Phenotypic Expression and Outcomes in Individuals With Rare Genetic Variants of Hypertrophic Cardiomyopathy

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:78

Article

de Marvao, Antonio¹  McGurk, Kathryn A.²  Zheng, Sean L.^2,3,4  Thanaj, Marjola¹  Bai, Wenjia^5,6  Duan, Jinming^1,5,7  Biffi, Carlo^1,5  Mazzarotto, Francesco^2,3,4,8,9  Statton, Ben¹  Dawes, Timothy J. W.^1,2  Savioli, Nicolo¹  Halliday, Brian P.^2,3,4  Xu, Xiao^2,3,4  Buchan, Rachel J.^2,3,4  Baksi, A. John^2,3,4  Quinlan, Marina¹  Tokarczuk, Pawel¹  Tayal, Upasana^2,3,4  Francis, Catherine^2,3,4  Whiffin, Nicola^2,3,4,10  Theotokis, Pantazis, I¹  Zhang, Xiaolei²  Jang, Mikyung^2,3,4  Berry, Alaine¹  Pantazis, Antonis^2,3,4  Barton, Paul J. R.^1,2,3,4  Rueckert, Daniel^5,11  Prasad, Sanjay K.^2,3,4  Walsh, Roddy¹²  Ho, Carolyn Y.¹³  Cook, Stuart A.^{1,2,3,4,14,15}  Ware, James S.^1,2,3,4  O'Regan, Declan P.¹ 

[1] Imperial Coll London, MRC, London Inst Med Sci, Hammersmith Hosp Campus,Du Cane Rd, London W12 0HS, England

[2] Imperial Coll London, Natl Heart & Lung Inst, London, England

[3] Royal Brompton Hosp, Cardiovasc Res Ctr, London, England

[4] Harefield Hosp, Cardiovasc Res Ctr, London, England

[5] Imperial Coll London, Dept Comp, Biomed Image Anal Grp, London, England

[6] Imperial Coll London, Dept Brain Sci, London, England

[7] Univ Birmingham, Sch Comp Sci, Birmingham, W Midlands, England

[8] Univ Florence, Dept Expt & Clin Med, Florence, Italy

[9] Careggi Univ Hosp, Cardiomyopathy Unit, Florence, Italy

[10] Univ Oxford, Wellcome Ctr Human Genet, Oxford, England

[11] Tech Univ Munich, Fac Informat & Med, Klinikum Rechts Isar, Munich, Germany

[12] Amsterdam UMC, Dept Expt Cardiol, AMC Heart Ctr, Amsterdam, Netherlands

[13] Brigham & Womens Hosp, Cardiovasc Div, 75 Francis St, Boston, MA 02115 USA

[14] Natl Heart Ctr Singapore, Singapore, Singapore

[15] Duke NUS Grad Med Sch, Singapore, Singapore

关键词: deep learning;    genetics;    hypertrophic cardiomyopathy;    penetrance;    cardiovascular magnetic resonance;   

DOI  :  10.1016/j.jacc.2021.07.017

来源: Elsevier

【 摘 要 】

BACKGROUND Hypertrophic cardiomyopathy (HCM) is caused by rare variants in sarcomere-encoding genes, but little is known about the clinical significance of these variants in the general population. OBJECTIVES The goal of this study was to compare lifetime outcomes and cardiovascular phenotypes according to the presence of rare variants in sarcomere-encoding genes among middle-aged adults. METHODS This study analyzed whole exome sequencing and cardiac magnetic resonance imaging in UK Biobank participants stratified according to sarcomere-encoding variant status. RESULTS The prevalence of rare variants (allele frequency <0.00004) in HCM-associated sarcomere-encoding genes in 200,584 participants was 2.9% (n = 5,712;1 in 35), and the prevalence of variants pathogenic or likely pathogenic for HCM (SARC-HCM-P/LP) was 0.25% (n = 493;1 in 407). SARC-HCM-P/LP variants were associated with an increased risk of death or major adverse cardiac events compared with controls (hazard ratio: 1.69; 95% confidence interval [CI]: 1.38-2.07; P < 0.001), mainly due to heart failure endpoints (hazard ratio: 4.23; 95% CI: 3.07-5.83; P < 0.001). In 21,322 participants with both cardiac magnetic resonance imaging and whole exome sequencing, SARC-HCM-P/LP variants were associated with an asymmetric increase in left ventricular maximum wall thickness (10.9 +/- 2.7 mm vs 9.4 +/- 1.6 mm; P < 0.001), but hypertrophy ($13 mm) was only present in 18.4% (n = 9 of 49; 95% CI: 9%-32%). SARC-HCM-P/LP variants were still associated with heart failure after adjustment for wall thickness (hazard ratio: 6.74; 95% CI: 2.43-18.7; P < 0.001). CONCLUSIONS In this population of middle-aged adults, SARC-HCM-P/LP variants have low aggregate penetrance for overt HCM but are associated with an increased risk of adverse cardiovascular outcomes and an attenuated cardiomyopathic phenotype. Although absolute event rates are low, identification of these variants may enhance risk stratification beyond familial disease. (J Am Coll Cardiol 2021;78:1097-1110) (c) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

【 授权许可】

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