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Kauferstein S, Beckmann BM. [Postmortem genetic analysis following sudden cardiac death : Background, approach, and future]. Herzschrittmacherther Elektrophysiol 2024; 35:31-38. [PMID: 38197940 DOI: 10.1007/s00399-023-00986-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Sudden cardiac death (SCD) is defined as an unexpected, nontraumatic death with a possible cardiac or unknown cause. The lowest incidence is observed in infancy and childhood (1 per 100,000), and the incidence is approximately 50 per 100,000 in the middle-aged population, reaching a plateau around the age of 80 (200 per 100,000). While most SCD cases occur in older people with coronary artery disease, there is a predominance of monogenetic and polygenetic diseases in the young. METHODS Postmortem genetic analysis (molecular autopsy) using next-generation sequencing reveals a definite pathogenic genetic alteration, which can explain SCD of young patients in near 20% of the cases. Hence, postmortem genetic analysis has become an important tool to unravel the inheritable cause of death. Furthermore, early identification of a pathogenic genetic sequence variant in the deceased is crucial to reduce risk in relatives due to preventive personalized measures. RESULTS AND CONCLUSION Postmortem genetic analysis forms together with the clinical assessment the basis for early identification of at-risk relatives. A new guideline for the management of ventricular arrhythmias and prevention of sudden death was recently published by the European Society of Cardiology. The new recommendations give genetic testing, also in deceased patients a much higher priority reflecting increasing relevance of genetic testing for diagnostic evaluation, risk stratification and prevention.
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Affiliation(s)
- Silke Kauferstein
- Institut für Rechtsmedizin, Zentrum für plötzlichen Herztod und familiäre Arrhythmiesyndrome, Universitätsklinikum Frankfurt, Kennedyallee 104, 60590, Frankfurt, Deutschland.
- Partner Site Rhein-Main, DZHK (German Centre for Cardiovascular Research), Frankfurt, Deutschland.
| | - Britt-Maria Beckmann
- Institut für Rechtsmedizin, Zentrum für plötzlichen Herztod und familiäre Arrhythmiesyndrome, Universitätsklinikum Frankfurt, Kennedyallee 104, 60590, Frankfurt, Deutschland
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Yeruva S, Stangner K, Jungwirth A, Hiermaier M, Shoykhet M, Kugelmann D, Hertl M, Egami S, Ishii N, Koga H, Hashimoto T, Weis M, Beckmann BM, Biller R, Schüttler D, Kääb S, Waschke J. Correction: Catalytic antibodies in arrhythmogenic cardiomyopathy patients cleave desmoglein 2 and N-cadherin and impair cardiomyocyte cohesion. Cell Mol Life Sci 2023; 80:296. [PMID: 37728633 PMCID: PMC10511356 DOI: 10.1007/s00018-023-04942-1] [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] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Sunil Yeruva
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany
| | - Konstanze Stangner
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany
| | - Anna Jungwirth
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany
| | - Matthias Hiermaier
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany
| | - Maria Shoykhet
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany
- Department of Otorhinolarynology, Technical University of Munich and University Hospital rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Daniela Kugelmann
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-University Marburg, 35037, Marburg, Germany
| | - Shohei Egami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Hiroshi Koga
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Graduate School of Medicine, Osaka City Metropolitan University, Osaka, Japan
| | - Michael Weis
- Krankenhaus Neuwittelsbach, Fachklinik Für Innere Medizin, Munich, Germany
| | - Britt-Maria Beckmann
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich (LMU), Campus Großhadern, Munich, Germany
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Ruth Biller
- ARVC-Selbsthilfe E.V, Patient Association, Munich, Germany
| | - Dominik Schüttler
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich (LMU), Campus Großhadern, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance (MHA), Partner Site Munich, Munich, Germany
- Walter Brendel Centre of Experimental Medicine, Ludwig-Maximilians University Munich (LMU), Munich, Germany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICON), LMU Munich, Munich, Germany
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich (LMU), Campus Großhadern, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance (MHA), Partner Site Munich, Munich, Germany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICON), LMU Munich, Munich, Germany
- Member of the European Reference Network for rare, low prevalance and complex diseases of the heart , ERN GUARD-Heart, Munich, Germany
| | - Jens Waschke
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany.
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Neumann B, Vink AS, Hermans BJM, Lieve KVV, Cömert D, Beckmann BM, Clur SAB, Blom NA, Delhaas T, Wilde AAM, Kääb S, Postema PG, Sinner MF. Manual vs. automatic assessment of the QT-interval and corrected QT. Europace 2023; 25:euad213. [PMID: 37470430 PMCID: PMC10469369 DOI: 10.1093/europace/euad213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/29/2023] [Accepted: 06/29/2023] [Indexed: 07/21/2023] Open
Abstract
AIMS Sudden cardiac death (SCD) is challenging to predict. Electrocardiogram (ECG)-derived heart rate-corrected QT-interval (QTc) is used for SCD-risk assessment. QTc is preferably determined manually, but vendor-provided automatic results from ECG recorders are convenient. Agreement between manual and automatic assessments is unclear for populations with aberrant QTc. We aimed to systematically assess pairwise agreement of automatic and manual QT-intervals and QTc. METHODS AND RESULTS A multi-centre cohort enriching aberrant QTc comprised ECGs of healthy controls and long-QT syndrome (LQTS) patients. Manual QT-intervals and QTc were determined by the tangent and threshold methods and compared to automatically generated, vendor-provided values. We assessed agreement globally by intra-class correlation coefficients and pairwise by Bland-Altman analyses and 95% limits of agreement (LoA). Further, manual results were compared to a novel automatic QT-interval algorithm. ECGs of 1263 participants (720 LQTS patients; 543 controls) were available [median age 34 (inter-quartile range 35) years, 55% women]. Comparing cohort means, automatic and manual QT-intervals and QTc were similar. However, pairwise Bland-Altman-based agreement was highly discrepant. For QT-interval, LoAs spanned 95 (tangent) and 92 ms (threshold), respectively. For QTc, the spread was 108 and 105 ms, respectively. LQTS patients exhibited more pronounced differences. For automatic QTc results from 440-540 ms (tangent) and 430-530 ms (threshold), misassessment risk was highest. Novel automatic QT-interval algorithms may narrow this range. CONCLUSION Pairwise vendor-provided automatic and manual QT-interval and QTc results can be highly discrepant. Novel automatic algorithms may improve agreement. Within the above ranges, automatic QT-interval and QTc results require manual confirmation, particularly if T-wave morphology is challenging.
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Affiliation(s)
- Benjamin Neumann
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - A Suzanne Vink
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ben J M Hermans
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Krystien V V Lieve
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Didem Cömert
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Britt-Maria Beckmann
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Legal Medicine, Goethe Univeristy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sally-Ann B Clur
- Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Stefan Kääb
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Pieter G Postema
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Moritz F Sinner
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
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Yeruva S, Stangner K, Jungwirth A, Hiermaier M, Shoykhet M, Kugelmann D, Hertl M, Egami S, Ishii N, Koga H, Hashimoto T, Weis M, Beckmann BM, Biller R, Schüttler D, Kääb S, Waschke J. Catalytic antibodies in arrhythmogenic cardiomyopathy patients cleave desmoglein 2 and N-cadherin and impair cardiomyocyte cohesion. Cell Mol Life Sci 2023; 80:203. [PMID: 37450050 PMCID: PMC10348947 DOI: 10.1007/s00018-023-04853-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
AIMS Arrhythmogenic cardiomyopathy (AC) is a severe heart disease predisposing to ventricular arrhythmias and sudden cardiac death caused by mutations affecting intercalated disc (ICD) proteins and aggravated by physical exercise. Recently, autoantibodies targeting ICD proteins, including the desmosomal cadherin desmoglein 2 (DSG2), were reported in AC patients and were considered relevant for disease development and progression, particularly in patients without underlying pathogenic mutations. However, it is unclear at present whether these autoantibodies are pathogenic and by which mechanisms show specificity for DSG2 and thus can be used as a diagnostic tool. METHODS AND RESULTS IgG fractions were purified from 15 AC patients and 4 healthy controls. Immunostainings dissociation assays, atomic force microscopy (AFM), Western blot analysis and Triton X-100 assays were performed utilizing human heart left ventricle tissue, HL-1 cells and murine cardiac slices. Immunostainings revealed that autoantibodies against ICD proteins are prevalent in AC and most autoantibody fractions have catalytic properties and cleave the ICD adhesion molecules DSG2 and N-cadherin, thereby reducing cadherin interactions as revealed by AFM. Furthermore, most of the AC-IgG fractions causing loss of cardiomyocyte cohesion activated p38MAPK, which is known to contribute to a loss of desmosomal adhesion in different cell types, including cardiomyocytes. In addition, p38MAPK inhibition rescued the loss of cardiomyocyte cohesion induced by AC-IgGs. CONCLUSION Our study demonstrates that catalytic autoantibodies play a pathogenic role by cleaving ICD cadherins and thereby reducing cardiomyocyte cohesion by a mechanism involving p38MAPK activation. Finally, we conclude that DSG2 cleavage by autoantibodies could be used as a diagnostic tool for AC.
