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Ishida H, Narita J, Ishii R, Suginobe H, Tsuru H, Wang R, Yoshihara C, Ueyama A, Ueda K, Hirose M, Hashimoto K, Nagano H, Kogaki S, Kuramoto Y, Miyashita Y, Asano Y, Ozono K. Clinical Outcomes and Genetic Analyses of Restrictive Cardiomyopathy in Children. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:382-389. [PMID: 37377035 DOI: 10.1161/circgen.122.004054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/02/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Restrictive cardiomyopathy in children is rare and outcomes are very poor. However, little information is available concerning genotype-outcome correlations. METHODS We analyzed the clinical characteristics and genetic testing, including whole exome sequencing, of 28 pediatric restrictive cardiomyopathy patients who were diagnosed from 1998 to 2021 at Osaka University Hospital in Japan. RESULTS The median age at diagnosis (interquartile range) was 6 (2.25-8.5) years. Eighteen patients received heart transplantations and 5 patients were on the waiting list. One patient died while waiting for transplantation. Pathologic or likely-pathogenic variants were identified in 14 of the 28 (50%) patients, including heterozygous TNNI3 missense variants in 8 patients. TNNT2, MYL2, and FLNC missense variants were also identified. No significant differences in clinical manifestations and hemodynamic parameters between positive and negative pathogenic variants were detected. However, 2- and 5-year survival rates were significantly lower in patients with pathogenic variants (50% and 22%) compared with survival in patients without pathogenic variants (62% and 54%; P=0.0496, log-rank test). No significant differences were detected in the ratio of patients diagnosed at nationwide school heart disease screening program between positive and negative pathogenic variants. Patients diagnosed by school screening showed better transplant-free survival compared with patients diagnosed by heart failure symptoms (P=0.0027 in log-rank test). CONCLUSIONS In this study, 50% of pediatric restrictive cardiomyopathy patients had pathogenic or likely-pathogenic gene variants, and TNNI3 missense variants were the most frequent. Patients with pathogenic variants showed significantly lower transplant-free survival compared with patients without pathogenic variants.
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Affiliation(s)
- Hidekazu Ishida
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
| | - Jun Narita
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
| | - Ryo Ishii
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
| | - Hidehiro Suginobe
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
| | - Hirofumi Tsuru
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
- Department of Pediatrics, Niigata University School of Medicine, Japan (H.T.)
| | - Renjie Wang
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
| | - Chika Yoshihara
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
| | - Atsuko Ueyama
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
| | - Kazutoshi Ueda
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
| | - Masaki Hirose
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
| | - Kazuhisa Hashimoto
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
| | - Hiroki Nagano
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
| | - Shigetoyo Kogaki
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
- Department of Pediatrics and Neonatology, Osaka General Medical Center, Japan (S.K.)
| | - Yuki Kuramoto
- Department of Cardiology (Y.K., Y.M., Y.A.), Osaka University Graduate School of Medicine, Japan
| | - Yohei Miyashita
- Department of Cardiology (Y.K., Y.M., Y.A.), Osaka University Graduate School of Medicine, Japan
| | - Yoshihiro Asano
- Department of Cardiology (Y.K., Y.M., Y.A.), Osaka University Graduate School of Medicine, Japan
- Department of Genome Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (Y.A.)
| | - Keiichi Ozono
- Department of Pediatrics (H.I., J.N., R.I., H.S., H.T., R.W., C.Y., A.U., K.U., M.H., K.H., H.N., S.K., K.O.), Osaka University Graduate School of Medicine, Japan
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