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Nitschke L, Cooper TA. Combinatorial effects of ion channel mis-splicing as a cause of myopathy in myotonic dystrophy. J Clin Invest 2024; 134:e176089. [PMID: 38165037 PMCID: PMC10760967 DOI: 10.1172/jci176089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Myotonic dystrophy type 1 (DM1) is an autosomal dominant disorder caused by an unstable expanded CTG repeat located in the 3'-UTR of the DM1 protein kinase (DMPK) gene. The pathogenic mechanism results in misregulated alternative splicing of hundreds of genes, creating the dilemma of establishing which genes contribute to the mechanism of DM1 skeletal muscle pathology. In this issue of the JCI, Cisco and colleagues systematically tested the combinatorial effects of DM1-relevant mis-splicing patterns in vivo and identified the synergistic effects of mis-spliced calcium and chloride channels as a major contributor to DM1 skeletal muscle impairment. The authors further demonstrated the therapeutic potential for calcium channel modulation to block the synergistic effects and rescue myopathy.
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Affiliation(s)
| | - Thomas A. Cooper
- Department of Pathology and Immunology
- Department of Integrative Physiology and Biophysics, and
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas, USA
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2
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Okşul M, Bilge Ö, Türken A, Işık F, Akyüz A, Çap M, Söner S, Akın H, Şener YZ, Taştan E. Evaluation of Index of Cardiac Electrophysiological Balance in Patients With Myotonic Dystrophy Type 1. Cureus 2023; 15:e34600. [PMID: 36883071 PMCID: PMC9985921 DOI: 10.7759/cureus.34600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Myotonic dystrophy type 1(MD1), which is characterized by decreased muscle tone, progressive muscle weakness, and cardiac involvement, is an autosomal dominant and progressive congenital muscle disease. Cardiac involvement more often manifests as conduction abnormalities and arrhythmias (such as supraventricular or ventricular). Approximately one-third of MD1-related deaths occur due to cardiac causes. The index of cardiac-electrophysiological balance (ICEB) is a current parameter calculated as QT interval/QRS duration. The increase in this parameter has been associated with malignant ventricular arrhythmias. In this study, our aim was to compare the ICEB values of MD1 patients and the normal population. MATERIAL AND METHOD A total of 62 patients were included in our study. They were divided into two groups - 32 MD patients and 30 controls. The demographic, clinical, laboratory, and electrocardiographic parameters of the two groups were compared. RESULTS The median age of the study population was 24 (20-36 IQR), and 36 (58%) of these patients were female. Body mass index was higher in the control group (p = 0.037). While in the MD1 group creatinine kinase was significantly higher (p <0.001), In the control group creatinine, aspartate aminotransferase, alanine aminotransferase, calcium, and lymphocyte levels were significantly higher (p=0.031, p= 0.003, p=0.001, p=0.002, p=0.031, respectively). ICEB [3.96 (3.65-4.46) vs 3.74 (3.49-3.85) p=0.015] and corrected ICEB (ICEBc) [4.48 (4.08-4.92) vs 4.20 (4.03-4.51) p = 0.048] were significantly higher in the MD1 group. CONCLUSION In our study, ICEB was found to be higher in MD1 patients than in the control group. Increased ICEB and ICEBc values in MD1 patients may precipitate ventricular arrhythmias in the future. Close monitoring of these parameters can be helpful in predicting possible ventricular arrhythmias and in risk stratification.
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Affiliation(s)
- Metin Okşul
- Department of Cardiology, University of Health Sciences Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, TUR
| | - Önder Bilge
- Department of Cardiology, University of Health Sciences Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, TUR
| | - Askeri Türken
- Department of Physical Therapy and Rehabilitation, University of Health Sciences Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, TUR
| | - Ferhat Işık
- Department of Cardiology, University of Health Sciences Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, TUR
| | - Abdurrahman Akyüz
- Department of Cardiology, University of Health Sciences Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, TUR
| | - Murat Çap
- Department of Cardiology, University of Health Sciences Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, TUR
| | - Serdar Söner
- Department of Cardiology, University of Health Sciences Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, TUR
| | - Halil Akın
- Department of Cardiology, Private Medicalpark Hospital, Ankara, TUR
| | - Yusuf Z Şener
- Department of Cardiology, Beypazari State Hospital, Ankara, TUR
| | - Ercan Taştan
- Department of Cardiology, University of Health Sciences Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, TUR
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3
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Brunet Garcia L, Hajra A, Field E, Wacher J, Walsh H, Norrish G, Manzur A, Muntoni F, Munot P, Robb S, Quinlivan R, Scoto M, Baranello G, Sarkozy A, Starling L, Kaski JP, Cervi E. Cardiac Manifestations of Myotonic Dystrophy in a Pediatric Cohort. Front Pediatr 2022; 10:910660. [PMID: 35757141 PMCID: PMC9218560 DOI: 10.3389/fped.2022.910660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Myotonic dystrophy type 1 (DM1) is the most prevalent inherited neuromuscular dystrophy in adults. It is a multisystem disease with cardiac manifestations. Whilst these are well-defined in adults, there are scarce published data in the pediatric population. This study aimed to investigate the yield and progression of cardiac disease in pediatric DM1 patients, focusing on congenital DM1 (cDM1). METHODS A retrospective observational study of all pediatric DM1 patients referred to our center (December 2000-November 2020) was conducted. Patients were classified into DM1 forms according to age of symptom onset and disease severity. Patients underwent clinical and cardiac evaluation with 12-lead ECG, transthoracic echocardiography and 24-h ECG Holter monitoring. RESULTS 67 DM1 pediatric patients were included: 56 (83.6%) cDM1 and 11 (16.4%) non-cDM1. Median follow-up time of cDM1 patients was 8.0 [3.25-11.0] years. 49 (87.5%) cDM1 patients had baseline 12-lead ECG and 44 (78.6%) had a follow-up 12-lead-ECG, with a median follow-up time from diagnosis to baseline ECG of 2.8 [1.0-8.5] years and to follow-up ECG of 10.9 [5.7-14.2] years. Overall, 43 (87.8%) presented ECG abnormalities, most commonly in the form of asymptomatic conduction disease (n = 23, 46.9%), of which 21 (42.9%) had first degree atrioventricular block (1st AVB). There was an increase of prevalence from baseline to follow-up ECG in low QRS voltage (16.7%), poor R wave progression (13.9%), abnormal repolarisation (11.9%) and 1st AVB (7.6%). one patient (1.8%) underwent pacemaker implantation for syncope in the context of progressive conduction disease. No patients developed left ventricular systolic dysfunction. 4 (7.1%) cDM1 patients died during follow up, including three who died suddenly with no clear cause of death. CONCLUSIONS This study is the first to analyse the prevalence and progression of ECG abnormalities in cDM1 pediatric patients. The high prevalence of abnormal findings, progressive changes and number of potentially associated events (1 pacemaker implantation and 3 unexplained sudden deaths) stresses the importance of systematic and continued cardiac evaluation of these patients.
