovascular Genetic Program, Department of Medical Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Juan Jimenez-Jaimez
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain
| | | | - Juan P Kaski
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Maria-Christina Kotta
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Laboratory of Cardiovascular Genetics, Milan, Italy.,Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart
| | - Najim Lahrouchi
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.,Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Naomasa Makita
- National Cerebral and Cardiovascular Center, Research Institute and Omics Research Center, Osaka, Japan
| | - Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Hans H Odland
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Seiko Ohno
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.,Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - John Papagiannis
- Division of Cardiology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Nicole Sekarski
- Paediatric Cardiology Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Kristian Tveten
- Department of Medical Genetics, Telemark Hospital Trust, Skien, Norway
| | - Matteo Vatta
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Invitae Corporation, San Francisco, CA, USA
| | - Gregory Webster
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arthur A M Wilde
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.,Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Julianne Wojciak
- Department of Genomic Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Alfred L George
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J Ackerman
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter J Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Laboratory of Cardiovascular Genetics, Milan, Italy.,Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart
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Ng K, Titus EW, Lieve KV, Roston TM, Mazzanti A, Deiter FH, Denjoy I, Ingles J, Till J, Robyns T, Connors SP, Steinberg C, Abrams DJ, Pang B, Scheinman MM, Bos JM, Duffett SA, van der Werf C, Maltret A, Green MS, Rutberg J, Balaji S, Cadrin-Tourigny J, Orland KM, Knight LM, Brateng C, Wu J, Tang AS, Skanes AC, Manlucu J, Healey JS, January CT, Krahn AD, Collins KK, Maginot KR, Fischbach P, Etheridge SP, Eckhardt LL, Hamilton RM, Ackerman MJ, Noguer FRI, Semsarian C, Jura N, Leenhardt A, Gollob MH, Priori SG, Sanatani S, Wilde AAM, Deo RC, Roberts JD. An International Multicenter Evaluation of Inheritance Patterns, Arrhythmic Risks, and Underlying Mechanisms of CASQ2-Catecholaminergic Polymorphic Ventricular Tachycardia. Circulation 2020; 142:932-947. [PMID: 32693635 PMCID: PMC7484339 DOI: 10.1161/circulationaha.120.045723] [Citation(s) in RCA: 31] [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] [Indexed: 01/01/2023]
Abstract
BACKGROUND Genetic variants in calsequestrin-2 (CASQ2) cause an autosomal recessive form of catecholaminergic polymorphic ventricular tachycardia (CPVT), although isolated reports have identified arrhythmic phenotypes among heterozygotes. Improved insight into the inheritance patterns, arrhythmic risks, and molecular mechanisms of CASQ2-CPVT was sought through an international multicenter collaboration. METHODS Genotype-phenotype segregation in CASQ2-CPVT families was assessed, and the impact of genotype on arrhythmic risk was evaluated using Cox regression models. Putative dominant CASQ2 missense variants and the established recessive CASQ2-p.R33Q variant were evaluated using oligomerization assays and their locations mapped to a recent CASQ2 filament structure. RESULTS A total of 112 individuals, including 36 CPVT probands (24 homozygotes/compound heterozygotes and 12 heterozygotes) and 76 family members possessing at least 1 presumed pathogenic CASQ2 variant, were identified. Among CASQ2 homozygotes and compound heterozygotes, clinical penetrance was 97.1% and 26 of 34 (76.5%) individuals had experienced a potentially fatal arrhythmic event with a median age of onset of 7 years (95% CI, 6-11). Fifty-one of 66 CASQ2 heterozygous family members had undergone clinical evaluation, and 17 of 51 (33.3%) met diagnostic criteria for CPVT. Relative to CASQ2 heterozygotes, CASQ2 homozygote/compound heterozygote genotype status in probands was associated with a 3.2-fold (95% CI, 1.3-8.0; P=0.013) increased hazard of a composite of cardiac syncope, aborted cardiac arrest, and sudden cardiac death, but a 38.8-fold (95% CI, 5.6-269.1; P<0.001) increased hazard in genotype-positive family members. In vitro turbidity assays revealed that p.R33Q and all 6 candidate dominant CASQ2 missense variants evaluated exhibited filamentation defects, but only p.R33Q convincingly failed to dimerize. Structural analysis revealed that 3 of these 6 putative dominant negative missense variants localized to an electronegative pocket considered critical for back-to-back binding of dimers. CONCLUSIONS This international multicenter study of CASQ2-CPVT redefines its heritability and confirms that pathogenic heterozygous CASQ2 variants may manifest with a CPVT phenotype, indicating a need to clinically screen these individuals. A dominant mode of inheritance appears intrinsic to certain missense variants because of their location and function within the CASQ2 filament structure.
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Affiliation(s)
- Kevin Ng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
- Cairns Hospital, Queensland, Australia
| | - Erron W. Titus
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Krystien V. Lieve
- Amsterdam University Medical Centre, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
| | - Thomas M. Roston
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Mazzanti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Frederick H. Deiter
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Isabelle Denjoy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
- Service de Cardiologie et CNMR Maladies Cardiacques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Jan Till
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Tomas Robyns
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
- Department of Cardiovascular Disease, University Hospitals Leuven, Leuven, Belgium
| | - Sean P. Connors
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | | | - Dominic J. Abrams
- Inherited Cardiac Arrhythmia Program, Boston Children’s Hospital, Harvard Medical School, Massachusetts, USA
| | - Benjamin Pang
- Arrhythmia Service, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Melvin M. Scheinman
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - J. Martijn Bos
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen A. Duffett
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Christian van der Werf
- Amsterdam University Medical Centre, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
| | - Alice Maltret
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
- Service de Cardiologie et CNMR Maladies Cardiacques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Martin S. Green
- Arrhythmia Service, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Julie Rutberg
- Arrhythmia Service, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Seshadri Balaji
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, Canada
| | - Kate M. Orland