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Affiliation(s)
- Sunil Yeruva
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany
| | - Konstanze Stangner
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany
| | - Anna Jungwirth
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany
| | - Matthias Hiermaier
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany
| | - Maria Shoykhet
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany
- Department of Otorhinolarynology, Technical University of Munich and University Hospital rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Daniela Kugelmann
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-University Marburg, 35037, Marburg, Germany
| | - Shohei Egami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Hiroshi Koga
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Graduate School of Medicine, Osaka City Metropolitan University, Osaka, Japan
| | - Michael Weis
- Krankenhaus Neuwittelsbach, Fachklinik Für Innere Medizin, Munich, Germany
| | - Britt-Maria Beckmann
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich (LMU), Campus Großhadern, Munich, Germany
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Ruth Biller
- ARVC-Selbsthilfe E.V, Patient Association, Munich, Germany
| | - Dominik Schüttler
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich (LMU), Campus Großhadern, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance (MHA), Partner Site Munich, Munich, Germany
- Walter Brendel Centre of Experimental Medicine, Ludwig-Maximilians University Munich (LMU), Munich, Germany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICON), LMU Munich, Munich, Germany
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich (LMU), Campus Großhadern, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance (MHA), Partner Site Munich, Munich, Germany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICON), LMU Munich, Munich, Germany
- Member of the European Reference Network for rare, low prevalance and complex diseases of the heart , ERN GUARD-Heart, Munich, Germany
| | - Jens Waschke
- Chair of Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany.
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Westphal DS, Federle D, Steger A, Vodermeier T, Scheiper-Welling S, Jenewein T, Beckmann BM, Kauferstein S, Martens E, Hahn F. Telemedical monitoring in patients with inborn cardiac disease - experience of a tertiary care centre. Mamm Genome 2022:10.1007/s00335-022-09972-x. [PMID: 36481846 PMCID: PMC9734484 DOI: 10.1007/s00335-022-09972-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The number of cardiologically relevant genetic findings will continue to increase. This is due to the use of high-throughput sequencing techniques and the critical role of incidental findings in cardiac disease genes. Telemedicine can be a useful diagnostic tool to monitor the heart rhythm of patients with inborn cardiac diseases. METHODS Patients were screened once they had been referred to our outpatient department for rare cardiac diseases between January 2020 and May 2022. Those patients who underwent genetic testing and were consequently diagnosed with a genetic disorder were included in this study. Their medical records were evaluated regarding implanted cardiac electronic devices and findings in the telemedical monitoring. RESULTS 304 patients were seen in our outpatient department for rare cardiac diseases in the mentioned period. In 100 cases, genetic testing was performed. 10 patients (10%) with an identified inborn cardiac disease were monitored via telemedicine until the end of May 2022. 4 patients were monitored by implantable loop recorders (ILR), 4 patients were monitored by Implantable Cardioverter Defibrillators (ICD), and 2 patients received both devices. Clinical relevant arrhythmias making medical intervention necessary were identified in 4 cases. In two cases, data interpretation was hampered by sinus tachycardia caused by physical exercise. DISCUSSION Telemonitoring of the heart rhythm by medical devices is beneficial for patients with monogenic heart diseases. Especially, when the indication for an ICD is not clear, implantation of a telemonitored ILR can be a suitable choice. However, rhythm analysis can be challenging in young patients who are physically active.
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Affiliation(s)
- Dominik S Westphal
- Department of Internal Medicine I, Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Munich, Germany.
- Institute of Human Genetics, Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Munich, Germany.
| | - David Federle
- Department of Internal Medicine I, Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Alexander Steger
- Department of Internal Medicine I, Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tanja Vodermeier
- Department of Internal Medicine I, Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Stefanie Scheiper-Welling
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Frankfurt, Germany
- German Red Cross Blood Center, Institute of Transfusion Medicine and Immunohaematology, University Hospital Frankfurt, Frankfurt, Germany
| | - Tina Jenewein
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Frankfurt, Germany
- German Red Cross Blood Center, Institute of Transfusion Medicine and Immunohaematology, University Hospital Frankfurt, Frankfurt, Germany
| | - Britt-Maria Beckmann
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Frankfurt, Germany
| | - Silke Kauferstein
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Frankfurt, Germany
| | - Eimo Martens
- Department of Internal Medicine I, Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Franziska Hahn
- Department of Internal Medicine I, Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Munich, Germany
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6
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Westphal DS, Hauser M, Beckmann BM, Wolf CM, Hessling G, Oberhoffer-Fritz R, Wacker-Gussmann A. Fetal Bradycardia Caused by Monogenic Disorders-A Review of the Literature. J Clin Med 2022; 11:jcm11236880. [PMID: 36498454 PMCID: PMC9741304 DOI: 10.3390/jcm11236880] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/03/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: The standard obstetric definition of fetal bradycardia is a sustained fetal heart rate < 110 bpm over at least 10 min. Fetal bradycardia can be the first and only prenatal presentation of a heart disease. We present an overview on different genetic disorders that should be taken into consideration in case of diagnosed fetal bradycardia. Methods: A literature review was conducted using a PubMed- and OMIM-based search for monogenetic disorders causing fetal bradycardia in September 2022. Results: The review on the literature identified nine monogenic diseases that could lead to fetal bradycardia. Four of these disorders can be associated with extracardiac findings. Discussion: Genetic testing should be considered in cases with fetal bradycardia, especially in cases of additional extracardiac findings. Broad sequencing techniques and improved prenatal phenotyping could help to establish a diagnosis in an increasing number of cases.
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Affiliation(s)
- Dominik S. Westphal
- Department of Internal Medicine I, Klinikum Rechts der Isar, School of Medicine and Health, Technical University Munich, 81675 Munich, Germany
- Institute of Human Genetics, Klinikum Rechts der Isar, School of Medicine and Health, Technical University Munich, 81675 Munich, Germany
- Correspondence:
| | | | - Britt-Maria Beckmann
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, 60596 Frankfurt, Germany
| | - Cordula M. Wolf
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80802 Munich, Germany
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Center Munich, School of Medicine and Health, Technical University Munich, 80636 Munich, Germany
| | - Gabriele Hessling
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Center Munich, School of Medicine and Health, Technical University Munich, 80636 Munich, Germany
| | - Renate Oberhoffer-Fritz
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Center Munich, School of Medicine and Health, Technical University Munich, 80636 Munich, Germany
- Institute of Preventive Pediatrics, TUM Department of Sport and Health Sciences, Technical University Munich, 80992 Munich, Germany
| | - Annette Wacker-Gussmann
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Center Munich, School of Medicine and Health, Technical University Munich, 80636 Munich, Germany
- Institute of Preventive Pediatrics, TUM Department of Sport and Health Sciences, Technical University Munich, 80992 Munich, Germany
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7
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Barc J, Tadros R, Glinge C, Chiang DY, Jouni M, Simonet F, Jurgens SJ, Baudic M, Nicastro M, Potet F, Offerhaus JA, Walsh R, Choi SH, Verkerk AO, Mizusawa Y, Anys S, Minois D, Arnaud M, Duchateau J, Wijeyeratne YD, Muir A, Papadakis M, Castelletti S, Torchio M, Ortuño CG, Lacunza J, Giachino DF, Cerrato N, Martins RP, Campuzano O, Van Dooren S, Thollet A, Kyndt F, Mazzanti A, Clémenty N, Bisson A, Corveleyn A, Stallmeyer B, Dittmann S, Saenen J, Noël A, Honarbakhsh S, Rudic B, Marzak H, Rowe MK, Federspiel C, Le Page S, Placide L, Milhem A, Barajas-Martinez H, Beckmann BM, Krapels IP, Steinfurt J, Winkel BG, Jabbari R, Shoemaker MB, Boukens BJ, Škorić-Milosavljević D, Bikker H, Manevy FC, Lichtner P, Ribasés M, Meitinger T, Müller-Nurasyid M, Veldink JH, van den Berg LH, Van Damme P, Cusi D, Lanzani C, Rigade S, Charpentier E, Baron E, Bonnaud S, Lecointe S, Donnart A, Le Marec H, Chatel S, Karakachoff M, Bézieau S, London B, Tfelt-Hansen J, Roden D, Odening KE, Cerrone M, Chinitz LA, Volders PG, van de Berg MP, Laurent G, Faivre L, Antzelevitch C, Kääb S, Arnaout AA, Dupuis JM, Pasquie JL, Billon O, Roberts JD, Jesel L, Borggrefe M, Lambiase PD, Mansourati J, Loeys B, Leenhardt A, Guicheney P, Maury P, Schulze-Bahr E, Robyns T, Breckpot J, Babuty D, Priori SG, Napolitano C, de Asmundis C, Brugada P, Brugada R, Arbelo E, Brugada J, Mabo P, Behar N, Giustetto C, Molina MS, Gimeno JR, Hasdemir C, Schwartz PJ, Crotti L, McKeown PP, Sharma S, Behr ER, Haissaguerre M, Sacher F, Rooryck C, Tan HL, Remme CA, Postema PG, Delmar M, Ellinor PT, Lubitz SA, Gourraud JB, Tanck MW, George AL, MacRae CA, Burridge PW, Dina C, Probst V, Wilde AA, Schott JJ, Redon R, Bezzina CR. Genome-wide association analyses identify new Brugada syndrome risk loci and highlight a new mechanism of sodium channel regulation in disease susceptibility. Nat Genet 2022; 54:232-239. [PMID: 35210625 DOI: 10.1038/s41588-021-01007-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/13/2021] [Indexed: 12/19/2022]
Abstract
Brugada syndrome (BrS) is a cardiac arrhythmia disorder associated with sudden death in young adults. With the exception of SCN5A, encoding the cardiac sodium channel NaV1.5, susceptibility genes remain largely unknown. Here we performed a genome-wide association meta-analysis comprising 2,820 unrelated cases with BrS and 10,001 controls, and identified 21 association signals at 12 loci (10 new). Single nucleotide polymorphism (SNP)-heritability estimates indicate a strong polygenic influence. Polygenic risk score analyses based on the 21 susceptibility variants demonstrate varying cumulative contribution of common risk alleles among different patient subgroups, as well as genetic associations with cardiac electrical traits and disorders in the general population. The predominance of cardiac transcription factor loci indicates that transcriptional regulation is a key feature of BrS pathogenesis. Furthermore, functional studies conducted on MAPRE2, encoding the microtubule plus-end binding protein EB2, point to microtubule-related trafficking effects on NaV1.5 expression as a new underlying molecular mechanism. Taken together, these findings broaden our understanding of the genetic architecture of BrS and provide new insights into its molecular underpinnings.
