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Carbajales J, Krishnan D, Principato M, Tomatti A, Paolucci A, Yoo HS, von Wulffen A, Ciampi N, Tepper R, Carradori J, Baranchuk A. Prevalence of Cardiac Arrhythmias and Distal Conduction Disorders in Patients With Chronic Chagas' Disease and Elevated Autoantibodies Against M2 Muscarinic Acetylcholine Receptors. Curr Probl Cardiol 2021; 46:100820. [PMID: 33743434 DOI: 10.1016/j.cpcardiol.2021.100820] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/17/2022]
Abstract
Chagas' disease (ChD) is a parasitic disease endemic to regions of Latin America and with an increasingly global reach. Up to 30% of patients with ChD develop severe dilated cardiomyopathy, ventricular arrhythmias, conduction disorders and/or sudden cardiac death. Autoantibodies against M2 muscarinic acetylcholine receptors (M2 mAChR) have been implicated in the pathogenesis of ChD. We sought to understand whether there was an association between anti-M2 mAChR autoantibody titers in patients with chronic ChD and the presence of distal cardiac conduction disorders or cardiac arrhythmias. We conducted a cross-sectional study in 79 patients from Argentina and Bolivia with chronic ChD without evident structural heart disease. Autoantibody titers were measured using indirect enzyme-linked immunosorbent assay. Elevated anti-M2 mAChR autoantibody titers were associated with the presence of distal conduction disease but not with cardiac arrhythmias. High anti-M2 mAChR autoantibody levels could assist with identifying early structural heart disease in patients with chronic ChD.
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Affiliation(s)
- Justo Carbajales
- Cardiovascular Genomic Section, Division of Cardiology, Acute General Hospital, Buenos Aires, Argentina.
| | - Dhruv Krishnan
- Department of Medicine, Queen's University, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Mario Principato
- Cardiovascular Genomic Section, Division of Cardiology, Acute General Hospital, Buenos Aires, Argentina
| | - Alejandro Tomatti
- Cardiovascular Genomic Section, Division of Cardiology, Acute General Hospital, Buenos Aires, Argentina
| | - Analía Paolucci
- Cardiovascular Genomic Section, Division of Cardiology, Acute General Hospital, Buenos Aires, Argentina
| | - Hyun Sok Yoo
- Cardiovascular Genomic Section, Division of Cardiology, Acute General Hospital, Buenos Aires, Argentina
| | - Alejandra von Wulffen
- Cardiovascular Genomic Section, Division of Cardiology, Acute General Hospital, Buenos Aires, Argentina
| | - Natalia Ciampi
- Cardiovascular Genomic Section, Division of Cardiology, Acute General Hospital, Buenos Aires, Argentina
| | - Rita Tepper
- Cardiovascular Genomic Section, Division of Cardiology, Acute General Hospital, Buenos Aires, Argentina
| | - Jorge Carradori
- Cardiovascular Genomic Section, Division of Cardiology, Acute General Hospital, Buenos Aires, Argentina
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston Health Sciences Center, Kingston, Ontario, Canada.
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Yoo HS, Medina N, von Wulffen MA, Ciampi N, Paolucci A, Garro HA, Principato MB, Acunzo RS, Carbajales J. A novel KCNH2 frameshift mutation (c.46delG) associated with high risk of sudden death in a family with congenital long QT syndrome type 2. Int J Arrhythm 2021. [DOI: 10.1186/s42444-020-00029-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
The congenital long QT syndrome type 2 is caused by mutations in KCNH2 gene that encodes the alpha subunit of potassium channel Kv11.1. The carriers of the pathogenic variant of KCNH2 gene manifest a phenotype characterized by prolongation of QT interval and increased risk of sudden cardiac death due to life-threatening ventricular tachyarrhythmias.
Results
A family composed of 17 members with a family history of sudden death and recurrent syncopes was studied. The DNA of proband with clinical manifestations of long QT syndrome was analyzed using a massive DNA sequencer that included the following genes: KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, ANK2, KCNJ2, CACNA1, CAV3, SCN1B, SCN4B, AKAP9, SNTA1, CALM1, KCNJ5, RYR2 and TRDN. DNA sequencing of proband identified a novel pathogenic variant of KCNH2 gene produced by a heterozygous frameshift mutation c.46delG, pAsp16Thrfs*44 resulting in the synthesis of a truncated alpha subunit of the Kv11.1 ion channel. Eight family members manifested the phenotype of long QT syndrome. The study of family segregation using Sanger sequencing revealed the identical variant in several members of the family with a positive phenotype.
Conclusions
The clinical and genetic findings of this family demonstrate that the novel frameshift mutation causing haploinsufficiency can result in a congenital long QT syndrome with a severe phenotypic manifestation and an elevated risk of sudden cardiac death.
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