4
|
Akhtar MM, Lorenzini M, Pavlou M, Ochoa JP, O’Mahony C, Restrepo-Cordoba MA, Segura-Rodriguez D, Bermúdez-Jiménez F, Molina P, Cuenca S, Ader F, Larrañaga-Moreira JM, Sabater-Molina M, Garcia-Alvarez MI, Arantzamendi LG, Truszkowska G, Ortiz-Genga M, Ruiz IS, Nielsen SK, Rasmussen TB, Robles Mezcua A, Alvarez-Rubio J, Eiskjaer H, Gautel M, Garcia-Pinilla JM, Ripoll-Vera T, Mogensen J, Limeres Freire J, Rodríguez-Palomares JF, Peña-Peña ML, Rangel-Sousa D, Palomino-Doza J, Arana Achaga X, Bilinska Z, Zamarreño Golvano E, Climent V, Peñalver MN, Barriales-Villa R, Charron P, Yotti R, Zorio E, Jiménez-Jáimez J, Garcia-Pavia P, Elliott PM. Association of Left Ventricular Systolic Dysfunction Among Carriers of Truncating Variants in Filamin C With Frequent Ventricular Arrhythmia and End-stage Heart Failure. JAMA Cardiol 2021; 6:891-901. [PMID: 33978673 PMCID: PMC8117057 DOI: 10.1001/jamacardio.2021.1106] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/22/2021] [Indexed: 12/28/2022]
Abstract
Importance Truncating variants in the gene encoding filamin C (FLNCtv) are associated with arrhythmogenic and dilated cardiomyopathies with a reportedly high risk of ventricular arrhythmia. Objective To determine the frequency of and risk factors associated with adverse events among FLNCtv carriers compared with individuals carrying TTN truncating variants (TTNtv). Design, Setting, and Participants This cohort study recruited 167 consecutive FLNCtv carriers and a control cohort of 244 patients with TTNtv matched for left ventricular ejection fraction (LVEF) from 19 European cardiomyopathy referral units between 1990 and 2018. Data analyses were conducted between June and October, 2020. Main Outcomes and Measures The primary end point was a composite of malignant ventricular arrhythmia (MVA) (sudden cardiac death, aborted sudden cardiac death, appropriate implantable cardioverter-defibrillator shock, and sustained ventricular tachycardia) and end-stage heart failure (heart transplant or mortality associated with end-stage heart failure). The secondary end point comprised MVA events only. Results In total, 167 patients with FLNCtv were studied (55 probands [33%]; 89 men [53%]; mean [SD] age at baseline evaluation, 43 [18] years). For a median follow-up of 20 months (interquartile range, 7-60 months), 29 patients (17.4%) reached the primary end point (19 patients with MVA and 10 patients with end-stage heart failure). Eight (44%) arrhythmic events occurred among individuals with baseline mild to moderate left ventricular systolic dysfunction (LVSD) (LVEF = 36%-49%). Univariable risk factors associated with the primary end point included proband status, LVEF decrement per 10%, ventricular ectopy (≥500 in 24 hours) and myocardial fibrosis detected on cardiac magnetic resonance imaging. The LVEF decrement (hazard ratio [HR] per 10%, 1.83 [95% CI, 1.30-2.57]; P < .001) and proband status (HR, 3.18 [95% CI, 1.12-9.04]; P = .03) remained independent risk factors on multivariable analysis (excluding myocardial fibrosis and ventricular ectopy owing to case censoring). There was no difference in freedom from MVA between FLNCtv carriers with mild to moderate or severe (LVEF ≤35%) LVSD (HR, 1.29 [95% CI, 0.45-3.72]; P = .64). Carriers of FLNCtv with impaired LVEF at baseline evaluation (n = 69) had reduced freedom from MVA compared with 244 TTNtv carriers with similar baseline LVEF (for mild to moderate LVSD: HR, 16.41 [95% CI, 3.45-78.11]; P < .001; for severe LVSD: HR, 2.47 [95% CI, 1.04-5.87]; P = .03). Conclusions and Relevance The high frequency of MVA among patients with FLNCtv with mild to moderate LVSD suggests that higher LVEF values than those currently recommended should be considered for prophylactic implantable cardioverter-defibrillator therapy in FLNCtv carriers.