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Affiliation(s)
- Julien Barc
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France. .,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, .
| | - Rafik Tadros
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medicine, Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Charlotte Glinge
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - David Y Chiang
- Medicine, Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mariam Jouni
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Floriane Simonet
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Sean J Jurgens
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Manon Baudic
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Michele Nicastro
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Franck Potet
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joost A Offerhaus
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roddy Walsh
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Arie O Verkerk
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Biology, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Yuka Mizusawa
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Soraya Anys
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Damien Minois
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Marine Arnaud
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France.,Université Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Yanushi D Wijeyeratne
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK.,Cardiology Clinical Academic Group, St. George's University Hospitals' NHS Foundation Trust, London, UK
| | - Alison Muir
- Cardiology, Belfast Health and Social Care Trust and Queen's University Belfast, Belfast, UK
| | - Michael Papadakis
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK.,Cardiology Clinical Academic Group, St. George's University Hospitals' NHS Foundation Trust, London, UK
| | - Silvia Castelletti
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Margherita Torchio
- Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy
| | - Cristina Gil Ortuño
- Cardiogenetic, Unidad de Cardiopatías Familiares, Instituto Murciano de Investigación Biosanitaria, Universidad de Murcia, Murcia, Spain
| | - Javier Lacunza
- Cardiology, Unidad de Cardiopatías Familiares, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Daniela F Giachino
- Clinical and Biological Sciences, Medical Genetics, University of Torino, Orbassano, Italy.,Medical Genetics, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Natascia Cerrato
- Medical Sciences, Cardiology, University of Torino, Torino, Italy
| | - Raphaël P Martins
- Cardiologie et Maladies vasculaires, Université Rennes1 - CHU Rennes, Rennes, France
| | - Oscar Campuzano
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain.,Medical Science Department, University of Girona, Girona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Biochemistry and Molecular Genetics Department, Hospital Clinic, University of Barcelona-IDIBAPS, Barcelona, Spain
| | - Sonia Van Dooren
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Centre for Medical Genetics, research group Reproduction and Genetics, research cluster Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Aurélie Thollet
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Florence Kyndt
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Andrea Mazzanti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular Cardiology, ICS Maugeri, IRCCS and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | | | - Anniek Corveleyn
- Department of Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Birgit Stallmeyer
- University Hospital Münster, Institute for Genetics of Heart Diseases (IfGH), Münster, Germany
| | - Sven Dittmann
- University Hospital Münster, Institute for Genetics of Heart Diseases (IfGH), Münster, Germany
| | - Johan Saenen
- Cardiology, Electrophysiology - Cardiogenetics, University of Antwerp/Antwerp University Hospital, Edegem, Belgium
| | - Antoine Noël
- Department of Cardiology, University Hospital of Brest, Brest, France
| | | | - Boris Rudic
- Department 1st of Medicine, Cardiology, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Mannheim, Germany
| | - Halim Marzak
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France
| | - Matthew K Rowe
- Medicine, Cardiology, Western University, London, Ontario, Canada
| | - Claire Federspiel
- Department of Cardiovascular Medicine, Vendée Hospital, Service de Cardiologie, La Roche sur Yon, France
| | | | - Leslie Placide
- Department of Cardiology, CHU Montpellier, Montpellier, France
| | - Antoine Milhem
- Department of Cardiology, CH La Rochelle, La Rochelle, France
| | | | - Britt-Maria Beckmann
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.,University Hospital of the Johann Wolfgang Goethe University Frankfurt, Institute of Legal Medicine, Frankfurt, Germany
| | - Ingrid P Krapels
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johannes Steinfurt
- Department of Cardiology and Angiology I, Heart Center, University Freiburg, Freiburg, Germany
| | - Bo Gregers Winkel
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Reza Jabbari
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Moore B Shoemaker
- Medicine, Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bas J Boukens
- Department of Medical Biology, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Doris Škorić-Milosavljević
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hennie Bikker
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Genome Diagnostics Laboratory, Clinical Genetics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Federico C Manevy
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Lichtner
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Marta Ribasés
- Psychiatric Genetics Unit, Institute Vall d'Hebron Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas Meitinger
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Martina Müller-Nurasyid
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,IBE, LMU Munich, Munich, Germany.,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany.,Department of Internal Medicine I (Cardiology), Hospital of the Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | | | - Jan H Veldink
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philip Van Damme
- Neurology Department University Hospital Leuven, Neuroscience Department KU Leuven, Center for Brain & Disease Research VIB, Leuven, Belgium
| | - Daniele Cusi
- Scientific Unit, Bio4Dreams - Business Nursery for Life Sciences, Milan, Italy
| | - Chiara Lanzani
- Nephrology, Genomics of Renal Diseases and Hypertension Unit, Università Vita Salute San Raffaele, Milan, Italy
| | - Sidwell Rigade
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Eric Charpentier
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,Université de Nantes, CHU Nantes, Inserm, CNRS, SFR Santé, Inserm UMS 016, CNRS UMS 3556, Nantes, France
| | - Estelle Baron
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Stéphanie Bonnaud
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,Université de Nantes, CHU Nantes, Inserm, CNRS, SFR Santé, Inserm UMS 016, CNRS UMS 3556, Nantes, France
| | - Simon Lecointe
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Audrey Donnart
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,Université de Nantes, CHU Nantes, Inserm, CNRS, SFR Santé, Inserm UMS 016, CNRS UMS 3556, Nantes, France
| | - Hervé Le Marec
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Stéphanie Chatel
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Matilde Karakachoff
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Stéphane Bézieau
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Barry London
- Department of Internal Medicine, Division of Cardiovascular Medicine, Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jacob Tfelt-Hansen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dan Roden
- Medicine, Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.,Medicine, Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.,Medicine, Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katja E Odening
- Department of Cardiology and Angiology I, Heart Center, University Freiburg, Freiburg, Germany.,Department of Cardiology, Translational Cardiology, University Hospital Bern, Bern, Switzerland
| | - Marina Cerrone
- Medicine, Leon H. Charney Division of Cardiology, Heart Rhythm Center and Cardiovascular Genetics Program, New York University School of Medicine, New York, NY, USA
| | - Larry A Chinitz
- Medicine, Leon H. Charney Division of Cardiology, Heart Rhythm Center and Cardiovascular Genetics Program, New York University School of Medicine, New York, NY, USA
| | - Paul G Volders
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maarten P van de Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gabriel Laurent
- Cardiology Department, ImVia lab team IFTIM, University Hospital Dijon, Dijon, France
| | | | | | - Stefan Kääb
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partnersite Munich, Munich, Germany
| | | | | | - Jean-Luc Pasquie
- Department of Cardiology, CNRS UMR9214 - Inserm U1046 - PHYMEDEXP, Université de Montpellier et CHU Montpellier, Montpellier, France
| | - Olivier Billon
- Department of Cardiovascular Medicine, Vendée Hospital, Service de Cardiologie, La Roche sur Yon, France
| | - Jason D Roberts
- Medicine, Cardiology, Western University, London, Ontario, Canada
| | - Laurence Jesel
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France.,INSERM 1260 - Regenerative Nanomedecine, University of Strasbourg, Strasbourg, France
| | - Martin Borggrefe
- Department 1st of Medicine, Cardiology, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Mannheim, Germany
| | - Pier D Lambiase
- Cardiology, Medicine, Barts Heart Centre, London, UK.,Institute of Cardiovasculr Science, UCL, Population Health, UCL, London, UK
| | | | - Bart Loeys
- Center for Medical Genetics, Cardiogenetics, University of Antwerp/Antwerp University Hospital, Edegem, Belgium
| | - Antoine Leenhardt
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Cardiology, Hopital Bichat, Paris, France
| | - Pascale Guicheney
- Sorbonne Université, Paris, France.,UMR_S1166, Faculté de médecine, Sorbonne Université, INSERM, Paris, France
| | - Philippe Maury
- Service de cardiologie, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Eric Schulze-Bahr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,University Hospital Münster, Institute for Genetics of Heart Diseases (IfGH), Münster, Germany
| | - Tomas Robyns
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jeroen Breckpot
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Human Genetics, Catholic University Leuven, Leuven, Belgium
| | | | - Silvia G Priori
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular Cardiology, ICS Maugeri, IRCCS and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Carlo Napolitano
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular Cardiology, ICS Maugeri, IRCCS and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Carlo de Asmundis
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis, Brussel-Vrije Universiteit Brussel, ERN Heart Guard Center, Brussels, Belgium.,IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Ramon Brugada
- Hospital Trueta, CiberCV, University of Girona, IDIBGI, Girona, Spain, Barcelona, Spain
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Philippe Mabo
- Cardiologie et Maladies vasculaires, Université Rennes1 - CHU Rennes, Rennes, France
| | - Nathalie Behar
- Cardiologie et Maladies vasculaires, Université Rennes1 - CHU Rennes, Rennes, France
| | - Carla Giustetto
- Medical Sciences, Cardiology, University of Torino, Torino, Italy
| | - Maria Sabater Molina
- Cardiogenetic, Unidad de Cardiopatías Familiares, Instituto Murciano de Investigación Biosanitaria, Universidad de Murcia, Murcia, Spain
| | - Juan R Gimeno