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Affiliation(s)
- Laia Brunet Garcia
- Hospital de Mataró, Barcelona, Spain.,Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Ankita Hajra
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Ella Field
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Joseph Wacher
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Helen Walsh
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Gabrielle Norrish
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Adnan Manzur
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Francesco Muntoni
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Pinki Munot
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Stephanie Robb
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | | | | | | | - Anna Sarkozy
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Luke Starling
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Juan Pablo Kaski
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Elena Cervi
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
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4
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Cardiac Pathology in Myotonic Dystrophy Type 1. Int J Mol Sci 2021; 22:ijms222111874. [PMID: 34769305 PMCID: PMC8584352 DOI: 10.3390/ijms222111874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/08/2023] Open
Abstract
Myotonic dystrophy type 1 (DM1), the most common muscular dystrophy affecting adults and children, is a multi-systemic disorder affecting skeletal, cardiac, and smooth muscles as well as neurologic, endocrine and other systems. This review is on the cardiac pathology associated with DM1. The heart is one of the primary organs affected in DM1. Cardiac conduction defects are seen in up to 75% of adult DM1 cases and sudden death due to cardiac arrhythmias is one of the most common causes of death in DM1. Unfortunately, the pathogenesis of cardiac manifestations in DM1 is ill defined. In this review, we provide an overview of the history of cardiac studies in DM1, clinical manifestations, and pathology of the heart in DM1. This is followed by a discussion of emerging data about the utility of cardiac magnetic resonance imaging (CMR) as a biomarker for cardiac disease in DM1, and ends with a discussion on models of cardiac RNA toxicity in DM1 and recent clinical guidelines for cardiologic management of individuals with DM1.
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5
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Tylock KM, Auerbach DS, Tang ZZ, Thornton CA, Dirksen RT. Biophysical mechanisms for QRS- and QTc-interval prolongation in mice with cardiac expression of expanded CUG-repeat RNA. J Gen Physiol 2021; 152:133632. [PMID: 31968060 PMCID: PMC7062505 DOI: 10.1085/jgp.201912450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/28/2019] [Accepted: 11/26/2019] [Indexed: 12/26/2022] Open
Abstract
Myotonic dystrophy type 1 (DM1), the most common form of muscular dystrophy in adults, results from the expression of toxic gain-of-function transcripts containing expanded CUG-repeats. DM1 patients experience cardiac electrophysiological defects, including prolonged PR-, QRS-, and QT-intervals, that increase susceptibility to sudden cardiac death (SCD). However, the specific biophysical and molecular mechanisms that underlie the electrocardiograph (ECG) abnormalities and SCD in DM1 are unclear. Here, we addressed this issue using a novel transgenic mouse model that exhibits robust cardiac expression of expanded CUG-repeat RNA (LC15 mice). ECG measurements in conscious LC15 mice revealed significantly prolonged QRS- and corrected QT-intervals, but a normal PR-interval. Although spontaneous arrhythmias were not observed in conscious LC15 mice under nonchallenged conditions, acute administration of the sodium channel blocker flecainide prolonged the QRS-interval and unveiled an increased susceptibility to lethal ventricular arrhythmias. Current clamp measurements in ventricular myocytes from LC15 mice revealed significantly reduced action potential upstroke velocity at physiological pacing (9 Hz) and prolonged action potential duration at all stimulation rates (1–9 Hz). Voltage clamp experiments revealed significant rightward shifts in the voltage dependence of sodium channel activation and steady-state inactivation, as well as a marked reduction in outward potassium current density. Together, these findings indicate that expression of expanded CUG-repeat RNA in the murine heart results in reduced sodium and potassium channel activity that results in QRS- and QT-interval prolongation, respectively.
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Affiliation(s)
- Kevin M Tylock
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY
| | - David S Auerbach
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY.,Department of Pharmacology, Upstate Medical University, Syracuse, NY
| | - Zhen Zhi Tang
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Charles A Thornton
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Robert T Dirksen
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY
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Predictors of respiratory decline in myotonic dystrophy type 1 (DM1): a longitudinal cohort study. Acta Neurol Belg 2021; 121:133-142. [PMID: 32651874 DOI: 10.1007/s13760-020-01425-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/30/2020] [Indexed: 12/21/2022]
Abstract
We studied 33 patients affected by juvenile and adult myotonic dystrophy type 1 (DM1). The aim of the study was to assess clinical and laboratory parameters that could predict the requirement of noninvasive ventilation (NIV) in DM1. Secondary outcome was to assess the interplay between genetic profile, muscle impairment severity and presence of cardiac comorbidities.Patients with genetic diagnosis of DM1 were recruited. An abnormal trinucleotide repeat (CTG) expansion of dystrophy protein kinase gene (DMPK) on chromosome 19q13.3 was the prerequisite for inclusion. The number of triplet repeats was measured in genomic DNA to classify subjects. A multidisciplinary team evaluated the patients every 6-8 months up to 18 years with serial cardiological and respiratory function assessments. Neurological progression was monitored using a validated DM1-specific rating scale (MIRS). Independent variables considered for the study outcomes were gender, genetic status, age of presentation, MIRS scores, and results of pulmonary function tests (PFTs).Patients were 17 males (51.5%) and 16 females (48.5%). 16 cases were younger than mean age of 31.4 years, the remaining 17 were up to 65. 12 subjects (36.4%) underwent NIV during follow up. Cardiac comorbidities were detected in 63.6% of cases and in 91% of patients in NIV. Among PFTs, forced vital capacity (FVC) was a reliable indicator of respiratory decline. FVC values were significantly associated with clinical muscle severity assessed by MIRS.Severity of muscular impairment, CTG expansion size, age and presence of cardiac comorbidities predict respiratory impairment in DM1.
