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van der Meulen MH, Herkert JC, den Boer SL, du Marchie Sarvaas GJ, Blom N, ten Harkel AD, Breur HM, Rammeloo LA, Tanke R, Marcelis C, van de Laar IM, Verhagen JM, Lekanne dit Deprez RH, Barge-Schaapveld DQ, Baas A, Sammani A, Christiaans I, van Tintelen JP, Dalinghaus M. Genetic Evaluation of A Nation-Wide Dutch Pediatric DCM Cohort: The Use of Genetic Testing in Risk Stratification. Circ Genom Precis Med 2022; 15:e002981. [DOI: 10.1161/circgen.120.002981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
This study aimed to describe the current practice and results of genetic evaluation in Dutch children with dilated cardiomyopathy and to evaluate genotype-phenotype correlations that may guide prognosis.
Methods:
We performed a multicenter observational study in children diagnosed with dilated cardiomyopathy, from 2010 to 2017.
Results:
One hundred forty-four children were included. Initial diagnostic categories were idiopathic dilated cardiomyopathy in 67 children (47%), myocarditis in 23 (16%), neuromuscular in 7 (5%), familial in 18 (13%), inborn error of metabolism in 4 (3%), malformation syndrome in 2 (1%), and “other” in 23 (16%). Median follow-up time was 2.1 years [IQR 1.0–4.3]. Hundred-seven patients (74%) underwent genetic testing. We found a likely pathogenic or pathogenic variant in 38 children (36%), most often in
MYH7
(n = 8). In 1 patient initially diagnosed with myocarditis, a pathogenic
LMNA
variant was found. During the study, 39 patients (27%) reached study endpoint (SE: all-cause death or heart transplantation). Patients with a likely pathogenic or pathogenic variant were more likely to reach SE compared with those without (hazard ratio 2.8; 95% CI 1.3–5.8,
P
= 0.007), while transplant-free survival was significantly lower (
P
= 0.006). Clinical characteristics at diagnosis did not differ between the 2 groups.
Conclusions:
Genetic testing is a valuable tool for predicting prognosis in children with dilated cardiomyopathy, with carriers of a likely pathogenic or pathogenic variant having a worse prognosis overall. Genetic testing should be incorporated in clinical work-up of all children with dilated cardiomyopathy regardless of presumed disease pathogenesis.
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Affiliation(s)
| | - Johanna C. Herkert
- Dept of Genetics, Univ of Groningen, Univ Medical Center Groningen, Groningen (J.C.H., I.C.)
| | | | | | - Nico Blom
- Dept of Pediatric Cardiology, Univ of Leiden, Leiden Univ Medical Center, Leiden (N.B., A.D.J.H.)
| | - Arend D.J. ten Harkel
- Dept of Pediatric Cardiology, Univ of Leiden, Leiden Univ Medical Center, Leiden (N.B., A.D.J.H.)
- Dept of Pediatric Cardiology, Univ of Amsterdam, Academic Medical Center, Amsterdam (A.D.J.H.)
| | - Hans M.P.J. Breur
- Dept of Pediatric Cardiology, Univ of Utrecht, Wilhelmina Children’s Hospital, Univ Medical Center Utrecht, Utrecht (H.M.P.J.B.)
| | - Lukas A.J. Rammeloo
- Dept of Pediatric Cardiology, Amsterdam Univ Medical Center, location Free Univ Medical Center, Amsterdam (L.A.J.R.)
| | - Ronald Tanke
- Dept of Pediatric Cardiology, Radboud Univ Medical Center, Nijmegen (R.T.)
| | - Carlo Marcelis
- Dept of Genetics, Radboud Univ Medical Center, Nijmegen (C.M.)
| | - Ingrid M.B.H. van de Laar
- Dept of Clinical Genetics, Erasmus MC, Univ Medical Center Rotterdam, Rotterdam (I.M.B.H.L., J.M.A.V.)
| | - Judith M.A. Verhagen
- Dept of Clinical Genetics, Erasmus MC, Univ Medical Center Rotterdam, Rotterdam (I.M.B.H.L., J.M.A.V.)
| | | | | | - Annette Baas
- Dept of Genetics, Univ of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands (A.B., A.S., J.P.T.)
| | - Arjan Sammani
- Dept of Genetics, Univ of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands (A.B., A.S., J.P.T.)
| | - Imke Christiaans
- Dept of Genetics, Univ of Groningen, Univ Medical Center Groningen, Groningen (J.C.H., I.C.)