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Cardiology, Unidad de Cardiopatías Familiares, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Bornova, Turkey
| | - Peter J Schwartz
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy
| | - Lia Crotti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Pascal P McKeown
- Cardiology, Belfast Health and Social Care Trust and Queen's University Belfast, Belfast, UK
| | - Sanjay Sharma
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK.,Cardiology Clinical Academic Group, St. George's University Hospitals' NHS Foundation Trust, London, UK
| | - Elijah R Behr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK.,Cardiology Clinical Academic Group, St. George's University Hospitals' NHS Foundation Trust, London, UK
| | - Michel Haissaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France.,Université Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France.,Université Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Caroline Rooryck
- CHU Bordeaux, Service de Génétique Médicale, Bordeaux, France.,Université de Bordeaux, Maladies Rares: Génétique et Métabolisme (MRGM), INSERM U1211, Bordeaux, France
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Carol A Remme
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter G Postema
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mario Delmar
- Medicine, Cardiology, New York University School of Medicine, New York, NY, USA
| | - Patrick T Ellinor
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital and Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Boston, MA, USA
| | - Steven A Lubitz
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital and Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Boston, MA, USA
| | - Jean-Baptiste Gourraud
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
| | - Michael W Tanck
- Clinical Epidemiology, Biostatistics and Bioinformatics, Clinical Methods and Public Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Alfred L George
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Calum A MacRae
- Medicine, Cardiovascular Medicine, Genetics and Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Paul W Burridge
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christian Dina
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Vincent Probst
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
| | - Arthur A Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean-Jacques Schott
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
| | - Richard Redon
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
| | - Connie R Bezzina
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, . .,Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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8
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Scheiper-Welling S, Zuccolini P, Rauh O, Beckmann BM, Geisen C, Moroni A, Thiel G, Kauferstein S. Characterization of an N-terminal Na v1.5 channel variant - a potential risk factor for arrhythmias and sudden death? BMC Med Genet 2020; 21:227. [PMID: 33213388 PMCID: PMC7678220 DOI: 10.1186/s12881-020-01170-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022]
Abstract
Background Alterations in the SCN5A gene encoding the cardiac sodium channel Nav1.5 have been linked to a number of arrhythmia syndromes and diseases including long-QT syndrome (LQTS), Brugada syndrome (BrS) and dilative cardiomyopathy (DCM), which may predispose to fatal arrhythmias and sudden death. We identified the heterozygous variant c.316A > G, p.(Ser106Gly) in a 35-year-old patient with survived cardiac arrest. In the present study, we aimed to investigate the functional impact of the variant to clarify the medical relevance. Methods Mutant as well as wild type GFP tagged Nav1.5 channels were expressed in HEK293 cells. We performed functional characterization experiments using patch-clamp technique. Results Electrophysiological measurements indicated, that the detected missense variant alters Nav1.5 channel functionality leading to a gain-of-function effect. Cells expressing S106G channels show an increase in Nav1.5 current over the entire voltage window. Conclusion The results support the assumption that the detected sequence aberration alters Nav1.5 channel function and may predispose to cardiac arrhythmias and sudden cardiac death. Supplementary Information The online version contains supplementary material available at 10.1186/s12881-020-01170-3.
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Affiliation(s)
- Stefanie Scheiper-Welling
- Institute of Legal Medicine, Goethe University of Frankfurt, Kennedyallee 104, 60596, Frankfurt am Main, Germany
| | - Paolo Zuccolini
- Department of Biology, Membrane Biophysics, Technische Universität Darmstadt, Schnittspahnstrasse 3, 64287, Darmstadt, Germany
| | - Oliver Rauh
- Department of Biology, Membrane Biophysics, Technische Universität Darmstadt, Schnittspahnstrasse 3, 64287, Darmstadt, Germany
| | - Britt-Maria Beckmann
- 1 Institute of Legal Medicine, Goethe University of Frankfurt, Kennedyallee104, 60596, Frankfurt am Main, Germany
| | - Christof Geisen
- German Red Cross Blood Center, Institute of Transfusion Medicine and Immunohaematology, University Hospital Frankfurt, Frankfurt, Germany
| | - Anna Moroni
- Department of Biosciences and CNR IBF-Mi, University of Milano, Via Celoria 26, 20133, Milan, Italy
| | - Gerhard Thiel
- Department of Biology, Membrane Biophysics, Technische Universität Darmstadt, Schnittspahnstrasse 3, 64287, Darmstadt, Germany
| | - Silke Kauferstein
- Institute of Legal Medicine, Goethe University of Frankfurt, Kennedyallee 104, 60596, Frankfurt am Main, Germany.
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9
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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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10
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Scheiper S, Ramos-Luis E, Blanco-Verea A, Niess C, Beckmann BM, Schmidt U, Kettner M, Geisen C, Verhoff MA, Brion M, Kauferstein S. Sudden unexpected death in the young - Value of massive parallel sequencing in postmortem genetic analyses. Forensic Sci Int 2018; 293:70-76. [PMID: 30415094 DOI: 10.1016/j.forsciint.2018.09.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 01/22/2023]
Abstract
Cases of sudden cardiac death (SCD) in young and apparently healthy individuals represent a devastating event in affected families. Hereditary arrhythmia syndromes, which include primary electrical heart disorders as well as cardiomyopathies, are known to contribute to a significant number of these sudden death cases. We performed postmortem genetic analyses in young sudden death cases (aged <45years) by means of a defined gene panel using massive parallel sequencing (MPS). The data were evaluated bioinformatically and detected sequence variants were assessed using common databases and applying in silico prediction tools. In this study, we identified variants with likely pathogenic effect in 6 of 9 sudden unexpected death (SUD) cases. Due to the detection of numerous unknown and unclassified variants, interpretation of the results proved to be challenging. However, by means of an appropriate evaluation of the findings, MPS represents an important tool to support the forensic investigation and implies great progress for relatives of young SCD victims facilitating adequate risk stratification and genetic counseling.
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Affiliation(s)
- Stefanie Scheiper
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt, Germany; German Red Cross Blood Center, Institute of Transfusion Medicine and Immunohaematology, University Hospital Frankfurt, Frankfurt, Germany.
| | - Eva Ramos-Luis
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela (A Coruña), Spain; Medicina Xenómica, Universidade de Santiago de Compostela-Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela (A Coruña), Spain
| | - Alejandro Blanco-Verea
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela (A Coruña), Spain; Medicina Xenómica, Universidade de Santiago de Compostela-Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela (A Coruña), Spain
| | - Constanze Niess
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Britt-Maria Beckmann
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Ulrike Schmidt
- Institute of Legal Medicine, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mattias Kettner
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Christof Geisen
- German Red Cross Blood Center, Institute of Transfusion Medicine and Immunohaematology, University Hospital Frankfurt, Frankfurt, Germany
| | - Marcel A Verhoff
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Maria Brion
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela (A Coruña), Spain; Medicina Xenómica, Universidade de Santiago de Compostela-Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela (A Coruña), Spain
| | - Silke Kauferstein
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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11
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Daunderer J, Ebermann T, Beckmann BM. Bedeutung und Probleme bei der Anwendung des Gendiagnostikgesetzes im klinischen Alltag. Aktuel Kardiol 2018. [DOI: 10.1055/a-0624-1781] [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: 10/28/2022]
Abstract
ZusammenfassungSeit Februar 2010 ist das Gendiagnostikgesetz in Kraft getreten. Das grundsätzlich begrüßenswerte Gesetz bereitet jedoch bei gesetzeskonformer Umsetzung im klinischen Alltag zum Teil erhebliche Probleme. Einige dieser Schwierigkeiten sollen im Folgenden angesprochen werden.
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Affiliation(s)
| | - Thorsten Ebermann
- Geschäftsführer, Bundesverband Niedergelassener Kardiologen e. V., München
| | - Britt-Maria Beckmann
- Medizinische Klinik und Poliklinik I Spezialambulanz für Herzgenetik, familiäre Arrhythmiesyndrome und plötzlichen Herztod, Ludwig-Maximilians-Universität München
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12
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Scheiper S, Hertel B, Beckmann BM, Kääb S, Thiel G, Kauferstein S. Characterization of a novel KCNJ2 sequence variant detected in Andersen-Tawil syndrome patients. BMC Med Genet 2017; 18:113. [PMID: 29017447 PMCID: PMC5634867 DOI: 10.1186/s12881-017-0472-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 09/27/2017] [Indexed: 11/30/2022]
Abstract
Background Mutations in the KCNJ2 gene encoding the ion channel Kir2.1 have been linked to the Andersen-Tawil syndrome (ATS). Molecular genetic screening performed in a family exhibiting clinical ATS phenotypes unmasked a novel sequence variant (c.434A > G, p.Y145C) in this gene. The aim of this study was to investigate the effect of this variant on Kir2.1 ion channel functionality. Methods Mutant as well as wild type GFP tagged Kir2.1 channels were expressed in HEK293 cells. In order to examine the effect of the new variant, electrophysiological measurements were performed using patch clamp technique. Cellular localization of the mutant in comparison to the wild type ion channel was analyzed by confocal laser scanning microscopy. Results The currents of cells expressing only mutant channels or a mixture of wild type and mutant were significantly reduced compared to those expressing wild type (WT) channels (p < 0.01). Whereas WT expressing cells exhibited at −120 mV an averaged current of −4.5 ± 1.9 nA, the mutant generates only a current of −0.17 ± 0.07 nA. A co-expression of mutant and WT channel generates only a partial rescue of the WT current. Confocal laser scanning microscopy indicated that the novel variant is not interfering with synthesis and/or protein trafficking. Conclusions The detected sequence variant causes loss-of-function of the Kir2.1 channel and explains the clinical phenotypes observed in Andersen-Tawil syndrome patients.