- University of Wisconsin-Madison Inherited Arrhythmia Clinic, Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Linda M. Knight
- Children’s Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia, USA
| | - Caitlin Brateng
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeremy Wu
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Anthony S. Tang
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Allan C. Skanes
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Jaimie Manlucu
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Craig T. January
- University of Wisconsin-Madison Inherited Arrhythmia Clinic, Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Cellular and Molecular Arrhythmia Research Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrew D. Krahn
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn K. Collins
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kathleen R. Maginot
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Peter Fischbach
- Children’s Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia, USA
| | - Susan P. Etheridge
- Department of Pediatrics, University of Utah, and Primary Children’s Hospital, Salt Lake City, Utah, USA
| | - Lee L. Eckhardt
- University of Wisconsin-Madison Inherited Arrhythmia Clinic, Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Cellular and Molecular Arrhythmia Research Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Robert M. Hamilton
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Michael J. Ackerman
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, Minnesota, USA
| | | | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Natalia Jura
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, California, USA
| | - Antoine Leenhardt
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
- Service de Cardiologie et CNMR Maladies Cardiacques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Michael H. Gollob
- Department of Physiology and Department of Medicine, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Silvia G. Priori
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Shubhayan Sanatani
- Department of Pediatrics, Children’s Heart Centre, BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arthur A. M. Wilde
- Amsterdam University Medical Centre, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
| | - Rahul C. Deo
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- One Brave Idea and Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Jason D. Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
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Hamilton RM, Merrill KC, Luthy KE, Nuttall C. Knowledge, attitudes, and perceptions of nurse practitioners about antibiotic stewardship. J Am Assoc Nurse Pract 2020; 33:909-915. [PMID: 32740336 DOI: 10.1097/jxx.0000000000000467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Antibiotic stewardship (ABS) is a set of strategies to optimize antimicrobial use while reducing antibiotic resistance, improving patient outcomes, and decreasing unnecessary costs. Nurse practitioners (NPs) play an essential role in health care education and represent a valuable potential resource for ABS efforts. PURPOSE The purpose of this study was to describe the knowledge, attitudes, and perceptions of NPs toward ABS. METHODS A convenience sample of NPs attending the American Association of Nurse Practitioners annual conference was given a modified descriptive survey. Descriptive statistics were used to assess normality. RESULTS A total of 194 NPs completed the questionnaire (88% female; 70% master's degree). Factors affecting the decisions of antibiotic prescriptions included patient condition (79%) and patient cost (58%). Nurse practitioners based their antibiotic decisions on the antibiogram (63%) in their setting, whereas 56% indicated they start with broad spectrum and tailor antibiotic choices after cultures are received. Nurse practitioners understood that inappropriate antibiotic use causes resistance (97%), harms the patient (97%), and optimum antibiotic use will reduce resistance (94%). Participants also recognized that strong knowledge of antibiotics was important (94%) and felt confident in using antibiotics (86%). However, 94% agreed that antibiotics are overused nationally, and only 62% thought antibiotics were overused in their setting. IMPLICATIONS FOR PRACTICE Nurse practitioners recognize that knowledge about antibiotics is important to their career and would like more education about antibiotics and feedback about their antibiotic choices. Finding effective ways to provide this education could change practice and improve antibiotic use.
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Affiliation(s)
| | | | - Karlen E Luthy
- College of Nursing, Brigham Young University, Provo, Utah
| | - Craig Nuttall
- College of Nursing, Brigham Young University, Provo, Utah
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Boycott KM, Campeau PM, Howley HE, Pavlidis P, Rogic S, Oriel C, Berman JN, Hamilton RM, Hicks GG, Lipshitz HD, Masson JY, Shoubridge EA, Junker A, Leroux MR, McMaster CR, Michaud JL, Turvey SE, Dyment D, Innes AM, van Karnebeek CD, Lehman A, Cohn RD, MacDonald IM, Rachubinski RA, Frosk P, Vandersteen A, Wozniak RW, Pena IA, Wen XY, Lacaze-Masmonteil T, Rankin C, Hieter P. The Canadian Rare Diseases Models and Mechanisms (RDMM) Network: Connecting Understudied Genes to Model Organisms. Am J Hum Genet 2020; 106:143-152. [PMID: 32032513 DOI: 10.1016/j.ajhg.2020.01.009] [Citation(s) in RCA: 28] [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] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/10/2020] [Indexed: 01/14/2023] Open
Abstract
Advances in genomics have transformed our ability to identify the genetic causes of rare diseases (RDs), yet we have a limited understanding of the mechanistic roles of most genes in health and disease. When a novel RD gene is first discovered, there is minimal insight into its biological function, the pathogenic mechanisms of disease-causing variants, and how therapy might be approached. To address this gap, the Canadian Rare Diseases Models and Mechanisms (RDMM) Network was established to connect clinicians discovering new disease genes with Canadian scientists able to study equivalent genes and pathways in model organisms (MOs). The Network is built around a registry of more than 500 Canadian MO scientists, representing expertise for over 7,500 human genes. RDMM uses a committee process to identify and evaluate clinician-MO scientist collaborations and approve 25,000 Canadian dollars in catalyst funding. To date, we have made 85 clinician-MO scientist connections and funded 105 projects. These collaborations help confirm variant pathogenicity and unravel the molecular mechanisms of RD, and also test novel therapies and lead to long-term collaborations. To expand the impact and reach of this model, we made the RDMM Registry open-source, portable, and customizable, and we freely share our committee structures and processes. We are currently working with emerging networks in Europe, Australia, and Japan to link international RDMM networks and registries and enable matches across borders. We will continue to create meaningful collaborations, generate knowledge, and advance RD research locally and globally for the benefit of patients and families living with RD.
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Affiliation(s)
- Kym M Boycott
- CHEO Research Institute, University of Ottawa, Ottawa, ON K1H 8L1, Canada.
