[A clinical case of reverse left ventricular remodeling in patient with pathogenic TTN mutation. Case report].

Pub Date : 2024-10-10 DOI:10.26442/00403660.2024.09.202852
S N Nasonova, A N Meshkov, I V Zhirov, Y F Osmolovskaya, A A Shoshina, A V Gagloev, I H Dzhumaniiazova, E A Zelenova, V V Erema, M S Gusakova, M V Ivanov, M V Terekhov, D A Kashtanova, A I Nekrasova, S I Mitrofanov, A S Shingaliev, V S Yudin, A A Keskinov, N V Gomyranova, U V Chubykina, M V Ezhov, S N Tereshchenko, S M Yudin, S A Boytsov
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Abstract

Dilated cardiomyopathy (DCM) is a leading cause of heart failure, sudden cardiac death, and heart transplantation in young patients. The causes of DCM are varied and include genetic factors and metabolic, infectious, toxic and others factors. Today it is known that germline mutations in more than 98 genes can be associated with the occurrence of DCM. However, the penetrance of these genes often depends on a combination of factors, including modifiable ones, i.e. those that change under the influence of the environment. About 20-25% of genetically determined forms of DCM are due to mutations in the titin gene (TTN). Titin is the largest protein in the body, which is an important component of the sarcomer. Although titin is the largest protein in the human body, its role in the physiology of heart and disease is not yet fully understood. However, a mutation in the TTN gene may later represent a potential therapeutic target for genetic and acquired cardiomyopathy. Thus, the analysis of clinical cases of cardiomyopathy in patients with identified mutations in the TTN gene is of great scientific interest. The article presents a clinical case of manifestation of DCM in patient with a revealed pathogenic variant of mutation in the gene TTN and reverse left ventricular remodeling of the against the background of optimal therapy of heart failure in a subsequent outpatient observation.

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[致病性 TTN 突变患者左心室反向重塑的临床病例。病例报告]。
扩张型心肌病(DCM)是导致年轻患者心力衰竭、心脏性猝死和心脏移植的主要原因。DCM 的病因多种多样,包括遗传因素、代谢因素、感染因素、毒性因素和其他因素。目前已知有超过 98 个基因的种系突变与 DCM 的发生有关。然而,这些基因的穿透性往往取决于多种因素,包括可改变的因素,即在环境影响下发生变化的因素。在由基因决定的 DCM 中,约有 20-25% 是由于 titin 基因(TTN)的突变造成的。titin 是人体内最大的蛋白质,是肌纤维的重要组成部分。虽然 titin 是人体内最大的蛋白质,但它在心脏生理和疾病中的作用尚未完全明了。然而,TTN 基因的突变日后可能成为遗传性和获得性心肌病的潜在治疗靶点。因此,对已发现 TTN 基因突变的心肌病患者的临床病例进行分析具有重要的科学意义。本文介绍了一例临床病例,该病例患者的 DCM 表现为 TTN 基因突变的致病变异,在随后的门诊观察中,在心力衰竭最佳治疗的背景下,左心室反向重塑。
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