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Affiliation(s)
- Stefanie Scheiper
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Kennedyallee 104, D-60596, Frankfurt, Germany.
| | - Brigitte Hertel
- Plant Membrane Biophysics, Technical University Darmstadt, Darmstadt, Germany
| | - Britt-Maria Beckmann
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Gerhard Thiel
- Plant Membrane Biophysics, Technical University Darmstadt, Darmstadt, Germany
| | - Silke Kauferstein
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Kennedyallee 104, D-60596, Frankfurt, Germany
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13
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Kauferstein S, Herz N, Scheiper S, Biel S, Jenewein T, Kunis M, Erkapic D, Beckmann BM, Neumann T. Relevance of molecular testing in patients with a family history of sudden death. Forensic Sci Int 2017; 276:18-23. [PMID: 28472724 DOI: 10.1016/j.forsciint.2017.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/23/2017] [Accepted: 04/04/2017] [Indexed: 12/19/2022]
Abstract
Sudden cardiac death (SCD) is a major cause of death in industrial countries. Although SCD occurs mainly in adults, it may also affect young persons, where genetic cardiac disorders comprise at least half of these cases. This includes primary arrhythmogenic disorders such as long QT syndrome and inherited cardiomyopathies. However, in many cases, postmortem examinations provide no conclusive results explaining the cause of death. Since family members of the deceased may eventually have inherited the same disease, they are at risk of SCD. In the present study, 28 patients with a family history of sudden unexplained death (SUD), of survived cardiac arrest and with a clinical diagnosis of an inherited cardiac disease were screened using phenotype-guided molecular analysis of genes associated with arrhythmogenic cardiac diseases. In 64% of the cases, gene variants with potentially pathogenic cardiac effects were detected suggesting that an arrhythmia syndrome may have caused the death of the deceased family member. Therefore, we recommend that relatives of SUD victims should undergo extended cardiac examination and, depending on the clinical diagnosis, a targeted genetic analysis should follow, which is crucial to identify family members at risk.
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Affiliation(s)
- Silke Kauferstein
- Institute of Legal Medicine, University of Frankfurt, Kennedyallee 104, 60596 Frankfurt/Main, Germany.
| | - Nadine Herz
- Institute of Legal Medicine, University of Frankfurt, Kennedyallee 104, 60596 Frankfurt/Main, Germany; Bundeskriminalamt, D-65173 Wiesbaden, Germany
| | - Stefanie Scheiper
- Institute of Legal Medicine, University of Frankfurt, Kennedyallee 104, 60596 Frankfurt/Main, Germany
| | - Stephanie Biel
- Institute of Legal Medicine, University of Frankfurt, Kennedyallee 104, 60596 Frankfurt/Main, Germany
| | - Tina Jenewein
- Institute of Legal Medicine, University of Frankfurt, Kennedyallee 104, 60596 Frankfurt/Main, Germany
| | - Malte Kunis
- Kerckhoff Heart and Thorax Center, Benekestraße 2, 61231 Bad Nauheim, Germany
| | - Damir Erkapic
- Kerckhoff Heart and Thorax Center, Benekestraße 2, 61231 Bad Nauheim, Germany; Medical Clinic I, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Britt-Maria Beckmann
- Medical Clinic I, Hospital Grosshadern, Ludwig-Maximilians University, München, Germany
| | - Thomas Neumann
- Kerckhoff Heart and Thorax Center, Benekestraße 2, 61231 Bad Nauheim, Germany
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14
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Jenewein T, Beckmann BM, Rose S, Osterhues HH, Schmidt U, Wolpert C, Miny P, Marschall C, Alders M, Bezzina CR, Wilde AAM, Kääb S, Kauferstein S. Genotype-phenotype dilemma in a case of sudden cardiac death with the E1053K mutation and a deletion in the SCN5A gene. Forensic Sci Int 2017; 275:187-194. [PMID: 28391114 DOI: 10.1016/j.forsciint.2017.02.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/13/2017] [Accepted: 02/23/2017] [Indexed: 12/19/2022]
Abstract
Mutations in the cardiac sodium channel gene SCN5A may result in various arrhythmia syndromes such as long QT syndrome type 3 (LQTS), Brugada syndrome (BrS), sick sinus syndrome (SSS), cardiac conduction diseases (CCD) and possibly dilated cardiomyopathy (DCM). In most of these inherited cardiac arrhythmia syndromes the phenotypical expression may range from asymptomatic phenotypes to sudden cardiac death (SCD). A 16-year-old female died during sleep. Autopsy did not reveal any explanation for her death and a genetic analysis was performed. A variant in the SCN5A gene (E1053K) that was previously described as disease causing was detected. Family members are carriers of the same E1053K variant, some even in a homozygous state, but surprisingly did not exhibit any pathological cardiac phenotype. Due to the lack of genotype-phenotype correlation further genetic studies were performed. A novel deletion in the promoter region of SCN5A was identified in the sudden death victim but was absent in other family members. These findings demonstrate the difficulties in interpreting the results of a family-based genetic screening and underline the phenotypic variability of SCN5A mutations.
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Affiliation(s)
- T Jenewein
- Institute of Legal Medicine, University of Frankfurt, Frankfurt am Main, Germany
| | - B M Beckmann
- University Hospital Munich, Department of Medicine I, Ludwig Maximilians University, Munich, Germany; German Cardiovascular Research Center (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany
| | - S Rose
- Institute of Legal Medicine, University of Frankfurt, Frankfurt am Main, Germany
| | - H H Osterhues
- District Hospital Loerrach, Medical Clinic, Loerrach, Germany
| | - U Schmidt
- Institute of Legal Medicine, University Hospital of Freiburg, Freiburg, Germany
| | - C Wolpert
- Klinik für Innere Medizin, Cardiology Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - P Miny
- Medical Genetics, University Hospital Basel, Basel, Switzerland
| | - C Marschall
- Center of Human Genetics and Laboratory Diagnostics, Martinsried, Germany
| | - M Alders
- Department of Clinical Genetics, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - C R Bezzina
- Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A A M Wilde
- Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
| | - S Kääb
- University Hospital Munich, Department of Medicine I, Ludwig Maximilians University, Munich, Germany; German Cardiovascular Research Center (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany
| | - S Kauferstein
- Institute of Legal Medicine, University of Frankfurt, Frankfurt am Main, Germany.
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15
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Ortiz-Bonnin B, Rinné S, Moss R, Streit AK, Scharf M, Richter K, Stöber A, Pfeufer A, Seemann G, Kääb S, Beckmann BM, Decher N. Electrophysiological characterization of a large set of novel variants in the SCN5A-gene: identification of novel LQTS3 and BrS mutations. Pflugers Arch 2016; 468:1375-87. [PMID: 27287068 DOI: 10.1007/s00424-016-1844-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/16/2016] [Accepted: 05/29/2016] [Indexed: 01/08/2023]
Abstract
SCN5A encodes for the α-subunit of the cardiac voltage-gated sodium channel Nav1.5. Gain-of-function mutations in SCN5A are related to congenital long QT syndrome (LQTS3) characterized by delayed cardiac repolarization, leading to a prolonged QT interval in the ECG. Loss-of-function mutations in SCN5A are related to Brugada syndrome (BrS), characterized by an ST-segment elevation in the right precordial leads (V1-V3). The aim of this study was the characterization of a large set of novel SCN5A variants found in patients with different cardiac phenotypes, mainly LQTS and BrS. SCN5A variants of 13 families were functionally characterized in Xenopus laevis oocytes using the two-electrode voltage-clamp technique. We found in most of the cases, but not all, that the electrophysiology of the variants correlated with the clinically diagnosed phenotype. A susceptibility to develop LQTS can be suggested in patients carrying the variants S216L, K480N, A572D, F816Y, and G983D. However, taking the phenotype into account, the presence of the variants in genomic data bases, the mutational segregation, combined with our in vitro and in silico experiments, the variants S216L, S262G, K480N, A572D, F816Y, G983D, and T1526P remain as variants of unknown significance. However, the SCN5A variants R568H and A993T can be classified as pathogenic LQTS3 causing mutations, while R222stop and R2012H are novel BrS causing mutations.