| | - Philippe M Campeau
- Centre de Recherche du CHU Ste-Justine, Department of Pediatrics, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Heather E Howley
- CHEO Research Institute, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Paul Pavlidis
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Sanja Rogic
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Christine Oriel
- Maternal Infant Child and Youth Research Network (MICYRN), Vancouver, BC V5Z 4H4, Canada
| | - Jason N Berman
- CHEO Research Institute, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Robert M Hamilton
- Labatt Family Heart Centre and Translational Medicine, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Geoffrey G Hicks
- Regenerative Medicine Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P5, Canada
| | - Howard D Lipshitz
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jean-Yves Masson
- Oncology Division, CHU de Québec-Université Laval, Laval University Cancer Research Center, Quebec City, QC, G1R 3S3, Canada
| | - Eric A Shoubridge
- Department of Human Genetics, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Anne Junker
- Department of Pediatrics, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Michel R Leroux
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | | | - Jaques L Michaud
- Centre de Recherche du CHU Ste-Justine, Department of Pediatrics, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Stuart E Turvey
- Department of Human Genetics, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - David Dyment
- CHEO Research Institute, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - A Micheil Innes
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Alberta Children's Hospital, Calgary, AB T2N 4N1, Canada
| | - Clara D van Karnebeek
- Department of Human Genetics, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada; Department of Pediatrics, Amsterdam University Medical Centres, Amsterdam, the Netherlands; Department of Clinical Genetics, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Anna Lehman
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Ronald D Cohn
- Genetics and Genome Biology Program, SickKids Research Institute, Department of Paediatrics and Molecular Genetics, University of Toronto, Toronto, ON M5G 0A4, Canada
| | - Ian M MacDonald
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Richard A Rachubinski
- Genetics and Genome Biology Program, SickKids Research Institute, Department of Paediatrics and Molecular Genetics, University of Toronto, Toronto, ON M5G 0A4, Canada
| | - Patrick Frosk
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
| | - Anthony Vandersteen
- Department of Pediatrics, Maritime Medical Genetics Service, Dalhousie University, IWK Health Centre, Halifax, NS B3K 6R8, Canada
| | - Richard W Wozniak
- Department of Cell Biology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - Izabella A Pena
- CHEO Research Institute, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Xiao-Yan Wen
- Zebrafish Centre for Advanced Drug Discovery, Keenan Research Centre for Biomedical Science, St Michael's Hospital, Unity Health Toronto, Department of Medicine, University of Toronto, Toronto, ON M5B 1T8
| | - Thierry Lacaze-Masmonteil
- Maternal Infant Child and Youth Research Network (MICYRN), Vancouver, BC V5Z 4H4, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Catharine Rankin
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Philip Hieter
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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Chatterjee D, Fatah M, Akdis D, Spears DA, Koopmann TT, Mittal K, Rafiq MA, Cattanach BM, Zhao Q, Healey JS, Ackerman MJ, Bos JM, Sun Y, Maynes JT, Brunckhorst C, Medeiros-Domingo A, Duru F, Saguner AM, Hamilton RM. An autoantibody identifies arrhythmogenic right ventricular cardiomyopathy and participates in its pathogenesis. Eur Heart J 2019; 39:3932-3944. [PMID: 30239670 DOI: 10.1093/eurheartj/ehy567] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/21/2018] [Indexed: 12/26/2022] Open
Abstract
Aims Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by right ventricular myocardial replacement and life-threatening ventricular arrhythmias. Desmosomal gene mutations are sometimes identified, but clinical and genetic diagnosis remains challenging. Desmosomal skin disorders can be caused by desmosomal gene mutations or autoantibodies. We sought to determine if anti-desmosome antibodies are present in subjects with ARVC. Methods and results We evaluated ARVC subjects and controls for antibodies to cardiac desmosomal cadherin proteins. Desmoglein-2 (DSG2), desmocollin-2, and N-cadherin proteins on western blots were exposed to sera, in primary and validation cohorts of subjects and controls, as well as the naturally occurring Boxer dog model of ARVC. We identified anti-DSG2 antibodies in 12/12 and 25/25 definite ARVC cohorts and 7/8 borderline subjects. Antibody was absent in 11/12, faint in 1/12, and absent in 20/20 of two control cohorts. Anti-DSG2 antibodies were present in 10/10 Boxer dogs with ARVC, and absent in 18/18 without. In humans, the level of anti-DSG2 antibodies correlated with the burden of premature ventricular contractions (r = 0.70), and antibodies caused gap junction dysfunction, a common feature of ARVC, in vitro. Anti-DSG2 antibodies were present in ARVC subjects regardless of whether an underlying mutation was identified, or which mutation was present. A disease-specific DSG2 epitope was identified. Conclusion Anti-DSG2 antibodies are a sensitive and specific biomarker for ARVC. The development of autoimmunity as a result of target-related mutations is unique. Anti-DSG2 antibodies likely explain the cardiac inflammation that is frequently identified in ARVC and may represent a new therapeutic target.
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Affiliation(s)
- Diptendu Chatterjee
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Room 1725D, 555 University Avenue, Toronto, Ontario, Canada
| | - Meena Fatah
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Room 1725D, 555 University Avenue, Toronto, Ontario, Canada
| | - Deniz Akdis
- Zurich ARVC Program, University Heart Centre Zurich Department of Cardiology, Rämistrasse 100, Zurich, Switzerland
| | - Danna A Spears
- University Health Network, Toronto General Hospital Electrophysiology Department, 200 Elizabeth Street, Toronto, Ontario, Canada
| | - Tamara T Koopmann
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Room 1725D, 555 University Avenue, Toronto, Ontario, Canada
| | - Kirti Mittal
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Room 1725D, 555 University Avenue, Toronto, Ontario, Canada
| | - Muhammad A Rafiq
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Room 1725D, 555 University Avenue, Toronto, Ontario, Canada
| | - Bruce M Cattanach
- MRC Mammalian Genetics Unit, MRC Harwell Institute, Harwell Science and Innovation Campus, Oxfordshire, UK
| | - Qili Zhao
- University of Toronto Department of Mechanical and Industrial Engineering, Kings College Road, Toronto, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute and McMaster University Department of Medicine (Division of Cardiology), 237 Barton Street East, Hamilton, Ontario, Canada
| | - Michael J Ackerman
- Mayo Clinic College of Medicine Department of Cardiovascular Medicine, 200 1st St SW, Rochester, MN, USA
| | - Johan Martijn Bos
- Mayo Clinic College of Medicine Department of Cardiovascular Medicine, 200 1st St SW, Rochester, MN, USA
| | - Yu Sun
- University of Toronto Department of Mechanical and Industrial Engineering, Kings College Road, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Rosebrugh Building (RS), 164 College Street, Room 40, Toronto, Ontario, Canada
| | - Jason T Maynes
- The Hospital for Sick Children and the University of Toronto Department of Anesthesia and Pain Medicine, 555 University Avenue, Toronto, Ontario, Canada
| | - Corinna Brunckhorst
- Zurich ARVC Program, University Heart Centre Zurich Department of Cardiology, Rämistrasse 100, Zurich, Switzerland
| | | | - Firat Duru
- Zurich ARVC Program, University Heart Centre Zurich Department of Cardiology, Rämistrasse 100, Zurich, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Winterthurerstr. 190, Zurich, Switzerland
| | - Ardan M Saguner
- Zurich ARVC Program, University Heart Centre Zurich Department of Cardiology, Rämistrasse 100, Zurich, Switzerland
| | - Robert M Hamilton
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Room 1725D, 555 University Avenue, Toronto, Ontario, Canada
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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28
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140:e382-e482. [DOI: 10.1161/cir.0000000000000628] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [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: 12/20/2022]
Affiliation(s)
| | | | | | | | - Kenneth A. Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- ACC/AHA Representative
| | - Michael R. Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
| | | | | | - José A. Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N. Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
- Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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Mellor GJ, Panwar P, Lee AK, Steinberg C, Hathaway JA, Bartels K, Christian S, Balaji S, Roberts JD, Simpson CS, Boczek NJ, Tester DJ, Radbill AE, Mok NS, Hamilton RM, Kaufman ES, Eugenio PL, Weiss R, January C, McDaniel GM, Leather RA, Erickson C, Falik S, Behr ER, Wilde AAM, Sanatani S, Ackerman MJ, Van Petegem F, Krahn AD, Laksman Z. Type 8 long QT syndrome: pathogenic variants in CACNA1C-encoded Cav1.2 cluster in STAC protein binding site. Europace 2019; 21:1725-1732. [DOI: 10.1093/europace/euz215] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/18/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Pathogenic gain-of-function variants in CACAN1C cause type-8 long QT syndrome (LQT8). We sought to describe the electrocardiographic features in LQT8 and utilize molecular modelling to gain mechanistic insights into its genetic culprits.