- Dept of Clinical Genetics, Univ of Leiden, Leiden Univ Medical Center, Leiden (D.Q.C.M.B-S., I.C.)
| | - J. Peter van Tintelen
- Dept of Clinical Genetics, Amsterdam Univ Medical Center, location AMC, Amsterdam (R.H.L.D., J.P.T.)
- Dept of Genetics, Univ of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands (A.B., A.S., J.P.T.)
| | - Michiel Dalinghaus
- Dept of Pediatric Cardiology, Erasmus MC, Univ Medical Center Rotterdam, Rotterdam (M.H.M., M.D.)
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Herkert JC, Verhagen JM, Yotti R, Haghighi A, Phelan DG, James PA, Brown NJ, Stutterd C, Macciocca I, Leong K, Bulthuis ML, van Bever Y, van Slegtenhorst MA, Boven LG, Roberts AE, Agarwal R, Seidman J, Lakdawala NK, Fernández-Avilés F, Burke MA, Pierpont ME, Braunlin E, Ḉağlayan AO, Barge-Schaapveld DQ, Birnie E, van Osch-Gevers L, van Langen IM, Jongbloed JD, Lockhart PJ, Amor DJ, Seidman CE, van de Laar IM. Expanding the clinical and genetic spectrum of ALPK3 variants: Phenotypes identified in pediatric cardiomyopathy patients and adults with heterozygous variants. Am Heart J 2020; 225:108-119. [PMID: 32480058 DOI: 10.1016/j.ahj.2020.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 03/14/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Biallelic damaging variants in ALPK3, encoding alpha-protein kinase 3, cause pediatric-onset cardiomyopathy with manifestations that are incompletely defined. METHODS AND RESULTS We analyzed clinical manifestations of damaging biallelic ALPK3 variants in 19 pediatric patients, including nine previously published cases. Among these, 11 loss-of-function (LoF) variants, seven compound LoF and deleterious missense variants, and one homozygous deleterious missense variant were identified. Among 18 live-born patients, 8 exhibited neonatal dilated cardiomyopathy (44.4%; 95% CI: 21.5%-69.2%) that subsequently transitioned into ventricular hypertrophy. The majority of patients had extracardiac phenotypes, including contractures, scoliosis, cleft palate, and facial dysmorphisms. We observed no association between variant type or location, disease severity, and/or extracardiac manifestations. Myocardial histopathology showed focal cardiomyocyte hypertrophy, subendocardial fibroelastosis in patients under 4 years of age, and myofibrillar disarray in adults. Rare heterozygous ALPK3 variants were also assessed in adult-onset cardiomyopathy patients. Among 1548 Dutch patients referred for initial genetic analyses, we identified 39 individuals with rare heterozygous ALPK3 variants (2.5%; 95% CI: 1.8%-3.4%), including 26 missense and 10 LoF variants. Among 149 U.S. patients without pathogenic variants in 83 cardiomyopathy-related genes, we identified six missense and nine LoF ALPK3 variants (10.1%; 95% CI: 5.7%-16.1%). LoF ALPK3 variants were increased in comparison to matched controls (Dutch cohort, P = 1.6×10-5; U.S. cohort, P = 2.2×10-13). CONCLUSION Biallelic damaging ALPK3 variants cause pediatric cardiomyopathy manifested by DCM transitioning to hypertrophy, often with poor contractile function. Additional extracardiac features occur in most patients, including musculoskeletal abnormalities and cleft palate. Heterozygous LoF ALPK3 variants are enriched in adults with cardiomyopathy and may contribute to their cardiomyopathy. Adults with ALPK3 LoF variants therefore warrant evaluations for cardiomyopathy.
