Keiichi Hirono1, Yukiko Hata2, Sayaka Watanabe Ozawa3, Takako Toda4, Nobuo Momoi5, Yutaka Fukuda6, Ryo Inuzuka7, Hiroki Nagamine7, Heima Sakaguchi8, Kenichi Kurosaki8, Mako Okabe3, Shinya Takarada3, Nariaki Miyao3, Hideyuki Nakaoka3, Keijiro Ibuki3, Hideki Origasa9, Neil E Bowles10, Naoki Nishida2, Fukiko Ichida11. 1. Department of Pediatrics, Graduate School of Medicine, University of Toyama, Japan. Electronic address: khirono1973@gmail.com. 2. Legal Medicine, Graduate School of Medicine, University of Toyama, Japan. 3. Department of Pediatrics, Graduate School of Medicine, University of Toyama, Japan. 4. Department of Pediatrics, University of Yamanashi, Japan. 5. Department of Pediatrics, Fukushima Medical University, Japan. 6. Department of Pediatrics, Takeda General Hospital, Japan. 7. Department of Pediatrics, University of Tokyo, Japan. 8. Dvision of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Japan. 9. Biostatistics and Clinical Epidemiology, Graduate School of Medicine, University of Toyama, Japan. 10. Department of Pediatrics (Cardiology), University of Utah, Salt Lake City, USA. 11. Department of Pediatrics, International University of Health and Welfare, Japan.
Abstract
BACKGROUND: Left ventricular noncompaction (LVNC) is a hereditary cardiomyopathy, associated with high morbidity and mortality, but the role of genetics in cases of fetal-onset has not been fully evaluated. The goal of this study was to identify the genetic background in LVNC fetal-onset patients using next-generation sequencing (NGS). METHODS: Thirty-three fetal-onset Japanese probands with LVNC (20 males and 13 females) were enrolled. In the enrolled patients, 81 genes associated with cardiomyopathy were screened using next-generation sequencing (NGS) retrospectively. RESULTS: Twenty-three patients had congestive heart failure (CHF), and six patients had arrhythmias. Prominent trabeculations were mostly observed in lateral LV, posterior LV, and apex of LV in patients with LVNC. Twelve died; three patients experienced intrauterine death or termination of pregnancy. Overall, 15 variants were found among eight genes in 16 patients. Seven variants were detected in MYH7 and two in TPM1. Sarcomere gene variants accounted for 75.0%. A multivariable proportional hazards model revealed that CHF at diagnosis and a higher ratio of the noncompacted layer/compacted layer in the LV posterior wall were independent risk factors for death in LVNC fetal-onset patients (odds ratio = 4.26 × 106 and 1.36 × 108, p = 0.0075 and 0.0005, respectively). CONCLUSIONS: The present study is the first report focusing on genetic background combined with clinical features in LVNC fetal-onset patients using NGS. Sarcomere variants were most commonly identified in fetal-onset patients, and greater attention should be paid to fetal-onset patients with LVNC having prominent trabeculations in the LV because they are more likely to develop CHF.
BACKGROUND: Left ventricular noncompaction (LVNC) is a hereditary cardiomyopathy, associated with high morbidity and mortality, but the role of genetics in cases of fetal-onset has not been fully evaluated. The goal of this study was to identify the genetic background in LVNC fetal-onset patients using next-generation sequencing (NGS). METHODS: Thirty-three fetal-onset Japanese probands with LVNC (20 males and 13 females) were enrolled. In the enrolled patients, 81 genes associated with cardiomyopathy were screened using next-generation sequencing (NGS) retrospectively. RESULTS: Twenty-three patients had congestive heart failure (CHF), and six patients had arrhythmias. Prominent trabeculations were mostly observed in lateral LV, posterior LV, and apex of LV in patients with LVNC. Twelve died; three patients experienced intrauterine death or termination of pregnancy. Overall, 15 variants were found among eight genes in 16 patients. Seven variants were detected in MYH7 and two in TPM1. Sarcomere gene variants accounted for 75.0%. A multivariable proportional hazards model revealed that CHF at diagnosis and a higher ratio of the noncompacted layer/compacted layer in the LV posterior wall were independent risk factors for death in LVNC fetal-onset patients (odds ratio = 4.26 × 106 and 1.36 × 108, p = 0.0075 and 0.0005, respectively). CONCLUSIONS: The present study is the first report focusing on genetic background combined with clinical features in LVNC fetal-onset patients using NGS. Sarcomere variants were most commonly identified in fetal-onset patients, and greater attention should be paid to fetal-onset patients with LVNC having prominent trabeculations in the LV because they are more likely to develop CHF.