Methods and results
Rare variants in CACNA1C were identified from genetic testing laboratories. Treating physicians provided clinical information. Variant pathogenicity was independently assessed according to recent guidelines. Pathogenic (P) and likely pathogenic (LP) variants were mapped onto a 3D modelled structure of the Cav1.2 protein. Nine P/LP variants, identified in 23 patients from 19 families with non-syndromic LQTS were identified. Six variants, found in 79% of families, clustered to a 4-residue section in the cytosolic II–III loop region which forms a region capable of binding STAC SH3 domains. Therefore, variants may affect binding of SH3-domain containing proteins. Arrhythmic events occurred in similar proportions of patients with II–III loop variants and with other P/LP variants (53% vs. 48%, P = 0.41) despite shorter QTc intervals (477 ± 31 ms vs. 515 ± 37 ms, P = 0.03). A history of sudden death was reported only in families with II–III loop variants (60% vs. 0%, P = 0.03). The predominant T-wave morphology was a late peaking T wave with a steep descending limb. Exercise testing demonstrated QTc prolongation on standing and at 4 min recovery after exercise.
Conclusion
The majority of P/LP variants in patients with CACNA1C-mediated LQT8 cluster in an SH3-binding domain of the cytosolic II–III loop. This represents a ‘mutation hotspot’ in LQT8. A late-peaking T wave with a steep descending limb and QT prolongation on exercise are commonly seen.
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Affiliation(s)
- Greg J Mellor
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
- Cardiology Department, Royal Papworth Hospital, Cambridge, UK
| | - Pankaj Panwar
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - Andrea K Lee
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
| | - Christian Steinberg
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
| | - Julie A Hathaway
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
| | - Kirsten Bartels
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
| | - Susan Christian
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Seshadri Balaji
- Division of Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Chris S Simpson
- Heart Rhythm Service, Division of Cardiology, Queen’s University, Kingston, ON, Canada
| | - Nicole J Boczek
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - David J Tester
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | | | - Ngai-Shing Mok
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Robert M Hamilton
- Labatt Family Heart Centre and Division of Cardiology, Department of Pediatrics, and Translational Medicine, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | | | - Paul L Eugenio
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Raul Weiss
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Craig January
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - George M McDaniel
- Division of Pediatric Cardiology, University of Virginia, Charlottesville, VA, USA
| | | | - Christopher Erickson
- Pediatric Cardiology, Children’s Hospital & Medical Center/University of Nebraska Medical Center, Omaha, NA, USA
| | - Shelley Falik
- Division of Cardiology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Elijah R Behr
- Cardiology Clinical Academic Group, St. George’s, University of London, London, UK
| | - Arthur A M Wilde
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | | | - Michael J Ackerman
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Filip Van Petegem
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
| | - Zachary Laksman
- Division of Cardiology, University of British Columbia, 1033 Davie St., Rm 211, Vancouver, BC, Canada
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Hamilton RM. Editorial commentary: Live better electrically? Optimizing the timing and application of pacing in congenital heart block. Trends Cardiovasc Med 2019; 30:287-288. [PMID: 31395307 DOI: 10.1016/j.tcm.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Robert M Hamilton
- The Hospital for Sick Children, Pediatrics (Cardiology), 555 University Ave Rm 1725D, Toronto, Ontario M5G1X8, Canada.
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Deshaies C, Hamilton RM, Shohoudi A, Trottier H, Poirier N, Aboulhosn J, Broberg CS, Cohen S, Cook S, Dore A, Fernandes SM, Fournier A, Kay J, Mondésert B, Mongeon FP, Opotowsky AR, Proietti A, Ting J, Zaidi A, Khairy P. Thromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery. J Am Coll Cardiol 2019; 74:1071-1081. [DOI: 10.1016/j.jacc.2019.06.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/24/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:e51-e156. [DOI: 10.1016/j.jacc.2018.10.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary. J Am Coll Cardiol 2019; 74:932-987. [DOI: 10.1016/j.jacc.2018.10.043] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Roberts JD, Murphy NP, Hamilton RM, Lubbers ER, James CA, Kline CF, Gollob MH, Krahn AD, Sturm AC, Musa H, El-Refaey M, Koenig S, Aneq MÅ, Hoorntje ET, Graw SL, Davies RW, Rafiq MA, Koopmann TT, Aafaqi S, Fatah M, Chiasson DA, Taylor MR, Simmons SL, Han M, van Opbergen CJ, Wold LE, Sinagra G, Mittal K, Tichnell C, Murray B, Codima A, Nazer B, Nguyen DT, Marcus FI, Sobriera N, Lodder EM, van den Berg MP, Spears DA, Robinson JF, Ursell PC, Green AK, Skanes AC, Tang AS, Gardner MJ, Hegele RA, van Veen TA, Wilde AA, Healey JS, Janssen PM, Mestroni L, van Tintelen JP, Calkins H, Judge DP, Hund TJ, Scheinman MM, Mohler PJ. Ankyrin-B dysfunction predisposes to arrhythmogenic cardiomyopathy and is amenable to therapy. J Clin Invest 2019; 129:3171-3184. [PMID: 31264976 PMCID: PMC6668697 DOI: 10.1172/jci125538] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/14/2019] [Indexed: 01/11/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an inherited arrhythmia syndrome characterized by severe structural and electrical cardiac phenotypes, including myocardial fibrofatty replacement and sudden cardiac death. Clinical management of ACM is largely palliative, owing to an absence of therapies that target its underlying pathophysiology, which stems partially from our limited insight into the condition. Following identification of deceased ACM probands possessing ANK2 rare variants and evidence of ankyrin-B loss of function on cardiac tissue analysis, an ANK2 mouse model was found to develop dramatic structural abnormalities reflective of human ACM, including biventricular dilation, reduced ejection fraction, cardiac fibrosis, and premature death. Desmosomal structure and function appeared preserved in diseased human and murine specimens in the presence of markedly abnormal β-catenin expression and patterning, leading to identification of a previously unknown interaction between ankyrin-B and β-catenin. A pharmacological activator of the WNT/β-catenin pathway, SB-216763, successfully prevented and partially reversed the murine ACM phenotypes. Our findings introduce what we believe to be a new pathway for ACM, a role of ankyrin-B in cardiac structure and signaling, a molecular link between ankyrin-B and β-catenin, and evidence for targeted activation of the WNT/β-catenin pathway as a potential treatment for this disease.