Collapse
MESH Headings
- Adult
- Cardiomyopathy, Dilated/genetics
- Cardiomyopathy, Dilated/mortality
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/therapy
- Codon, Nonsense
- Connectin/genetics
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Female
- Filamins/genetics
- Heart Failure/genetics
- Heart Failure/mortality
- Heart Failure/physiopathology
- Heart Failure/therapy
- Heart Transplantation/statistics & numerical data
- Humans
- Male
- Middle Aged
- Mutation
- Stroke Volume
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/genetics
- Tachycardia, Ventricular/physiopathology
- Ventricular Dysfunction, Left/genetics
- Ventricular Dysfunction, Left/physiopathology
Collapse
Affiliation(s)
- Mohammed Majid Akhtar
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Massimiliano Lorenzini
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, United Kingdom
| | | | - Constantinos O’Mahony
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Maria Alejandra Restrepo-Cordoba
- Department of Cardiology, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | | | | | - Pilar Molina
- Pathology Department, Institute of Legal Medicine and Forensic Sciences of Valencia and Faculty of Medicine of the Universitat de València, CAFAMUSME Research Group, IIS La Fe, Valencia, Spain
| | - Sofia Cuenca
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitarias Gregorio Marañón, Spain
| | - Flavie Ader
- APHP, UF Cardiogénétique et Myogénétique, Service de Biochimie Métabolique, Hôpitaux Universitaires de la Pitié- Salpêtrière- Charles Foix, 47-83 Bd de l’Hôpital, Paris, France
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - Jose M. Larrañaga-Moreira
- Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
- Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), A Coruña, Spain
- Department of Cardiology, Universidade da Coruña, A Coruña, Spain
- Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Maria Sabater-Molina
- Inherited Cardiac Disease Unit, Hospital Universitario Virgen Arrixaca, Murcia, Spain
- Universidad de Murcia, Murcia, Spain
| | - Maria I. Garcia-Alvarez
- Cardiology Department, University General Hospital of Alicante, Alicante, Spain
- Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Grazyna Truszkowska
- Molecular Biology Laboratory, Department of Medical Biology, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | | | - Itziar Solla Ruiz
- Cardiology Specialist in Heart Failure and Inherited Cardiac Diseases, Department of Cardiology, Hospital Universitario Donostia, Spain
| | | | | | - Ainhoa Robles Mezcua
- Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBER-CV, IBIMA, Malaga, Spain
| | - Jorge Alvarez-Rubio
- Inherited Cardiovascular Diseases Unit, Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hans Eiskjaer
- Department of Cardiology, Aarhus University Hospital, Hjertesygdomme, Aarhus, Denmark
| | - Mathias Gautel
- Randall Institute, King’s College London, London, United Kingdom
| | - José M. Garcia-Pinilla
- Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBER-CV, IBIMA, Malaga, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Diseases Unit, Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Javier Limeres Freire
- Department of Cardiology, Vall d’ Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’ Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose F. Rodríguez-Palomares
- Department of Cardiology, Vall d’ Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’ Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Luisa Peña-Peña
- Heart Failure and Heart Transplantation Unit, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Diego Rangel-Sousa
- Heart Failure and Heart Transplantation Unit, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Julian Palomino-Doza
- Hereditary Cardiopathies Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Instituto de Investigación 12 de Octubre i+12, Madrid, Spain
| | - Xabier Arana Achaga
- Cardiology Specialist in Heart Failure and Inherited Cardiac Diseases, Department of Cardiology, Hospital Universitario Donostia, Spain
| | - Zofia Bilinska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | | | - Vincent Climent
- Cardiology Department, University General Hospital of Alicante, Alicante, Spain
- Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
- Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), A Coruña, Spain
- Department of Cardiology, Universidade da Coruña, A Coruña, Spain
- Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Philippe Charron
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, Paris, France
- APHP, Centre de Référence pour les Maladies Cardiaques Héréditaires, Département de Génétique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Raquel Yotti
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitarias Gregorio Marañón, Spain
| | - Esther Zorio
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department at Hospital Universitario y Politécnico La Fe and Research Group on Inherited Heart Diseases, Sudden Death and Mechanisms of Disease (CaFaMuSMe) from the Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Juan Jiménez-Jáimez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pablo Garcia-Pavia
- Department of Cardiology, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | - Perry M. Elliott
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| |
Collapse
|