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Affiliation(s)
- Beatriz Ortiz-Bonnin
- Institute of Physiology and Pathophysiology, Vegetative Physiology, Philipps-University of Marburg, Deutschhausstraße 1-2, 35037, Marburg, Germany
| | - Susanne Rinné
- Institute of Physiology and Pathophysiology, Vegetative Physiology, Philipps-University of Marburg, Deutschhausstraße 1-2, 35037, Marburg, Germany
| | - Robin Moss
- Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg - Bad Krozingen, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anne K Streit
- Institute of Physiology and Pathophysiology, Vegetative Physiology, Philipps-University of Marburg, Deutschhausstraße 1-2, 35037, Marburg, Germany
| | - Michael Scharf
- Institute of Physiology and Pathophysiology, Vegetative Physiology, Philipps-University of Marburg, Deutschhausstraße 1-2, 35037, Marburg, Germany
| | - Katrin Richter
- Institute of Physiology and Pathophysiology, Vegetative Physiology, Philipps-University of Marburg, Deutschhausstraße 1-2, 35037, Marburg, Germany
| | - Anika Stöber
- Institute of Physiology and Pathophysiology, Vegetative Physiology, Philipps-University of Marburg, Deutschhausstraße 1-2, 35037, Marburg, Germany
| | - Arne Pfeufer
- Helmholtz Zentrum München GmbH, Deutsches Forschungszentrum für Gesundheit und Umwelt, Institut für Humangenetik, Oberschleißheim, Germany
| | - Gunnar Seemann
- Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg - Bad Krozingen, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Kääb
- Department of Medicine, University Hospital of the Ludwig Maximilians University-Campus Innenstadt and Großhadern, Munich, Germany
| | - Britt-Maria Beckmann
- Department of Medicine, University Hospital of the Ludwig Maximilians University-Campus Innenstadt and Großhadern, Munich, Germany
| | - Niels Decher
- Institute of Physiology and Pathophysiology, Vegetative Physiology, Philipps-University of Marburg, Deutschhausstraße 1-2, 35037, Marburg, Germany.
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Siebermair J, Sinner MF, Beckmann BM, Laubender RP, Martens E, Sattler S, Fichtner S, Estner HL, Kääb S, Wakili R. Early repolarization pattern is the strongest predictor of arrhythmia recurrence in patients with idiopathic ventricular fibrillation: results from a single centre long-term follow-up over 20 years. Europace 2016; 18:718-25. [DOI: 10.1093/europace/euv301] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/10/2015] [Indexed: 11/14/2022] Open
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Tülümen E, Schulze-Bahr E, Zumhagen S, Stallmeyer B, Seebohm G, Beckmann BM, Kääb S, Rudic B, Liebe V, Wolpert C, Herrera-Siklody C, Veltmann C, Schimpf R, Borggrefe M. Early repolarization pattern: a marker of increased risk in patients with catecholaminergic polymorphic ventricular tachycardia. Europace 2015; 18:1587-1592. [DOI: 10.1093/europace/euv357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 09/28/2015] [Indexed: 11/13/2022] Open
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Reithmann C, Beckmann BM, Kääb S. Purkinje-related ventricular fibrillation associated with a homozygous H558R polymorphism in the sodium channel SCN5A gene. Europace 2015; 18:896. [PMID: 26084969 DOI: 10.1093/europace/euv134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christopher Reithmann
- Medizinische Klinik I, Helios Klinikum München-West, Akademisches Lehrkrankenhaus der Universität München, Steinerweg 5, 81241 München, Germany;
| | - Britt-Maria Beckmann
- Medizinische Klinik I, Klinikum Grosshadern, Ludwig-Maximilians Universität München, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Stefan Kääb
- Medizinische Klinik I, Klinikum Grosshadern, Ludwig-Maximilians Universität München, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Makita N, Yagihara N, Crotti L, Johnson CN, Beckmann BM, Roh MS, Shigemizu D, Lichtner P, Ishikawa T, Aiba T, Homfray T, Behr ER, Klug D, Denjoy I, Mastantuono E, Theisen D, Tsunoda T, Satake W, Toda T, Nakagawa H, Tsuji Y, Tsuchiya T, Yamamoto H, Miyamoto Y, Endo N, Kimura A, Ozaki K, Motomura H, Suda K, Tanaka T, Schwartz PJ, Meitinger T, Kääb S, Guicheney P, Shimizu W, Bhuiyan ZA, Watanabe H, Chazin WJ, George AL. Novel calmodulin mutations associated with congenital arrhythmia susceptibility. ACTA ACUST UNITED AC 2014; 7:466-74. [PMID: 24917665 DOI: 10.1161/circgenetics.113.000459] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Genetic predisposition to life-threatening cardiac arrhythmias such as congenital long-QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT) represent treatable causes of sudden cardiac death in young adults and children. Recently, mutations in calmodulin (CALM1, CALM2) have been associated with severe forms of LQTS and CPVT, with life-threatening arrhythmias occurring very early in life. Additional mutation-positive cases are needed to discern genotype-phenotype correlations associated with calmodulin mutations. METHODS AND RESULTS We used conventional and next-generation sequencing approaches, including exome analysis, in genotype-negative LQTS probands. We identified 5 novel de novo missense mutations in CALM2 in 3 subjects with LQTS (p.N98S, p.N98I, p.D134H) and 2 subjects with clinical features of both LQTS and CPVT (p.D132E, p.Q136P). Age of onset of major symptoms (syncope or cardiac arrest) ranged from 1 to 9 years. Three of 5 probands had cardiac arrest and 1 of these subjects did not survive. The clinical severity among subjects in this series was generally less than that originally reported for CALM1 and CALM2 associated with recurrent cardiac arrest during infancy. Four of 5 probands responded to β-blocker therapy, whereas 1 subject with mutation p.Q136P died suddenly during exertion despite this treatment. Mutations affect conserved residues located within Ca(2+)-binding loops III (p.N98S, p.N98I) or IV (p.D132E, p.D134H, p.Q136P) and caused reduced Ca(2+)-binding affinity. CONCLUSIONS CALM2 mutations can be associated with LQTS and with overlapping features of LQTS and CPVT.
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Schwarz F, Schwab F, Beckmann BM, Schuessler F, Zinsser D, Gölz T, Kääb S, Reiser MF, Theisen D. [Magnetic resonance imaging of hypertrophic cardiomyopathy : evaluation of diastolic function]. Radiologe 2013; 53:15-23. [PMID: 23338245 DOI: 10.1007/s00117-012-2381-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) has a prevalence of approximately 0.2% and is clinically asymptomatic in many patients or presents with unspecific symptoms. This explains the importance of imaging for the diagnosis of HCM as well as for the assessment of the clinical course. The definitive finding in HCM is myocardial hypertrophy with thickening of the ventricular wall ≥ 15 mm. While echocardiography is an excellent screening tool magnetic resonance imaging (MRI) allows a comprehensive analysis of the heart in HCM. This includes a detailed analysis of the distribution and extent of myocardial hypertrophy, a thorough evaluation of systolic and diastolic cardiac function, the assessment of the presence and extent of dynamic outflow tract obstruction as well as the description of the systolic anterior motion (SAM) phenomenon of the mitral valve with secondary mitral insufficiency. When contrast material is administered, additional information about myocardial perfusion as well as the presence and extent of myocardial fibrosis can be obtained. This study compared systolic functional parameters as well as end systolic and end diastolic wall thickness of patients with and without diastolic dysfunction.
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Affiliation(s)
- F Schwarz
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Deutschland.
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Affiliation(s)
- Britt-Maria Beckmann
- Department of Medicine 1, University Hospital of the Ludwig Maximilians University-Campus Grosshadern, Munich, Germany
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Crotti L, Johnson CN, Graf E, De Ferrari GM, Cuneo BF, Ovadia M, Papagiannis J, Feldkamp MD, Rathi SG, Kunic JD, Pedrazzini M, Wieland T, Lichtner P, Beckmann BM, Clark T, Shaffer C, Benson DW, Kääb S, Meitinger T, Strom TM, Chazin WJ, Schwartz PJ, George AL. Calmodulin mutations associated with recurrent cardiac arrest in infants. Circulation 2013; 127:1009-17. [PMID: 23388215 DOI: 10.1161/circulationaha.112.001216] [Citation(s) in RCA: 271] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Life-threatening disorders of heart rhythm may arise during infancy and can result in the sudden and tragic death of a child. We performed exome sequencing on 2 unrelated infants presenting with recurrent cardiac arrest to discover a genetic cause. METHODS AND RESULTS We ascertained 2 unrelated infants (probands) with recurrent cardiac arrest and dramatically prolonged QTc interval who were both born to healthy parents. The 2 parent-child trios were investigated with the use of exome sequencing to search for de novo genetic variants. We then performed follow-up candidate gene screening on an independent cohort of 82 subjects with congenital long-QT syndrome without an identified genetic cause. Biochemical studies were performed to determine the functional consequences of mutations discovered in 2 genes encoding calmodulin. We discovered 3 heterozygous de novo mutations in either CALM1 or CALM2, 2 of the 3 human genes encoding calmodulin, in the 2 probands and in 2 additional subjects with recurrent cardiac arrest. All mutation carriers were infants who exhibited life-threatening ventricular arrhythmias combined variably with epilepsy and delayed neurodevelopment. Mutations altered residues in or adjacent to critical calcium binding loops in the calmodulin carboxyl-terminal domain. Recombinant mutant calmodulins exhibited several-fold reductions in calcium binding affinity. CONCLUSIONS Human calmodulin mutations disrupt calcium ion binding to the protein and are associated with a life-threatening condition in early infancy. Defects in calmodulin function will disrupt important calcium signaling events in heart, affecting membrane ion channels, a plausible molecular mechanism for potentially deadly disturbances in heart rhythm during infancy.