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Affiliation(s)
- Jason D. Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, UCSF, San Francisco, California, USA
| | - Nathaniel P. Murphy
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert M. Hamilton
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Ellen R. Lubbers
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cynthia A. James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Crystal F. Kline
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael H. Gollob
- Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D. Krahn
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amy C. Sturm
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania, USA
| | - Hassan Musa
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mona El-Refaey
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sara Koenig
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Meriam Åström Aneq
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Edgar T. Hoorntje
- Netherlands Heart Institute, Utrecht, Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sharon L. Graw
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Denver, Aurora, Colorado, USA
| | - Robert W. Davies
- Program in Genetics and Genome Biology and The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Muhammad Arshad Rafiq
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
- Department of Bioscience, COMSATS University, Islamabad, Pakistan
| | - Tamara T. Koopmann
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Shabana Aafaqi
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Meena Fatah
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - David A. Chiasson
- Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matthew R.G. Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Denver, Aurora, Colorado, USA
| | - Samantha L. Simmons
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mei Han
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Chantal J.M. van Opbergen
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center, Utrecht, Utrecht University, Utrecht, Netherlands
| | - Loren E. Wold
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Kirti Mittal
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alberto Codima
- Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Duy T. Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado, USA
| | - Frank I. Marcus
- Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, Arizona, USA
| | - Nara Sobriera
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elisabeth M. Lodder
- Amsterdam University Medical Center, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Maarten P. van den Berg
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Danna A. Spears
- Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John F. Robinson
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Anna K. Green
- Departments of Clinical Genetics and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Allan C. Skanes
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Anthony S. Tang
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Martin J. Gardner
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert A. Hegele
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Toon A.B. van Veen
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center, Utrecht, Utrecht University, Utrecht, Netherlands
| | - Arthur A.M. Wilde
- Amsterdam University Medical Center, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Paul M.L. Janssen
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Denver, Aurora, Colorado, USA
| | - J. Peter van Tintelen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Clinical Genetics, Amsterdam, Netherlands
- Department of Genetics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel P. Judge
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas J. Hund
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Melvin M. Scheinman
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, UCSF, San Francisco, California, USA
| | - Peter J. Mohler
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Roston TM, Yuchi Z, Kannankeril PJ, Hathaway J, Vinocur JM, Etheridge SP, Potts JE, Maginot KR, Salerno JC, Cohen MI, Hamilton RM, Pflaumer A, Mohammed S, Kimlicka L, Kanter RJ, LaPage MJ, Collins KK, Gebauer RA, Temple JD, Batra AS, Erickson C, Miszczak-Knecht M, Kubuš P, Bar-Cohen Y, Kantoch M, Thomas VC, Hessling G, Anderson C, Young ML, Choi SHJ, Cabrera Ortega M, Lau YR, Johnsrude CL, Fournier A, Van Petegem F, Sanatani S. The clinical and genetic spectrum of catecholaminergic polymorphic ventricular tachycardia: findings from an international multicentre registry. Europace 2018; 20:541-547. [PMID: 28158428 DOI: 10.1093/europace/euw389] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/03/2016] [Indexed: 11/12/2022] Open
Abstract
Aims Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an ion channelopathy characterized by ventricular arrhythmia during exertion or stress. Mutations in RYR2-coded Ryanodine Receptor-2 (RyR2) and CASQ2-coded Calsequestrin-2 (CASQ2) genes underlie CPVT1 and CPVT2, respectively. However, prognostic markers are scarce. We sought to better characterize the phenotypic and genotypic spectrum of CPVT, and utilize molecular modelling to help account for clinical phenotypes. Methods and results This is a Pediatric and Congenital Electrophysiology Society multicentre, retrospective cohort study of CPVT patients diagnosed at <19 years of age and their first-degree relatives. Genetic testing was undertaken in 194 of 236 subjects (82%) during 3.5 (1.4-5.3) years of follow-up. The majority (60%) had RyR2-associated CPVT1. Variant locations were predicted based on a 3D structural model of RyR2. Specific residues appear to have key structural importance, supported by an association between cardiac arrest and mutations in the intersubunit interface of the N-terminus, and the S4-S5 linker and helices S5 and S6 of the RyR2 C-terminus. In approximately one quarter of symptomatic patients, cardiac events were precipitated by only normal wakeful activities. Conclusion This large, multicentre study identifies contemporary challenges related to the diagnosis and prognostication of CPVT patients. Structural modelling of RyR2 can improve our understanding severe CPVT phenotypes. Wakeful rest, rather than exertion, often precipitated life-threatening cardiac events.