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7
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Mazzoli M, Ariatti A, Garuti GC, Agnoletto V, Genovese M, Gozzi M, Kaleci S, Marchioni A, Malagoli M, Galassi G. Predictors of prognosis in type 1 myotonic dystrophy (DM1): longitudinal 18-years experience from a single center. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2020; 39:109-120. [PMID: 33305167 PMCID: PMC7711325 DOI: 10.36185/2532-1900-015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022]
Abstract
The aim of the study was to identify possible predictors of neurological worsening and need of non-invasive ventilation (NIV) in individuals affected by myotonic dystrophy type 1 (DM1), the most common form of adult-onset muscular dystrophy.
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Affiliation(s)
- Marco Mazzoli
- Department of Biomedical, Metabolic and Neural Sciences, University Hospitals of Modena, Italy
| | - Alessandra Ariatti
- Department of Biomedical, Metabolic and Neural Sciences, University Hospitals of Modena, Italy
| | | | | | | | - Manuela Gozzi
- Radiology Unit, University Hospitals of Modena, Italy
| | - Shaniko Kaleci
- Department of Surgical, Medical, Dental and Morphological Science with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Italy
| | - Alessandro Marchioni
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospitals of Modena, Italy
| | | | - Giuliana Galassi
- Department of Biomedical, Metabolic and Neural Sciences, University Hospitals of Modena, Italy
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8
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The Biomarker Potential of miRNAs in Myotonic Dystrophy Type I. J Clin Med 2020; 9:jcm9123939. [PMID: 33291833 PMCID: PMC7762003 DOI: 10.3390/jcm9123939] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023] Open
Abstract
MicroRNAs (miRNAs) are mostly known for their gene regulation properties, but they also play an important role in intercellular signaling. This means that they can be found in bodily fluids, giving them excellent biomarker potential. Myotonic Dystrophy type I (DM1) is the most frequent autosomal dominant muscle dystrophy in adults, with an estimated prevalence of 1:8000. DM1 symptoms include muscle weakness, myotonia, respiratory failure, cardiac conduction defects, cataracts, and endocrine disturbances. Patients display heterogeneity in both age of onset and disease manifestation. No treatment or cure currently exists for DM1, which shows the necessity for a biomarker that can predict disease progression, providing the opportunity to implement preventative measures before symptoms arise. In the past two decades, extensive research has been conducted in the miRNA expression profiles of DM1 patients and their biomarker potential. Here we review the current state of the field with a tissue-specific focus, given the multi-systemic nature of DM1 and the intracellular signaling role of miRNAs.
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9
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Itoh H, Hisamatsu T, Tamura T, Segawa K, Takahashi T, Takada H, Kuru S, Wada C, Suzuki M, Suwazono S, Sasaki S, Okumura K, Horie M, Takahashi MP, Matumura T. Cardiac Conduction Disorders as Markers of Cardiac Events in Myotonic Dystrophy Type 1. J Am Heart Assoc 2020; 9:e015709. [PMID: 32812471 PMCID: PMC7660777 DOI: 10.1161/jaha.119.015709] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Myotonic dystrophy type 1 involves cardiac conduction disorders. Cardiac conduction disease can cause fatal arrhythmias or sudden death in patients with myotonic dystrophy type 1. Methods and Results This study enrolled 506 patients with myotonic dystrophy type 1 (aged ≥15 years; >50 cytosine-thymine-guanine repeats) and was treated in 9 Japanese hospitals for neuromuscular diseases from January 2006 to August 2016. We investigated genetic and clinical backgrounds including health care, activities of daily living, dietary intake, cardiac involvement, and respiratory involvement during follow-up. The cause of death or the occurrence of composite cardiac events (ie, ventricular arrhythmias, advanced atrioventricular blocks, and device implantations) were evaluated as significant outcomes. During a median follow-up period of 87 months (Q1-Q3, 37-138 months), 71 patients expired. In the univariate analysis, pacemaker implantations (hazard ratio [HR], 4.35; 95% CI, 1.22-15.50) were associated with sudden death. In contrast, PQ interval ≥240 ms, QRS duration ≥120 ms, nutrition, or respiratory failure were not associated with the incidence of sudden death. The multivariable analysis revealed that a PQ interval ≥240 ms (HR, 2.79; 95% CI, 1.9-7.19, P<0.05) or QRS duration ≥120 ms (HR, 9.41; 95% CI, 2.62-33.77, P < 0.01) were independent factors associated with a higher occurrence of cardiac events than those observed with a PQ interval <240 ms or QRS duration <120 ms; these cardiac conduction parameters were not related to sudden death. Conclusions Cardiac conduction disorders are independent markers associated with cardiac events. Further investigation on the prediction of occurrence of sudden death is warranted.