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Verhagen JM, van den Born M, Kurul S, Asimaki A, van de Laar IM, Frohn-Mulder IM, Kammeraad JA, Yap SC, Bartelings MM, van Slegtenhorst MA, von der Thüsen JH, Wessels MW. Homozygous Truncating Variant in
PKP2
Causes Hypoplastic Left Heart Syndrome. Circ: Genomic and Precision Medicine 2018; 11:e002397. [DOI: 10.1161/circgen.118.002397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Judith M.A. Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.M.A.V., M.v.d.B., S.K., I.M.B.H.v.d.L., M.A.v.S., M.W.W.)
| | - Myrthe van den Born
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.M.A.V., M.v.d.B., S.K., I.M.B.H.v.d.L., M.A.v.S., M.W.W.)
| | - Serife Kurul
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.M.A.V., M.v.d.B., S.K., I.M.B.H.v.d.L., M.A.v.S., M.W.W.)
| | - Angeliki Asimaki
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (A.A.)
| | - Ingrid M.B.H. van de Laar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.M.A.V., M.v.d.B., S.K., I.M.B.H.v.d.L., M.A.v.S., M.W.W.)
| | - Ingrid M.E. Frohn-Mulder
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (I.M.E.F.-M., J.A.E.K.)
| | - Janneke A.E. Kammeraad
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (I.M.E.F.-M., J.A.E.K.)
| | - Sing C. Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (S.C.Y.)
| | - Margot M. Bartelings
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands (M.M.B.)
| | - Marjon A. van Slegtenhorst
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.M.A.V., M.v.d.B., S.K., I.M.B.H.v.d.L., M.A.v.S., M.W.W.)
| | - Jan H. von der Thüsen
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.H.v.d.T.)
| | - Marja W. Wessels
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.M.A.V., M.v.d.B., S.K., I.M.B.H.v.d.L., M.A.v.S., M.W.W.)
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van Hagen IM, van der Linde D, van de Laar IM, Muiño Mosquera L, De Backer J, Roos-Hesselink JW. Pregnancy in Women With SMAD3 Mutation. J Am Coll Cardiol 2017; 69:1356-1358. [DOI: 10.1016/j.jacc.2016.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/21/2016] [Accepted: 12/28/2016] [Indexed: 11/30/2022]
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Almomani R, Verhagen JM, Herkert JC, Brosens E, van Spaendonck-Zwarts KY, Asimaki A, van der Zwaag PA, Frohn-Mulder IM, Bertoli-Avella AM, Boven LG, van Slegtenhorst MA, van der Smagt JJ, van IJcken WF, Timmer B, van Stuijvenberg M, Verdijk RM, Saffitz JE, du Plessis FA, Michels M, Hofstra RM, Sinke RJ, van Tintelen JP, Wessels MW, Jongbloed JD, van de Laar IM. Biallelic Truncating Mutations in ALPK3 Cause Severe Pediatric Cardiomyopathy. J Am Coll Cardiol 2016; 67:515-25. [DOI: 10.1016/j.jacc.2015.10.093] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/25/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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van der Linde D, Bekkers JA, Mattace-Raso FU, van de Laar IM, Moelker A, van den Bosch AE, van Dalen BM, Timmermans J, Bertoli-Avella AM, Wessels MW, Bogers AJ, Roos-Hesselink JW. Progression Rate and Early Surgical Experience in the New Aggressive Aneurysms-Osteoarthritis Syndrome. Ann Thorac Surg 2013; 95:563-9. [DOI: 10.1016/j.athoracsur.2012.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/06/2012] [Accepted: 07/11/2012] [Indexed: 01/05/2023]
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Wessels MW, van de Laar IM, Roos-Hesselink J, Strikwerda S, Majoor-Krakauer DF, de Vries BB, Kerstjens-Frederikse WS, Vos YJ, de Graaf BM, Bertoli-Avella AM, Willems PJ. Autosomal dominant inheritance of cardiac valves anomalies in two families: Extended spectrum of left-ventricular outflow tract obstruction. Am J Med Genet A 2009; 149A:216-25. [DOI: 10.1002/ajmg.a.32594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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