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Affiliation(s)
- Thomas M Roston
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Zhiguang Yuchi
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Prince J Kannankeril
- Department of Pediatrics and the Vanderbilt Center for Arrhythmia Research and Therapeutics (VanCART) Vanderbilt University Medical Center and the Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Nashville, TN 37232-9119, USA
| | - Julie Hathaway
- BC Inherited Arrhythmia Program, 211-1033 Davie St, Vancouver, BC V6E 1M7, Canada
| | - Jeffrey M Vinocur
- Department of Pediatrics, University of Rochester, 601 Elmwood Ave, Box 631, Rochester, NY 14642, USA
| | - Susan P Etheridge
- Department of Pediatrics, University of Utah, 81 N Mario Capecchi Drive Salt Lake City, UT 84113, USA
| | - James E Potts
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Kathleen R Maginot
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 1675 Highland Ave, Madison, WI 53792, USA
| | - Jack C Salerno
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Mitchell I Cohen
- Division of Cardiology Phoenix Children's Hospital, 1919 E. Thomas Road, 2nd Floor, Heart Center, Phoenix, AZ 85016, USA
| | - Robert M Hamilton
- Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue Toronto, Ontario M5G 1X8, Canada
| | - Andreas Pflaumer
- Royal Children's Hospital MCRI and University of Melbourne, 50 Flemington Road Parkville, Melbourne 3052, Australia
| | - Saira Mohammed
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Lynn Kimlicka
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Ronald J Kanter
- Nicklaus Children's Hospital, 3100 SW 62 Ave, Cardiology ACB - 2nd Floor Miami, FL 33155, USA
| | - Martin J LaPage
- Department of Pediatrics, University of Michigan, 1500 E Medical Center Drive, #6303, Ann Arbor, MI 48109, USA
| | - Kathryn K Collins
- Department of Pediatrics, University of Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Roman A Gebauer
- Department of Pediatric Cardiology, Heart Center, University of Leipzig, Strümpellstrasse 39, Leipzig, Germany
| | - Joel D Temple
- Department of Pediatrics, A. I. DuPont Hospital For Children, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | - Anjan S Batra
- Department of Pediatrics, University of California at Irvine Medical Center, 1140 W. La Veta Ave., Suite 750, Orange, CA 92868, USA
| | - Christopher Erickson
- Division of Cardiology, UNMC/CUMC/Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA
| | - Maria Miszczak-Knecht
- Department of Cardiology, Children's Memorial Health Institute, Dzieci Polskich 20, 04 -730 Warsaw, Poland
| | - Peter Kubuš
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Vúvalu 84, 15006, Prague, Czech Republic
| | - Yaniv Bar-Cohen
- Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd #34, Los Angeles, CA 90027, USA
| | - Michal Kantoch
- Stollery Children's Hospital, University of Alberta, Clinical Sciences Building, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada
| | - Vincent C Thomas
- Division of Cardiology, UNMC/CUMC/Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University, Lazarettstr. 3680636 Munich, Germany
| | - Chris Anderson
- Providence Sacred Heart Children's Hospital, 101 W. 8th Ave. Suite 4300E, Spokane, WA 99204, USA
| | - Ming-Lon Young
- Department of Pediatrics, Joe DiMaggio Children's Hospital, 1150 North 35th Avenue Suite 575, Hollywood, FL 33021, USA
| | - Sally H J Choi
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Michel Cabrera Ortega
- Department of Arrhythmia and Cardiac Pacing, Cardiocentro Pediatrico William Soler, 100 y perla, Boyeros. 10800, Havana, Cuba
| | - Yung R Lau
- Division of Pediatric Cardiology, University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL 35233, USA
| | - Christopher L Johnsrude
- Department of Pediatrics, University of Louisville, 601 S Floyd St #602, Louisville, KY 40208, USA
| | - Anne Fournier
- Département de Pédiatrie, CHU Ste Justine, 3175, chemin Côte Sainte-Catherine, Montréal, QC H3T 1C5 Canada
| | - Filip Van Petegem
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Shubhayan Sanatani
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Heart Rhythm 2018; 16:e227-e279. [PMID: 30412777 DOI: 10.1016/j.hrthm.2018.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/22/2022]
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Circulation 2018; 140:e333-e381. [PMID: 30586771 DOI: 10.1161/cir.0000000000000627] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | | | - Kenneth A Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,ACC/AHA Representative
| | - Michael R Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,HRS Representative
| | | | | | - José A Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,HRS Representative.,Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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Hamilton RM, Cunningham KS, Behr ER. Surviving Sudden Death: Where Does Next-Generation Sequencing Fit in the Assessment of Sudden Death Victims and Their Families. ACTA ACUST UNITED AC 2017; 10:CIRCGENETICS.117.002015. [PMID: 29247120 DOI: 10.1161/circgenetics.117.002015] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert M Hamilton
- From the Hospital for Sick Children and Research Institute, Toronto, Canada (R.M.H.); Pediatrics (Cardiology) and Translational Medicine, University of Toronto, Canada (R.M.H.); The Ontario Forensic Pathology Service, Toronto, Canada (K.C.); and Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (E.B.).
| | - Kristopher S Cunningham
- From the Hospital for Sick Children and Research Institute, Toronto, Canada (R.M.H.); Pediatrics (Cardiology) and Translational Medicine, University of Toronto, Canada (R.M.H.); The Ontario Forensic Pathology Service, Toronto, Canada (K.C.); and Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (E.B.)
| | - Elijah R Behr
- From the Hospital for Sick Children and Research Institute, Toronto, Canada (R.M.H.); Pediatrics (Cardiology) and Translational Medicine, University of Toronto, Canada (R.M.H.); The Ontario Forensic Pathology Service, Toronto, Canada (K.C.); and Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (E.B.)
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Rafiq MA, Chaudhry A, Care M, Spears DA, Morel CF, Hamilton RM. Whole exome sequencing identified 1 base pair novel deletion in BCL2-associated athanogene 3 (BAG3) gene associated with severe dilated cardiomyopathy (DCM) requiring heart transplant in multiple family members. Am J Med Genet A 2017; 173:699-705. [PMID: 28211974 DOI: 10.1002/ajmg.a.38087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 12/03/2015] [Accepted: 11/15/2016] [Indexed: 02/03/2023]
Abstract
Dilated cardiomyopathy (DCM) is characterized by dilation and impaired contraction of the left ventricle or both ventricles. Among hereditary DCM, the genetic causes are heterogeneous, and include mutations encoding cytoskeletal, nucleoskeletal, mitochondrial, and calcium-handling proteins. We report three severely affected males, in a four-generation pedigree, with DCM phenotype who underwent cardiac transplant. Cardiomegaly with marked biventricular dilation and fibrosis were noticeable histopathological findings. The affected males had tested negative on a 46-gene pancardiomyopathy panel. Whole Exome Sequencing (WES) was performed to reveal mutation in the gene responsible in generation of DCM phenotypes. The 1-bp (Chr10:121435979delC; c.913delC) novel heterozygous deletion in exon 4 of BAG3, was identified in three affected males, resulted in frame-shift and a premature termination codon (p.Met306-Stop) producing a truncated BAG3 protein lacking functionally important PXXP and BAG domains. WES data were further utilized to map 10 SNP markers around the discovered mutation to generate shared disease haplotype in all affected individuals encompassing 11 Mb on 10q25.3-26.2 harboring BAG3. Finally genotypes were inferred for the unavailable/deceased individuals in the pedigrees. Here we propose that Chr10:121435979delC in BAG3 is a causal mutation in these subjects. Our and earlier studies indicate that BAG3 mutations are associated with DCM phenotypes. BAG3 should be added to cardiomyopathy gene panels for screening of DCM patients, and patients previously considered gene elusive should undergo sequencing of the BAG3 gene. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Muhammad Arshad Rafiq
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada.,Department of Bio-Sciences, COMSATS Institute of Information Technology (CIIT), Islamabad, Pakistan
| | - Ayeshah Chaudhry
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Care
- Fred A. Litwin Family Center in Genetic Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Danna A Spears
- Division of Cardiology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Chantal F Morel
- Fred A. Litwin Family Center in Genetic Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert M Hamilton
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
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Barsalou J, Jaeggi E, Laskin CA, Brown P, Tian SY, Hamilton RM, Silverman ED. Prenatal exposure to antimalarials decreases the risk of cardiac but not non-cardiac neonatal lupus: a single-centre cohort study. Rheumatology (Oxford) 2017; 56:1552-1559. [DOI: 10.1093/rheumatology/kex191] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Indexed: 11/14/2022] Open
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Affiliation(s)
- Hiroko Asakai
- Labatt Family Heart Centre and Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children and Research Institute and University of Toronto, Toronto, Canada
| | - Laura Fenwick
- Labatt Family Heart Centre and Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children and Research Institute and University of Toronto, Toronto, Canada
| | - Robert M Hamilton
- Labatt Family Heart Centre and Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children and Research Institute and University of Toronto, Toronto, Canada
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Sanatani S, Cunningham T, Khairy P, Cohen MI, Hamilton RM, Ackerman MJ. The Current State and Future Potential of Pediatric and Congenital Electrophysiology. JACC Clin Electrophysiol 2017; 3:195-206. [PMID: 29759513 DOI: 10.1016/j.jacep.2017.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 10/19/2022]
Abstract
Pediatric electrophysiologists specialize in the diagnosis and treatment of rhythm abnormalities in pediatric, congenital heart disease, and inherited arrhythmia syndrome patients. The field originated out of the unique knowledge base that rhythm management in young patients required. In the 1970s, pediatric electrophysiology was recognized as a distinct cardiac subspecialty and it has evolved rapidly since that time. Despite the considerable growth in personnel, technology, and complexity that the field has undergone, further opportunities to progress pediatric electrophysiology exist. In this review, we highlight some of the clinical focus of pediatric and adult congenital electrophysiologists to date and identify areas within this specialty where the pediatric and congenital electrophysiology community could come together in order to drive improvements in rhythm management for patients.