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Affiliation(s)
- Hideki Itoh
- Department of Cardiovascular Medicine Shiga University of Medical Science Otsu Japan.,Division of Patient Safety Hiroshima University Hospital Hiroshima Japan
| | - Takashi Hisamatsu
- Department of Public Health Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Takuhisa Tamura
- Department of Neurology National Hospital Organization Higashisaitama National Hospital Saitama Japan
| | - Kazuhiko Segawa
- Department of Cardiology National Center Hospital National Center of Neurology and Psychiatry Tokyo Japan
| | - Toshiaki Takahashi
- Department of Neurology National Hospital Organization Sendai-Nishitaga Hospital Sendai Japan
| | - Hiroto Takada
- Department of Neurology National Hospital Organization Aomori National Hospital Aomori Japan
| | - Satoshi Kuru
- Department of Neurology National Hospital Organization Suzuka National Hospital Suzuka Japan
| | - Chizu Wada
- Department of Neurology National Hospital Organization Akita National Hospital Akita Japan
| | - Mikiya Suzuki
- Department of Neurology National Hospital Organization Higashisaitama National Hospital Saitama Japan
| | - Shugo Suwazono
- Division of Neurology and Center for Clinical Neuroscience National Hospital Organization Okinawa National Hospital Ginowan Japan
| | - Shingo Sasaki
- Department of Advanced Management of Cardiac Arrhythmias Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Ken Okumura
- Advanced Arrhythmia Therapeutic Branch Division of Cardiology Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine Shiga University of Medical Science Otsu Japan.,Center for Epidemiologic Research in Asia and Department of Cardiology Shiga University of Medical Science Otsu Japan
| | - Masanori P Takahashi
- Department of Functional Diagnostic Science Osaka University Graduate School of Medicine Suita Japan
| | - Tsuyoshi Matumura
- Department of Neurology National Hospital Organization Osaka Toneyama Medical Center 5-1-1 Toyonaka Japan
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10
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Onoda H, Imamura T, Ushijima R, Sobajima M, Kinugawa K. A Young Patient Presenting with Atrioventricular Block Diagnosed as Myotonic Dystrophy. Intern Med 2020; 59:1531-1533. [PMID: 32188809 PMCID: PMC7364259 DOI: 10.2169/internalmedicine.4259-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We encountered a 42-year-old woman with a history of diabetes mellitus and cataracts presenting with repeated syncope whose electrocardiogram showed advanced atrioventricular block. On admission, we excluded major potential differential diagnoses as causes of an atrioventricular block but did not suspect myotonic dystrophy, which was eventually diagnosed by chance based on a suspected weakness of the respiratory muscles followed by a detailed neurological physical examination. Myotonic dystrophy should be suspected as a differential diagnosis when relatively young patients present with conductance disorder.
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Affiliation(s)
- Hiroshi Onoda
- The Second Department of Internal Medicine, University of Toyama, Japan
- Division of Cardiology, Niigata Prefectural Central Hospital, Japan
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Ryuichi Ushijima
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Mitsuo Sobajima
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Japan
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11
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Schmid J, Beer M, Berghold A, Stojakovic T, Scharnagl H, Dieplinger B, Quasthoff S, Binder JS, Rainer PP. Cardiac involvement in a cross-sectional cohort of myotonic dystrophies and other skeletal myopathies. ESC Heart Fail 2020; 7:1900-1908. [PMID: 32476276 PMCID: PMC7373928 DOI: 10.1002/ehf2.12763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/10/2020] [Accepted: 04/27/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Cardiac involvement in myopathies that primarily affect the skeletal muscle is variable and may be subtle, necessitating sensitive diagnostic approaches. Here, we describe the prevalence of cardiac abnormalities in a cohort of patients with skeletal muscle disease presenting at a tertiary care neuromuscular centre. Methods and results We systematically investigated patients with skeletal myopathies and comprehensively analysed their cardiac phenotype including 24 h electrocardiogram, echocardiography with strain analyses, contrast‐enhanced cardiac magnetic resonance imaging, and, if at increased risk of coronary artery disease, computed tomography coronary angiography. We prospectively screened 91 patients with diverse skeletal myopathies and enrolled 73 patients. The most pronounced cardiac involvement was present in patients with dystrophic myopathies (cardiac abnormalities in 59% of patients). We analysed myotonic dystrophies (n = 29) in more detail and found prolonged QRS (99.4 ± 15.6 vs. 91.5 ± 10.3 ms; P = 0.027) and QTc times (441.1 ± 28.1 vs. 413.0 ± 23.3 ms; P < 0.001) and increased left atrial size (27.28 ± 3.9 vs. 25.0 ± 3.2 mm/m2; P = 0.021) when compared with healthy controls. Left ventricular systolic function was reduced (ejection fraction < 55%) in 31% of myotonic dystrophies, while only 4% had an ejection fraction < 50%. Apical peak systolic longitudinal strain was slightly reduced (P = 0.023). Conclusions Screening for cardiac involvement in the skeletal muscle disease seems prudent particularly in patients with dystrophic myopathies. In the subset of myotonic dystrophy patients, QRS and QTc times as well as myocardial strain may be useful parameters. Their potential for predicting cardiac adverse events needs further evaluation.
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Affiliation(s)
- Johannes Schmid
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Meinrad Beer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Benjamin Dieplinger
- Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Seilerstaette 4, 4010, Linz, Austria
| | - Stefan Quasthoff
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Josepha S Binder
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
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12
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McNally EM, Mann DL, Pinto Y, Bhakta D, Tomaselli G, Nazarian S, Groh WJ, Tamura T, Duboc D, Itoh H, Hellerstein L, Mammen PPA. Clinical Care Recommendations for Cardiologists Treating Adults With Myotonic Dystrophy. J Am Heart Assoc 2020; 9:e014006. [PMID: 32067592 PMCID: PMC7070199 DOI: 10.1161/jaha.119.014006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Myotonic dystrophy is an inherited systemic disorder affecting skeletal muscle and the heart. Genetic testing for myotonic dystrophy is diagnostic and identifies those at risk for cardiac complications. The 2 major genetic forms of myotonic dystrophy, type 1 and type 2, differ in genetic etiology yet share clinical features. The cardiac management of myotonic dystrophy should include surveillance for arrhythmias and left ventricular dysfunction, both of which occur in progressive manner and contribute to morbidity and mortality. To promote the development of care guidelines for myotonic dystrophy, the Myotonic Foundation solicited the input of care experts and organized the drafting of these recommendations. As a rare disorder, large scale clinical trial data to guide the management of myotonic dystrophy are largely lacking. The following recommendations represent expert consensus opinion from those with experience in the management of myotonic dystrophy, in part supported by literature-based evidence where available.