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Affiliation(s)
- Lia Crotti
- Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy
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Beckmann BM, Kääb S. [Genetic testing in hereditary arrythmia syndromes today and in the future]. Herzschrittmacherther Elektrophysiol 2012; 23:161-166. [PMID: 22993117 DOI: 10.1007/s00399-012-0230-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 07/16/2012] [Accepted: 07/20/2012] [Indexed: 06/01/2023]
Abstract
Genetic testing already has a substantial impact in identifying hereditary arrhythmia syndromes after sudden death in young patients. This report provides information on current developments, available options and reasonable approaches in the clinical setting. In addition the limitations of genetic testing are discussed. Genetic testing is only useful for patients in the context of clinical findings interpreted by an experienced cardiogenetics team.
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Affiliation(s)
- Britt-Maria Beckmann
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, D-81377, München, Germany.
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Kääb S, Crawford DC, Sinner MF, Behr ER, Kannankeril PJ, Wilde AAM, Bezzina CR, Schulze-Bahr E, Guicheney P, Bishopric NH, Myerburg RJ, Schott JJ, Pfeufer A, Beckmann BM, Martens E, Zhang T, Stallmeyer B, Zumhagen S, Denjoy I, Bardai A, Van Gelder IC, Jamshidi Y, Dalageorgou C, Marshall V, Jeffery S, Shakir S, Camm AJ, Steinbeck G, Perz S, Lichtner P, Meitinger T, Peters A, Wichmann HE, Ingram C, Bradford Y, Carter S, Norris K, Ritchie MD, George AL, Roden DM. A large candidate gene survey identifies the KCNE1 D85N polymorphism as a possible modulator of drug-induced torsades de pointes. ACTA ACUST UNITED AC 2011; 5:91-9. [PMID: 22100668 DOI: 10.1161/circgenetics.111.960930] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Drug-induced long-QT syndrome (diLQTS) is an adverse drug effect that has an important impact on drug use, development, and regulation. We tested the hypothesis that common variants in key genes controlling cardiac electric properties modify the risk of diLQTS. METHODS AND RESULTS In a case-control setting, we included 176 patients of European descent from North America and Europe with diLQTS, defined as documented torsades de pointes during treatment with a QT-prolonging drug. Control samples were obtained from 207 patients of European ancestry who displayed <50 ms QT lengthening during initiation of therapy with a QT-prolonging drug and 837 control subjects from the population-based KORA study. Subjects were successfully genotyped at 1424 single-nucleotide polymorphisms (SNPs) in 18 candidate genes including 1386 SNPs tagging common haplotype blocks and 38 nonsynonymous ion channel gene SNPs. For validation, we used a set of cases (n=57) and population-based control subjects of European descent. The SNP KCNE1 D85N (rs1805128), known to modulate an important potassium current in the heart, predicted diLQTS with an odds ratio of 9.0 (95% confidence interval, 3.5-22.9). The variant allele was present in 8.6% of cases, 2.9% of drug-exposed control subjects, and 1.8% of population control subjects. In the validation cohort, the variant allele was present in 3.5% of cases and in 1.4% of control subjects. CONCLUSIONS This high-density candidate SNP approach identified a key potassium channel susceptibility allele that may be associated with the rare adverse drug reaction torsades de pointes.
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Affiliation(s)
- Stefan Kääb
- Department of Medicine I, University Hospital Munich, Campus Grosshadern, Ludwig-Maximilians University, Munich, Germany
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Beckmann BM, Pfeufer A, Kääb S. Inherited cardiac arrhythmias: diagnosis, treatment, and prevention. Dtsch Arztebl Int 2011; 108:623-33; quiz 634. [PMID: 21977220 DOI: 10.3238/arztebl.2011.0623] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 07/04/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND The incidence of sudden cardiac death in persons under age 40 is roughly 3 per 100 000 persons per year in Germany and North America. Many of these deaths are found to be due to hereditary heart diseases, often a primary structural heart disease associated with arrhythmia or else a primary arrhythmia syndrome in a structurally normal heart. Such diseases are usually of autosomal dominant inheritance, often affect otherwise healthy persons, and can generally be well treated if recognized early. Patients commonly have affected relatives who are still asymptomatic. METHODS This review is based on articles up to May 2010 that were retrieved by a selective search of the Medline database via PubMed, with additional consideration of the relevant European and American guidelines and the German Law on Genetic Diagnosis. RESULTS AND CONCLUSION Hereditary arrhythmia syndromes are now found in more than half of all initially unexplained cases of sudden cardiac death in young persons. Among such cases, the hereditary arrhythmia syndrome is primary in 70% and caused by an arrhythmogenic structural heart disease in 30%. In addition to autopsy findings, a thorough family history, relevant medical findings obtained during life (if available), the examination of relatives, and directed molecular testing where appropiate enabled establishing the diagnosis. Arrthymia syndromes that can cause sudden death are often detectable during life if physicians and the public are appropriately sensitized.
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Sinner MF, Reinhard W, Müller M, Beckmann BM, Martens E, Perz S, Pfeufer A, Winogradow J, Stark K, Meisinger C, Wichmann HE, Peters A, Riegger GAJ, Steinbeck G, Hengstenberg C, Kääb S. Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study (MONICA/KORA). PLoS Med 2010; 7:e1000314. [PMID: 20668657 PMCID: PMC2910598 DOI: 10.1371/journal.pmed.1000314] [Citation(s) in RCA: 222] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 06/16/2010] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early repolarization pattern (ERP) on electrocardiogram was associated with idiopathic ventricular fibrillation and sudden cardiac arrest in a case-control study and with cardiovascular mortality in a Finnish community-based sample. We sought to determine ERP prevalence and its association with cardiac and all-cause mortality in a large, prospective, population-based case-cohort study (Monitoring of Cardiovascular Diseases and Conditions [MONICA]/KORA [Cooperative Health Research in the Region of Augsburg]) comprised of individuals of Central-European descent. METHODS AND FINDINGS Electrocardiograms of 1,945 participants aged 35-74 y, representing a source population of 6,213 individuals, were analyzed applying a case-cohort design. Mean follow-up was 18.9 y. Cause of death was ascertained by the 9th revision of the International Classification of Disease (ICD-9) codes as documented in death certificates. ERP-attributable effects on mortality were determined by a weighted Cox proportional hazard model adjusted for covariables. Prevalence of ERP was 13.1% in our study. ERP was associated with cardiac and all-cause mortality, most pronounced in those of younger age and male sex; a clear ERP-age interaction was detected (p = 0.005). Age-stratified analyses showed hazard ratios (HRs) for cardiac mortality of 1.96 (95% confidence interval [CI] 1.05-3.68, p = 0.035) for both sexes and 2.65 (95% CI 1.21-5.83, p = 0.015) for men between 35-54 y. An inferior localization of ERP further increased ERP-attributable cardiac mortality to HRs of 3.15 (95% CI 1.58-6.28, p = 0.001) for both sexes and to 4.27 (95% CI 1.90-9.61, p<0.001) for men between 35-54 y. HRs for all-cause mortality were weaker but reached significance. CONCLUSIONS We found a high prevalence of ERP in our population-based cohort of middle-aged individuals. ERP was associated with about a 2- to 4-fold increased risk of cardiac mortality in individuals between 35 and 54 y. An inferior localization of ERP was associated with a particularly increased risk. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Moritz F. Sinner
- University Hospital Munich, Campus Grosshadern, Medical Department I, Ludwig-Maximilians University Munich, Munich, Germany
| | - Wibke Reinhard
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Martina Müller
- University Hospital Munich, Campus Grosshadern, Medical Department I, Ludwig-Maximilians University Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Britt-Maria Beckmann
- University Hospital Munich, Campus Grosshadern, Medical Department I, Ludwig-Maximilians University Munich, Munich, Germany
| | - Eimo Martens
- University Hospital Munich, Campus Grosshadern, Medical Department I, Ludwig-Maximilians University Munich, Munich, Germany
| | - Siegfried Perz
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Arne Pfeufer
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Human Genetics, Technical University Munich, Munich, Germany
| | - Janina Winogradow
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Klaus Stark
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Christa Meisinger
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - H.-Erich Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
- Klinikum Grosshadern, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Günter A. J. Riegger
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Gerhard Steinbeck
- University Hospital Munich, Campus Grosshadern, Medical Department I, Ludwig-Maximilians University Munich, Munich, Germany
| | - Christian Hengstenberg
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Stefan Kääb
- University Hospital Munich, Campus Grosshadern, Medical Department I, Ludwig-Maximilians University Munich, Munich, Germany
- * E-mail:
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Hinterseer M, Beckmann BM, Thomsen MB, Pfeufer A, Ulbrich M, Sinner MF, Perz S, Wichmann HE, Lengyel C, Schimpf R, Maier SK, Varró A, Vos MA, Steinbeck G, Kääb S. Usefulness of short-term variability of QT intervals as a predictor for electrical remodeling and proarrhythmia in patients with nonischemic heart failure. Am J Cardiol 2010; 106:216-20. [PMID: 20599006 DOI: 10.1016/j.amjcard.2010.02.033] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 02/24/2010] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
Abstract
The high incidence of sudden cardiac death in heart failure (HF) reflects electrophysiologic changes in response to myocardial failure. We previously showed that short-term variability of QT intervals (STV(QT)) identifies latent repolarization disorders in patients with drug-induced or congenital long QT syndrome. This study sought to determine (1) if STV(QT) is increased in patients with dilated cardiomyopathy (DC) and moderate congestive HF and (2) if increased STV(QT) is associated with ventricular arrhythmia in patients with HF. Sixty patients (53 +/- 12 years of age, 14 women) with DC and moderate HF (New York Heart Association classes II to III) were compared to matched controls. Twenty patients had implantable cardiac defibrillators secondary to a history of ventricular tachycardia (VT). Two cardiologists blinded to diagnosis manually measured QT intervals. Beat-to-beat variability of repolarization was determined from Poincaré plots of 30 consecutive QT intervals as was STV(QT). QTc intervals were comparable in patients and controls (419 +/- 36 vs 415 +/- 32 ms, respectively, p >0.05), whereas STV(QT) was significantly higher in patients with HF (7.8 +/- 3 vs 4.1 +/- 2 ms, respectively, p <0.05). STV(QT) was more increased in patients with a history of VT compared to those without VT (10.1 +/- 2 vs 6.6 +/- 2 ms, respectively, p <0.05). Increased STV(QT) and decreased ejection fraction were associated with a history of VT; however, STV(QT) was the strongest indicator. In conclusion, the present study demonstrates for the first time that STV(QT) is increased in patients with DC with HF. Patients with DC and HF and implantable cardiac defibrillators for secondary prevention had the highest STV(QT). Thus, increased STV(QT) in the context of moderate HF may reflect a latent repolarization disorder and increased susceptibility to sudden death in patients with DC, which is not identified by a prolonged QT interval.