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Affiliation(s)
- Shubhayan Sanatani
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
| | - Taylor Cunningham
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Mitchell I Cohen
- Phoenix Children's Heart Center, Phoenix Children's Hospital, Phoenix, Arizona
| | - Robert M Hamilton
- Division of Cardiology, The Labatt Heart Centre, The Hospital for Sick Children, and Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Ackerman
- Departments of Cardiovascular Diseases, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Rochester, Minnesota
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Hamilton RM. "Chip off the old block"-Do genetic factors contribute to postoperative heart block? Heart Rhythm 2016; 14:410-411. [PMID: 27988370 DOI: 10.1016/j.hrthm.2016.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Robert M Hamilton
- Labatt Family Heart Centre/Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, University of Toronto, Toronto, Ontario, Canada.
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Koopmann TT, Hamilton RM. Modeling junctional dysrhythmias: Disassembling the JET engine. Heart Rhythm 2016; 13:2356-2357. [PMID: 27520543 DOI: 10.1016/j.hrthm.2016.08.020] [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] [Received: 07/30/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Tamara T Koopmann
- Physiology & Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robert M Hamilton
- Physiology & Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
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Chaix MA, Koopmann TT, Goyette P, Alikashani A, Latour F, Fatah M, Hamilton RM, Rioux JD. Novel CALM3 mutations in pediatric long QT syndrome patients support a CALM3-specific calmodulinopathy. HeartRhythm Case Rep 2016; 2:250-254. [PMID: 28491681 PMCID: PMC5419757 DOI: 10.1016/j.hrcr.2016.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Marie-A Chaix
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal, Montreal, Quebec, Canada
| | - Tamara T Koopmann
- Physiology and Experimental Medicine, The Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | | | | | | | - Meena Fatah
- Physiology and Experimental Medicine, The Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Robert M Hamilton
- Physiology and Experimental Medicine, The Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - John D Rioux
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal, Montreal, Quebec, Canada
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Abstract
Gap junctions are essential for the proper function of many native mammalian tissues including neurons, cardiomyocytes, embryonic tissues, and muscle. Assessing these channels is therefore fundamental to understanding disease pathophysiology, developing therapies for a multitude of acquired and genetic conditions, and providing novel approaches to drug delivery and cellular communication. Microinjection is a robust, albeit difficult, technique, which provides considerable information that is superior to many of the simpler techniques due to its ability to isolate cells, quantify kinetics, and allow cross-comparison of multiple cell lines. Despite its user-dependent nature, the strengths of the technique are considerable and with the advent of new, automation technologies may improve further. This text describes the basic technique of microinjection and briefly discusses modern automation advances that can improve the success rates of this technique.
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Affiliation(s)
- Michael D Fridman
- Department of Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Jun Liu
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Yu Sun
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Robert M Hamilton
- Department of Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Pediatrics - Division of Cardiology, Hospital for Sick Children, Toronto, ON, Canada.
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Roston TM, Vinocur JM, Maginot KR, Mohammed S, Salerno JC, Etheridge SP, Cohen M, Hamilton RM, Pflaumer A, Kanter RJ, Potts JE, LaPage MJ, Collins KK, Gebauer RA, Temple JD, Batra AS, Erickson C, Miszczak-Knecht M, Kubuš P, Bar-Cohen Y, Kantoch M, Thomas VC, Hessling G, Anderson C, Young ML, Ortega MC, Lau YR, Johnsrude CL, Fournier A, Kannankeril PJ, Sanatani S. Catecholaminergic polymorphic ventricular tachycardia in children: analysis of therapeutic strategies and outcomes from an international multicenter registry. Circ Arrhythm Electrophysiol 2015; 8:633-42. [PMID: 25713214 PMCID: PMC4472494 DOI: 10.1161/circep.114.002217] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [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: 05/06/2014] [Accepted: 02/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Catecholaminergic polymorphic ventricular tachycardia is an uncommon, potentially lethal, ion channelopathy. Standard therapies have high failure rates and little is known about treatment in children. Newer options such as flecainide and left cardiac sympathetic denervation are not well validated. We sought to define treatment outcomes in children with catecholaminergic polymorphic ventricular tachycardia. METHODS AND RESULTS This is a Pediatric and Congenital Electrophysiology Society multicenter, retrospective cohort study of catecholaminergic polymorphic ventricular tachycardia patients diagnosed before 19 years of age. The cohort included 226 patients, including 170 probands and 56 relatives. Symptomatic presentation was reported in 176 (78%). Symptom onset occurred at 10.8 (interquartile range, 6.8-13.2) years with a delay to diagnosis of 0.5 (0-2.6) years. Syncope (P<0.001), cardiac arrest (P<0.001), and treatment failure (P=0.008) occurred more often in probands. β-Blockers were prescribed in 205 of 211 patients (97%) on medication, and 25% experienced at least 1 treatment failure event. Implantable cardioverter defibrillators were placed in 121 (54%) and was associated with electrical storm in 22 (18%). Flecainide was used in 24% and left cardiac sympathetic denervation in 8%. Six deaths (3%) occurred during a cumulative follow-up of 788 patient-years. CONCLUSIONS This study demonstrates a malignant phenotype and lengthy delay to diagnosis in catecholaminergic polymorphic ventricular tachycardia. Probands were typically severely affected. β-Blockers were almost universally initiated; however, treatment failure, noncompliance and subtherapeutic dosing were often reported. Implantable cardioverter defibrillators were common despite numerous device-related complications. Treatment failure was rare in the quarter of patients on flecainide. Left cardiac sympathetic denervation was not uncommon although the indication was variable.