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Affiliation(s)
| | | | - Yigal Pinto
- University of AmsterdamAmsterdamThe Netherlands
| | | | | | | | | | - Takuhisa Tamura
- National Hospital Organization Higashisaitama National HospitalSaitamaJapan
| | - Denis Duboc
- Hopital CochinUniversite Paris DescartesParisFrance
| | - Hideki Itoh
- Shiga University of Medical ScienceShigaJapan
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13
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Lamacie MM, Warman-Chardon J, Crean AM, Florian A, Wahbi K. The Added Value of Cardiac Magnetic Resonance in Muscular Dystrophies. J Neuromuscul Dis 2019; 6:389-399. [PMID: 31561382 PMCID: PMC6918915 DOI: 10.3233/jnd-190415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Muscular dystrophies (MD) represent a heterogeneous group of rare genetic diseases that often lead to significant weakness due to progressive muscle degeneration. In many forms of MD, cardiac manifestations including heart failure, atrial and ventricular arrhythmias and conduction abnormalities can occur and may be a predominant feature of the disease. Cardiac magnetic resonance (CMR) can assess cardiac anatomy, global and regional ventricular function, volumes and mass as well as presence of myocardial inflammation, infiltration or fibrosis. The role for cardiac MRI has been well-established in a wide range of muscular dystrophies related cardiomyopathies. CMR is a more sensitive technique than echocardiography for early diagnosis of cardiac involvement. It has also great potential to improve the prediction of long-term outcome, particularly the development of heart failure and arrhythmic events; however it still has to be validated by longitudinal studies including large populations. This review will outline the utility of CMR in patients with muscular dystrophies for assessment of myocardial involvement, risk stratification, and in guiding therapeutic management.
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Affiliation(s)
- Mariana M Lamacie
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada
| | - Jodi Warman-Chardon
- Division of Neurology, Department of Medicine, University of Ottawa, Ontario, Canada
| | - Andrew M Crean
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada
| | - Anca Florian
- Department of Cardiology I, University Hospital Muenster, Muenster, Germany
| | - Karim Wahbi
- APHP, Cochin Hospital, Cardiology Department, FILNEMUS, Centre de Référence de Pathologie Neuromusculaire Nord/Est/Ile de France, Paris-Descartes, Sorbonne Paris Cité University, Paris, France; INSERM Unit, Paris Cardiovascular Research Centre (PARCC), Paris, France
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14
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Bosè F, Renna LV, Fossati B, Arpa G, Labate V, Milani V, Botta A, Micaglio E, Meola G, Cardani R. TNNT2 Missplicing in Skeletal Muscle as a Cardiac Biomarker in Myotonic Dystrophy Type 1 but Not in Myotonic Dystrophy Type 2. Front Neurol 2019; 10:992. [PMID: 31611837 PMCID: PMC6776629 DOI: 10.3389/fneur.2019.00992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/02/2019] [Indexed: 12/31/2022] Open
Abstract
Cardiac involvement is one of the most important manifestations of the multisystemic phenotype of patients affected by myotonic dystrophy (DM) and represents the second cause of premature death. Molecular mechanisms responsible for DM cardiac defects are still unclear; however, missplicing of the cardiac isoform of troponin T (TNNT2) and of the cardiac sodium channel (SCN5A) genes might contribute to the reduced myocardial function and conduction abnormalities seen in DM patients. Since, in DM skeletal muscle, the TNNT2 gene shows the same aberrant splicing pattern observed in cardiac muscle, the principal aim of this work was to verify if the TNNT2 aberrant fetal isoform expression could be secondary to myopathic changes or could reflect the DM cardiac phenotype. Analysis of alternative splicing of TNNT2 and of several genes involved in DM pathology has been performed on muscle biopsies from patients affected by DM type 1 (DM1) or type 2 (DM2) with or without cardiac involvement. Our analysis shows that missplicing of muscle-specific genes is higher in DM1 and DM2 than in regenerating control muscles, indicating that these missplicing could be effectively important in DM skeletal muscle pathology. When considering the TNNT2 gene, missplicing appears to be more evident in DM1 than in DM2 muscles since, in DM2, the TNNT2 fetal isoform appears to be less expressed than the adult isoform. This evidence does not seem to be related to less severe muscle histopathological alterations that appear to be similar in DM1 and DM2 muscles. These results seem to indicate that the more severe TNNT2 missplicing observed in DM1 could not be related only to myopathic changes but could reflect the more severe general phenotype compared to DM2, including cardiac problems that appear to be more severe and frequent in DM1 than in DM2 patients. Moreover, TNNT2 missplicing significantly correlates with the QRS cardiac parameter in DM1 but not in DM2 patients, indicating that this splicing event has good potential to function as a biomarker of DM1 severity and it should be considered in pharmacological clinical trials to monitor the possible effects of different therapeutic approaches on skeletal muscle tissues.
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Affiliation(s)
- Francesca Bosè
- Laboratory of Muscle Histopathology and Molecular Biology, IRCCS-Policlinico San Donato, Milan, Italy
| | - Laura Valentina Renna
- Laboratory of Muscle Histopathology and Molecular Biology, IRCCS-Policlinico San Donato, Milan, Italy
| | - Barbara Fossati
- Department of Neurology, IRCCS-Policlinico San Donato, Milan, Italy.,Department of Neurorehabilitation Sciences, Casa Cura Policlinico (CCP), Milan, Italy
| | - Giovanni Arpa
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Valentina Labate
- University Cardiology Unit, IRCCS-Policlinico San Donato, Milan, Italy
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, Milan, Italy
| | - Annalisa Botta
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Emanuele Micaglio
- Department of Arrhythmology, IRCCS Policlinico San Donato, Milan, Italy
| | - Giovanni Meola
- Department of Neurology, IRCCS-Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Rosanna Cardani
- Laboratory of Muscle Histopathology and Molecular Biology, IRCCS-Policlinico San Donato, Milan, Italy
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15
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Nikhanj A, Sivakumaran S, Miskew-Nichols B, Siddiqi ZA, Oudit GY. Ventricular tachycardia in patients with type 1 myotonic dystrophy: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5513091. [PMID: 31449640 PMCID: PMC6601193 DOI: 10.1093/ehjcr/ytz095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/05/2019] [Accepted: 05/18/2019] [Indexed: 11/28/2022]
Abstract
Background Type 1 myotonic dystrophy (DM1) is associated with a variety of cardiac conduction abnormalities and the frequent need for permanent pacing. However, the role of ventricular tachycardia (VT) and the implied risk of sudden cardiac death (SCD) is poorly understood. Case summary This study examined a 56-patient DM1 cohort of men and women, and identified five patients (two females and three males) with ventricular arrhythmias (8.9%). Patients were reviewed on a case-by-case basis, with their clinical presentation and management of VT and the associated cardiomyopathy indicated. Patient cardiac function was determined by 12-lead electrocardiogram, 48-h Holter monitor, and transthoracic echocardiography. These patients were therefore suitable candidates for implantable cardioverter-defibrillator implantation and received these devices; four of the five patients also received cardiac resynchronization therapy. Medical therapies included angiotensin converting enzyme inhibition, mineralocorticoid receptor antagonist, and following device implantation, beta-blocker therapy was initiated. Discussion Our case series demonstrates the prevalence of VT in patients with DM1 highlighting the associated risks of SCD in this patient population. The burden of ventricular arrhythmias, advanced conduction disease, and cardiomyopathy are best treated with a combination of device and medical therapies.