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Hinterseer M, Beckmann BM, Thomsen MB, Pfeufer A, Dalla Pozza R, Loeff M, Netz H, Steinbeck G, Vos MA, Kääb S. Relation of increased short-term variability of QT interval to congenital long-QT syndrome. Am J Cardiol 2009; 103:1244-8. [PMID: 19406266 DOI: 10.1016/j.amjcard.2009.01.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Revised: 01/13/2009] [Accepted: 01/13/2009] [Indexed: 10/21/2022]
Abstract
Apart from clinical symptoms the diagnosis and risk stratification in long-QT syndrome (LQTS) is usually based on the surface electrocardiogram. Studies have indicated that not only prolongation of the QT interval but also an increased short-term variability of QT interval (STV(QT)) is a marker for a decreased repolarization reserve in patients with drug-induced LQTS. The aims of this study were to determine if STV(QT) (1) is higher in patients with LQTS compared with controls, (2) if this effect is more pronounced in a high-risk LQTS population, and (3) could increase the diagnostic power of the surface electrocardiogram in identifying mutation carriers. Forty mutation carriers were compared with age- and gender-matched control subjects in the absence of beta-receptor-blocking agents. Lead II or V(5) RR and QT intervals from 30 consecutive beats were manually measured. STV(QT) was determined from Poincaré plots of QT intervals (STV(QT) = Sigma|QTn + 1 - QTn|/[30 x radical2]). Compared with controls, patients with LQTS had a prolonged QTc interval (449 +/- 41 vs 411 +/- 32 ms, p = 0.00049) and increased STV(QT) (6.4 +/- 3.2 vs 4.1 +/- 1.6 ms, p = 0.005). In patients with the highest risk of clinical events, defined as a QTc interval >500 ms or symptoms before beta-blocker therapy, STV(QT) was 9 +/- 4 ms. QTc interval had a sensitivity of 43% and a specificity of 97% in identifying mutation carriers (thresholds 450 ms for men and 460 ms for women). Receiver operator characteristic analysis showed that an STV(QT) of 4.9 ms was the optimal cut-off value to predict mutation carriers. When incorporating an STV(QT) >4.9 ms for those whose QTc interval was within the normal limits, sensitivity to distinguish mutation carriers increased to 83% with a specificity of 68%, so that another 15 mutation carriers could be identified. In conclusion, these are the first results in humans showing that STV(QT) is increased in congenital LQTS, this effect is increased in patients with symptoms before therapy, and, hence, STV(QT) could prove to be a useful noninvasive additive marker for diagnostic screening to bridge the gap before results of genetic testing are available.
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Zellerhoff S, Pistulli R, Mönnig G, Hinterseer M, Beckmann BM, Köbe J, Steinbeck G, Kääb S, Haverkamp W, Fabritz L, Gradaus R, Breithardt G, Schulze-Bahr E, Böcker D, Kirchhof P. Atrial Arrhythmias in long-QT syndrome under daily life conditions: a nested case control study. J Cardiovasc Electrophysiol 2008; 20:401-7. [PMID: 19017345 DOI: 10.1111/j.1540-8167.2008.01339.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The long-QT syndromes (LQTS) are inherited electrical cardiomyopathies characterized by prolonged ventricular repolarization and ventricular arrhythmias. Several genetic reports have associated defects in LQTS-causing genes with atrial fibrillation (AF). We therefore studied whether atrial arrhythmias occur in patients with LQTS under daily-life conditions. METHODS We systematically assessed atrial arrhythmias in LQTS patients and matched controls using implanted defibrillators or pacemakers as monitors of atrial rhythm in a nested case-control study. Twenty-one LQTS patients (3 male; 39 +/- 18 years old; 18 on beta blocker, ICD therapy duration 6.3 +/- 2.7 years; 4 LQT1, 6 LQT2, 2 LQT3) were matched to 21 control subjects (13 male; 50 +/- 19 years old; 3 on beta blocker; pacemaker therapy duration 8.5 +/- 5.5 years; 19 higher-degree AV block, 2 others). LQTS patients were identified by a systematic search of the LQTS patient databases in Münster and Munich. RESULTS One-third (7 of 21) of the LQTS patients developed self-terminating atrial arrhythmias (atrial cycle lengths <250 ms). Only one control patient developed a single episode of postoperative AF (P < 0.05 vs LQTS). CONCLUSIONS LQTS patients at high risk for ventricular arrhythmias may develop short-lasting atrial arrhythmias under daily-life conditions, suggesting that prolonged atrial repolarization may contribute to the initiation of AF.
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Affiliation(s)
- Stephan Zellerhoff
- Department of Cardiology and Angiology, Hospital of the University of Münster, Germany
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Sinner MF, Pfeufer A, Akyol M, Beckmann BM, Hinterseer M, Wacker A, Perz S, Sauter W, Illig T, Näbauer M, Schmitt C, Wichmann HE, Schömig A, Steinbeck G, Meitinger T, Kääb S. The non-synonymous coding IKr-channel variant KCNH2-K897T is associated with atrial fibrillation: results from a systematic candidate gene-based analysis of KCNH2 (HERG). Eur Heart J 2008; 29:907-14. [PMID: 18222980 DOI: 10.1093/eurheartj/ehm619] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS Atrial fibrillation (AF) is the most frequent arrhythmia in humans. Rare familial forms exist. Recent evidence indicates a genetic susceptibility to common forms of AF. The alpha-subunit of the myocardial I(Kr)-channel, encoded by the KCNH2 gene, is crucial to ventricular and atrial repolarization. Patients with mutations in KCNH2 present with higher incidence of AF. Common variants in KCNH2 have been shown to modify ventricular repolarization. We intended to investigate, whether such variants may also modulate atrial repolarization and predispose to AF. METHODS AND RESULTS In a two-stage association study we analysed 1207 AF-cases and 2475 controls. In stage I 40 tagSNPs (single nucleotide polymorphisms) from the KCNH2 genomic region were genotyped in 671 AF-cases and 694 controls. Of five associated variants, the common K897-allele of the KCNH2-K897T variant was replicated in n = 536 independent AF cases and n = 1781 controls in stage II [overall odds ratio 1.25, 95% confidence interval 1.11-1.41, P = 0.00033]. This association remained significant after adjustment for gender and age. CONCLUSION We report a genetic association finding including positive replication between the K897-allele and higher incidence of AF. This provides a molecular correlate for complex genetic predispositions to AF. The consequences of the K897T variant at the atrial level will require further functional investigations.
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Affiliation(s)
- Moritz F Sinner
- Department of Medicine I, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Marchioninistr. 15, Munich D-81377, Germany
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Hofman N, Wilde AAM, Kääb S, van Langen IM, Tanck MWT, Mannens MMAM, Hinterseer M, Beckmann BM, Tan HL. Diagnostic criteria for congenital long QT syndrome in the era of molecular genetics: do we need a scoring system? Eur Heart J 2006; 28:575-80. [PMID: 17090615 DOI: 10.1093/eurheartj/ehl355] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Previously published diagnostic systems, based on ECG analysis and clinical parameters (Schwartz criteria and Keating criteria), have been used to estimate the probability of inherited long QT syndrome (LQTS). Nowadays, a certain diagnosis can often be made by DNA testing. We aimed to establish the predictive power of the Schwartz and Keating criteria, using DNA testing as a reference, and to determine the best diagnostic strategy. METHODS AND RESULTS We studied 513 relatives (aged >10 years) of 77 consecutive LQTS probands with a known disease-causing mutation. The Schwartz criteria identified 'high probability of LQTS' (score >or=4) in 41 of 208 mutation carriers, yielding 19% sensitivity and 99% specificity. The Keating criteria had 36% sensitivity and 99% specificity. Alternatively, by analysing QTc duration alone, we found that 430 ms is the optimal cut-off value to distinguish carriers (>or=430 ms) from non-carriers (<430 ms), yielding 72% sensitivity and 86% specificity (area under the curve 0.788). CONCLUSION The existing clinical criteria have good specificity in identifying mutation carriers. However, their sensitivity is too low for clinical use. Analysis of QTc duration alone is more useful to screen for LQTS carriership (QTc >or= 430 ms) as its sensitivity is far superior, although its specificity remains acceptable. In genotyped families, genetic testing is the preferred diagnostic test.
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Affiliation(s)
- Nynke Hofman
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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