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MESH Headings
- Adolescent
- Age Factors
- Anti-Arrhythmia Agents/adverse effects
- Anti-Arrhythmia Agents/therapeutic use
- Child
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock/adverse effects
- Electric Countershock/instrumentation
- Electric Countershock/mortality
- Female
- Humans
- Male
- Patient Selection
- Phenotype
- Registries
- Retrospective Studies
- Risk Factors
- Severity of Illness Index
- Sympathectomy/adverse effects
- Sympathectomy/mortality
- Tachycardia, Ventricular/complications
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/therapy
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Thomas M. Roston
- Department of Pediatrics, Divisions of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Saira Mohammed
- Department of Pediatrics, Divisions of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Jack C. Salerno
- Department of Pediatrics, University of Washington, Seattle, WA
| | | | | | | | - Andreas Pflaumer
- Royal Children’s Hospital MCRI & University of Melbourne, Australia
| | | | - James E. Potts
- Department of Pediatrics, Divisions of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Anjan S. Batra
- University of California at Irvine Medical Center, Orange, CA
| | | | | | - Peter Kubuš
- Children’s Heart Center, Prague, Czech Republic
| | | | - Michal Kantoch
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | | | | | - Chris Anderson
- Providence Sacred Heart Children’s Hospital, Spokane, WA
| | | | | | - Yung R. Lau
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Shubhayan Sanatani
- Department of Pediatrics, Divisions of Cardiology, University of British Columbia, Vancouver, BC, Canada
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Cattanach BM, Dukes-McEwan J, Wotton PR, Stephenson HM, Hamilton RM. A pedigree-based genetic appraisal of Boxer ARVC and the role of the Striatin mutation. Vet Rec 2015; 176:492. [PMID: 25661582 PMCID: PMC4433500 DOI: 10.1136/vr.102821] [Citation(s) in RCA: 19] [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] [Subscribe] [Scholar Register] [Accepted: 12/23/2014] [Indexed: 11/24/2022]
Abstract
The objective of this paper was to investigate by pedigree-based genetic means the origins and inheritance of arrhythmogenic right ventricular cardiomyopathy (ARVC) in UK Boxers and assess the role of the proposed causal mutation in the gene, Striatin (STRN). All ARVC cases traced back to a small number of imported American dogs deriving from the group of Boxers studied by Harpster (1983) to define the disease, strongly suggesting that the disease is the same in the two countries. Dogs with and without the STRN mutation were found in both ARVC affected and normal Boxers showing that the mutation is not responsible for the disease. Evidence was found that the STRN mutation is, however, genetically linked with the gene responsible on the same chromosome. The linkage implies that the two genes can separate by meiotic recombination such that both ARVC-affected and ARVC-unaffected lines of dogs may carry either the STRN mutation or its wild-type allele. These have been found. Homozygotes for the STRN mutation tended to be severely affected at early ages, suggesting that there is an interaction between the known effects of the STRN mutation on the cardiomyocyte and ARVC.
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Affiliation(s)
- B M Cattanach
- MRC Mammalian Genetics Unit, Harwell Science and Innovation Campus, Oxfordshire OX11 0RD, UK
| | - J Dukes-McEwan
- University of Liverpool Small Animal Teaching Hospital, Leahurst, Chester High Road, Neston CH64 7TE, UK
| | - P R Wotton
- University of Glasgow School of Veterinary Medicine, Bearsden Road, Glasgow G61 1QH, UK
| | - H M Stephenson
- University of Liverpool Small Animal Teaching Hospital, Leahurst, Chester High Road, Neston CH64 7TE, UK HS Cardiology Ltd, Barnfield Farm, Tunstall, Carnforth LA6 2RU, UK
| | - R M Hamilton
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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50
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Siragam V, Cui X, Masse S, Ackerley C, Aafaqi S, Strandberg L, Tropak M, Fridman MD, Nanthakumar K, Liu J, Sun Y, Su B, Wang C, Liu X, Yan Y, Mendlowitz A, Hamilton RM. TMEM43 mutation p.S358L alters intercalated disc protein expression and reduces conduction velocity in arrhythmogenic right ventricular cardiomyopathy. PLoS One 2014; 9:e109128. [PMID: 25343256 PMCID: PMC4208740 DOI: 10.1371/journal.pone.0109128] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 09/08/2014] [Indexed: 01/04/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a myocardial disease characterized by fibro-fatty replacement of myocardium in the right ventricular free wall and frequently results in life-threatening ventricular arrhythmias and sudden cardiac death. A heterozygous missense mutation in the transmembrane protein 43 (TMEM43) gene, p.S358L, has been genetically identified to cause autosomal dominant ARVC type 5 in a founder population from the island of Newfoundland, Canada. Little is known about the function of the TMEM43 protein or how it leads to the pathogenesis of ARVC. We sought to determine the distribution of TMEM43 and the effect of the p.S358L mutation on the expression and distribution of various intercalated (IC) disc proteins as well as functional effects on IC disc gap junction dye transfer and conduction velocity in cell culture. Through Western blot analysis, transmission electron microscopy (TEM), immunofluorescence (IF), and electrophysiological analysis, our results showed that the stable expression of p.S358L mutation in the HL-1 cardiac cell line resulted in decreased Zonula Occludens (ZO-1) expression and the loss of ZO-1 localization to cell-cell junctions. Junctional Plakoglobin (JUP) and α-catenin proteins were redistributed to the cytoplasm with decreased localization to cell-cell junctions. Connexin-43 (Cx43) phosphorylation was altered, and there was reduced gap junction dye transfer and conduction velocity in mutant TMEM43-transfected cells. These observations suggest that expression of the p.S358L mutant of TMEM43 found in ARVC type 5 may affect localization of proteins involved in conduction, alter gap junction function and reduce conduction velocity in cardiac tissue.
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Affiliation(s)
- Vinayakumar Siragam
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Xuezhi Cui
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Stephane Masse
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Cameron Ackerley
- Division of Pathology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Shabana Aafaqi
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Linn Strandberg
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Michael Tropak
- Genetics and Genome Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Michael D. Fridman
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | | | - Jun Liu
- Advanced Micro and Nanosystems Laboratory, Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Yu Sun
- Advanced Micro and Nanosystems Laboratory, Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Bin Su
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Caroline Wang
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Xiaoru Liu
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Yuqing Yan
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Ariel Mendlowitz
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Robert M. Hamilton
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
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