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Affiliation(s)
- Anish Nikhanj
- Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Avenue NW, Edmonton, Alberta, Canada
| | - Soori Sivakumaran
- Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Avenue NW, Edmonton, Alberta, Canada
| | - Bailey Miskew-Nichols
- Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Avenue NW, Edmonton, Alberta, Canada
| | - Zaeem A Siddiqi
- Division of Neurology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Avenue NW, Edmonton, Alberta, Canada
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16
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Chmielewski L, Bietenbeck M, Patrascu A, Rösch S, Sechtem U, Yilmaz A, Florian AR. Non-invasive evaluation of the relationship between electrical and structural cardiac abnormalities in patients with myotonic dystrophy type 1. Clin Res Cardiol 2019; 108:857-867. [PMID: 30767060 DOI: 10.1007/s00392-019-01414-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cardiac involvement in myotonic dystrophy type 1 (MD1) includes conduction disease, arrhythmias, and left-ventricular (LV) systolic dysfunction leading to an increased sudden cardiac death risk. An understanding of the interplay between electrical and structural myocardial changes could improve the prediction of adverse cardiac events. We aimed to explore the relationship between signs of cardiomyopathy by conventional and advanced cardiovascular magnetic resonance (CMR), and electrical abnormalities in MD1. METHODS Fifty-seven MD1 patients (43 ± 13 years, 46% male) and 15 matched controls (41 ± 7 years, 53% male) underwent CMR including cine-imaging with feature-tracking strain analysis, late gadolinium enhancement (LGE), and native/post-contrast T1-mapping with extracellular volume calculation. Standard 12-lead and long-term ECG monitoring were performed as screening for rhythm and/or conduction abnormalities. RESULTS Abnormal ECGs were recorded in 40% of MD1; a pathologic CMR was found in 44%: 21% had an impaired LV-EF and 32% showed non-ischemic LGE. When looking at MD1 patients with available long-term ECG monitoring (n = 39), those with atrial fibrillation (Afib)/flutter(Afl) episodes had lower LV-EF (52 ± 7 vs. 60 ± 5%, p = 0.002), lower global longitudinal strain (- 17 ± 3 vs. - 20 ± 3%, p = 0.034), a trend to lower left atrial emptying fraction (LA-EF) (44 ± 14 vs. 55 ± 8%, p = 0.08), and higher prevalence of LGE (88% vs. 23%, p = 0.001) with an intramural (75% vs. 23%, p = 0.01) and septal (63% vs. 13%, p = 0.009) pattern. In a model including LV-EF (OR 0.8, 95% CI 0.7-1.0, p = NS) and LGE presence (OR 14.8, 95% CI 1.4-159.0, p = 0.026), only LGE was independently associated with the occurrence of Afib/Afl episodes. CONCLUSION Myocardial abnormalities depicted by non-ischemic LGE-CMR were the only independent predictor for the occurrence of Afib/Afl on ECG monitoring, previously shown to predict adverse cardiac events in MD1.
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Affiliation(s)
- Lukas Chmielewski
- Department of Cardiology I, University Hospital Muenster, Münster, Germany
| | - Michael Bietenbeck
- Department of Cardiology I, University Hospital Muenster, Münster, Germany
| | | | - Sabine Rösch
- Division of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Udo Sechtem
- Division of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Ali Yilmaz
- Department of Cardiology I, University Hospital Muenster, Münster, Germany
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17
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Best AF, Hilbert JE, Wood L, Martens WB, Nikolenko N, Marini-Bettolo C, Lochmüller H, Rosenberg PS, Moxley RT, Greene MH, Gadalla SM. Survival patterns and cancer determinants in families with myotonic dystrophy type 1. Eur J Neurol 2018; 26:58-65. [PMID: 30051542 DOI: 10.1111/ene.13763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/21/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Research indicates that patients with myotonic dystrophy type 1 (DM1) are at increased risk of cancer and early death. Family data may provide insights given DM1 phenotypic heterogeneity, the broad range of non-muscular manifestations and the usual delays in the diagnosis of DM1. METHOD Family history data were collected from 397 genetically and/or clinically confirmed DM1 patients (respondents) enrolled in the US or UK myotonic dystrophy registries. Standardized mortality ratios were calculated for DM1 first-degree relatives (parents, siblings and offspring) by their reported DM1 status (affected, unaffected or unknown). For cancer-related analyses, mixed effects logistic regression models were used to evaluate factors associated with cancer development in DM1 families, including familial clustering. RESULTS A total of 467 deaths and 337 cancers were reported amongst 1737 first-degree DM1 relatives. Mortality risk amongst relatives reported as DM1-unaffected was comparable to that of the general population [standardized mortality ratio (SMR) 0.82, P = 0.06], whilst significantly higher mortality risks were noted in DM1-affected relatives (SMR = 2.47, P < 0.0001) and in those whose DM1 status was unknown (SMR = 1.60, P < 0.0001). In cancer risk analyses, risk was higher amongst families in which the DM1 respondent had cancer (odds ratio 1.95, P = 0.0001). Unknown DM1 status in the siblings (odds ratio 2.59, P = 0.004) was associated with higher cancer risk. CONCLUSION There is an increased risk of death, and probably cancer, in relatives with DM1 and in those whose DM1 status is unknown. This suggests a need to perform a careful history and physical examination, supplemented by genetic testing, to identify family members at risk for DM1 and who might benefit from disease-specific clinical care and surveillance.
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Affiliation(s)
- A F Best
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - J E Hilbert
- Department of Neurology, Neuromuscular Disease Center, University of Rochester Medical Center, Rochester, NY, USA
| | - L Wood
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - W B Martens
- Department of Neurology, Neuromuscular Disease Center, University of Rochester Medical Center, Rochester, NY, USA
| | - N Nikolenko
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - C Marini-Bettolo
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - H Lochmüller
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,Department of Neuropediatrics and Muscle Disorders, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Centro Nacional de Análisis Genómico (CNAG-CRG), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - P S Rosenberg
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - R T Moxley
- Department of Neurology, Neuromuscular Disease Center, University of Rochester Medical Center, Rochester, NY, USA
| | - M H Greene
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - S M Gadalla
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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18
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Gamet A, Degand B, Le Gal F, Bidegain N, Delaubier A, Gilbert-Dussardier B, Christiaens L, Garcia R. Twenty-four-hour ambulatory ECG monitoring relevancy in myotonic dystrophy type 1 follow-up: Prognostic value and heart rate variability evolution. Ann Noninvasive Electrocardiol 2018; 24:e12587. [PMID: 30101452 DOI: 10.1111/anec.12587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/18/2018] [Accepted: 07/24/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Patient prognosis in type 1 myotonic dystrophy (DM1) is very poor. Annual 24-hour holter ECG monitoring is recommended but its relevance is debated. Main objective was to determine whether holter ECG parameters could predict global death in DM1 patients and secondarily to assess whether they could predict cardiovascular events and sudden cardiac death, to compare DM1 patients and healthy controls, and to assess their evolution in DM1 over a 5-year period. METHODS This retrospective study included genetically confirmed DM1. Primary endpoint was global death. Secondary endpoints were labeled "sudden cardiac death" which was a composite of sudden cardiac death, aborted sudden cardiac death, implantable cardioverter defibrillator therapy, sustained ventricular tachycardia, atrioventricular block grade 3, pause >3 s; and "cardiovascular events" which was a composite of all-cause mortality, pacemaker or cardioverter defibrillator implantation, sustained ventricular tachycardia, supraventricular tachycardia, hospitalization for acute cardiac cause and heart failure. RESULTS Forty-seven patients (22 women, 40 ± 13 years old) were included. Three (7%) DM1 patients died, 9 (19%) experienced "sudden cardiac death" endpoint and 21 (45%) experienced "cardiovascular event" endpoint during mean follow-up of 95 ± 22 months. None of holter ECG parameters were discriminant to predict death or secondary endpoints. Compared to healthy controls, DM1 patients had higher SDNN and LF/HF ratio. Finally, heart rate variability parameters remained stable over a mean interval of 61 ± 15 months excepting pNN50 which decreased significantly. CONCLUSION Results suggest that annually-repeated holter ECG in DM1 is not useful for stratifying risk of sudden death and cardiovascular outcomes.
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Affiliation(s)
| | - Bruno Degand
- Department of Cardiology, CHU Poitiers, Poitiers, France
| | | | | | - Anne Delaubier
- Department of Physical Medicine and Rehabilitation, CHU Poitiers, Poitiers, France
| | | | - Luc Christiaens
- Department of Cardiology, CHU Poitiers, Poitiers, France.,Univ Poitiers, Poitiers, France
| | - Rodrigue Garcia
- Department of Cardiology, CHU Poitiers, Poitiers, France.,Univ Poitiers, Poitiers, France
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19
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Kamihara T, Yasuma F, Murohara T. Nonsustained ventricular tachycardia does not affect the prognosis of neuromuscular diseases: A preliminary and retrospective study. J Arrhythm 2018; 34:254-260. [PMID: 29951140 PMCID: PMC6009987 DOI: 10.1002/joa3.12057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nonsustained ventricular tachycardia (NSVT) is sometimes observed in patients with neuromuscular diseases (NMDs). The aim of this study was to assess the role of NSVT in the survival prognosis of NMD patients. METHODS We retrospectively analyzed the patients with NMDs who had undergone Holter ECG recordings at a single center between February and August 2012. Sixty-eight patients were enrolled in this study. The 5 year follow-up was assessed according to the cumulative event-free rate. RESULTS Twenty-one patients died during the follow-up, seven of whom died by cardiac death. The Kaplan-Meier survival curve that compared the patients with NSVT and those without NSVT indicated the NSVT was not related to the rate of all causes of death or cardiac death in those patients with NMDs. The survival curve was not significantly changed after the adjustment by age and ejection fraction. CONCLUSION No significant correlations between NSVT and the prognosis in patients with NMDs were found.
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Affiliation(s)
- Takahiro Kamihara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | | | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
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20
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Koene RJ, Adkisson WO, Benditt DG. Syncope and the risk of sudden cardiac death: Evaluation, management, and prevention. J Arrhythm 2017; 33:533-544. [PMID: 29255498 PMCID: PMC5728985 DOI: 10.1016/j.joa.2017.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/04/2017] [Accepted: 07/04/2017] [Indexed: 12/17/2022] Open
Abstract
Syncope is a clinical syndrome defined as a relatively brief self-limited transient loss of consciousness (TLOC) caused by a period of inadequate cerebral nutrient flow. Most often the trigger is an abrupt drop of systemic blood pressure. True syncope must be distinguished from other common non-syncope conditions in which real or apparent TLOC may occur such as seizures, concussions, or accidental falls. The causes of syncope are diverse, but in most instances, are relatively benign (e.g., reflex and orthostatic faints) with the main risks being accidents and/or injury. However, in some instances, syncope may be due to more worrisome conditions (particularly those associated with cardiac structural disease or channelopathies); in such circumstances, syncope may be an indicator of increased morbidity and mortality risk, including sudden cardiac death (SCD). Establishing an accurate basis for the etiology of syncope is crucial in order to initiate effective therapy. In this review, we focus primarily on the causes of syncope that are associated with increased SCD risk (i.e., sudden arrhythmic cardiac death), and the management of these patients. In addition, we discuss the limitations of our understanding of SCD in relation to syncope, and propose future studies that may ultimately address how to improve outcomes of syncope patients and reduce SCD risk.
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Affiliation(s)
| | | | - David G. Benditt
- From the Cardiac Arrhythmia Center, Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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21
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Provenzano C, Cappella M, Valaperta R, Cardani R, Meola G, Martelli F, Cardinali B, Falcone G. CRISPR/Cas9-Mediated Deletion of CTG Expansions Recovers Normal Phenotype in Myogenic Cells Derived from Myotonic Dystrophy 1 Patients. MOLECULAR THERAPY-NUCLEIC ACIDS 2017; 9:337-348. [PMID: 29246312 PMCID: PMC5684470 DOI: 10.1016/j.omtn.2017.10.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 02/05/2023]
Abstract
Myotonic dystrophy type 1 (DM1) is the most common adult-onset muscular dystrophy, characterized by progressive myopathy, myotonia, and multi-organ involvement. This dystrophy is an inherited autosomal dominant disease caused by a (CTG)n expansion within the 3′ untranslated region of the DMPK gene. Expression of the mutated gene results in production of toxic transcripts that aggregate as nuclear foci and sequester RNA-binding proteins, resulting in mis-splicing of several transcripts, defective translation, and microRNA dysregulation. No effective therapy is yet available for treatment of the disease. In this study, myogenic cell models were generated from myotonic dystrophy patient-derived fibroblasts. These cells exhibit typical disease-associated ribonuclear aggregates, containing CUG repeats and muscleblind-like 1 protein, and alternative splicing alterations. We exploited these cell models to develop new gene therapy strategies aimed at eliminating the toxic mutant repeats. Using the CRISPR/Cas9 gene-editing system, the repeat expansions were removed, therefore preventing nuclear foci formation and splicing alterations. Compared with the previously reported strategies of inhibition/degradation of CUG expanded transcripts by various techniques, the advantage of this approach is that affected cells can be permanently reverted to a normal phenotype.
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Affiliation(s)
- Claudia Provenzano
- Institute of Cell Biology and Neurobiology, National Research Council, Monterotondo, Rome, Italy
| | - Marisa Cappella
- Institute of Cell Biology and Neurobiology, National Research Council, Monterotondo, Rome, Italy; DAHFMO-Unit of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Rea Valaperta
- Molecular Biology Laboratory, Policlinico San Donato-IRCCS, San Donato Milanese, Milan, Italy
| | - Rosanna Cardani
- Muscle Histopathology and Molecular Biology Laboratory, Policlinico San Donato-IRCCS, San Donato Milanese, Milan, Italy
| | - Giovanni Meola
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Fabio Martelli
- Molecular Cardiology Laboratory, Policlinico San Donato-IRCCS, San Donato Milanese, Milan, Italy
| | - Beatrice Cardinali
- Institute of Cell Biology and Neurobiology, National Research Council, Monterotondo, Rome, Italy.
| | - Germana Falcone
- Institute of Cell Biology and Neurobiology, National Research Council, Monterotondo, Rome, Italy.
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22
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Abstract
Nonischemic dilated cardiomyopathy (DCM) often has a genetic pathogenesis. Because of the large number of genes and alleles attributed to DCM, comprehensive genetic testing encompasses ever-increasing gene panels. Genetic diagnosis can help predict prognosis, especially with regard to arrhythmia risk for certain subtypes. Moreover, cascade genetic testing in family members can identify those who are at risk or with early stage disease, offering the opportunity for early intervention. This review will address diagnosis and management of DCM, including the role of genetic evaluation. We will also overview distinct genetic pathways linked to DCM and their pathogenetic mechanisms. Historically, cardiac morphology has been used to classify cardiomyopathy subtypes. Determining genetic variants is emerging as an additional adjunct to help further refine subtypes of DCM, especially where arrhythmia risk is increased, and ultimately contribute to clinical management.
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Affiliation(s)
- Elizabeth M McNally
- From the Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago IL (E.M.M.); and Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora (L.M.).
| | - Luisa Mestroni
- From the Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago IL (E.M.M.); and Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora (L.M.).
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23
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Sochala M, Wahbi K, Sorbets E, Lazarus A, Bécane HM, Stojkovic T, Fayssoil A, Laforêt P, Béhin A, Sroussi M, Eymard B, Duboc D, Meune C. Risk for Complications after Pacemaker or Cardioverter Defibrillator Implantations in Patients with Myotonic Dystrophy Type 1. J Neuromuscul Dis 2017; 4:175-181. [DOI: 10.3233/jnd-170232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Maximilien Sochala
- Department of Cardiology, AP-HP, Cochin Hospital, Paris Descartes University, Paris, France
| | - Karim Wahbi
- Department of Cardiology, AP-HP, Cochin Hospital, Paris Descartes University, Paris, France
- AP-HP, Pitié-Salpêtrière Hospital, Myology Institute, Paris, France
| | - Emmanuel Sorbets
- Department of Cardiology, AP-HP, Avicenne Hospital, Bobigny, France; Paris XIII University, Bobigny, France
| | - Arnaud Lazarus
- InParys Clinical Research Associates, Saint Cloud, Paris, France
| | | | - Tanya Stojkovic
- AP-HP, Pitié-Salpêtrière Hospital, Myology Institute, Paris, France
| | | | - Pascal Laforêt
- AP-HP, Pitié-Salpêtrière Hospital, Myology Institute, Paris, France
- Pierre and Marie Curie University, Paris, France
| | - Anthony Béhin
- AP-HP, Pitié-Salpêtrière Hospital, Myology Institute, Paris, France
| | - Marjorie Sroussi
- Department of Cardiology, AP-HP, Cochin Hospital, Paris Descartes University, Paris, France
| | - Bruno Eymard
- AP-HP, Pitié-Salpêtrière Hospital, Myology Institute, Paris, France
- Pierre and Marie Curie University, Paris, France
| | - Denis Duboc
- Department of Cardiology, AP-HP, Cochin Hospital, Paris Descartes University, Paris, France
- AP-HP, Pitié-Salpêtrière Hospital, Myology Institute, Paris, France
| | - Christophe Meune
- Department of Cardiology, AP-HP, Avicenne Hospital, Bobigny, France; Paris XIII University, Bobigny, France
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Russo V, Nigro G, Politano L. Role of electrophysiological evaluation for the best device choice to prevent sudden cardiac death in patients with Myotonic Dystrophy Type 1 and Emery Dreifuss Muscular Dystrophy. Trends Cardiovasc Med 2017; 31:e1-e2. [PMID: 28237579 DOI: 10.1016/j.tcm.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/01/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
| | - Gerardo Nigro
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy
| | - Luisa Politano
- Department of Experimental Medicine, Cardiomyology and Medical Genetics, Second University of Naples, Naples, Italy
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