伴有明显或亚临床肥厚性心肌病的MYBPC3变异携带者左心室下射血时间

IF 3.7 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Isabell Yan, Zoe Möhring, Daniel Reichart, Fanny Kortüm, Julia Münch, Rixa Woitschach, Paulus Kirchhof, Lucie Carrier, Carolyn Y. Ho, Thomas Eschenhagen, Monica Patten
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In this study, we tested whether LVET is specifically altered in patients carrying <i>MYBPC3</i> variants by retrospective echocardiographic analysis in two genotype-defined HCM cohorts.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>LVET was measured by echocardiography and adjusted for heart rate [LVET index (LVETI)] in 166 patients. Variant carriers were stratified for the presence (LVH+) or absence of left ventricular hypertrophy with septal thickness of ≥13 mm (LVH−). 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引用次数: 0

摘要

目的:肥厚性心肌病(HCM)是一种遗传性心肌病,常由MYBPC3和MYH7致病变异引起,分别编码肌球蛋白结合蛋白C3和肌球蛋白重链7。这些变异可导致肌动蛋白-肌球蛋白过桥循环增加,导致心室过度收缩,但缺乏Mybpc3的小鼠表现出左心室射血时间(LVET)减少,这是收缩功能障碍的标志。在这项研究中,我们通过回顾性超声心动图分析在两个基因型定义的HCM队列中检测了携带MYBPC3变异的患者中LVET是否特异性改变。方法:采用超声心动图测量166例患者的LVET,并调整心率[LVET指数(LVETI)]。根据左室间隔厚度≥13 mm (LVH-)存在(LVH+)或不存在(LVH-)的变异携带者进行分层。以LVETI为因变量,以性别、年龄、左室射血分数(LVEF)、舒张期室间隔内径(IVSd)、舒张功能障碍、静息时左室流出道(LVOT)梯度和用药史为混杂因素,采用多变量方差分析(MANOVA)确定变异携带者与对照组LVETI的差异。结果:在共166例携带MYBPC3或MYH7致病变异的患者(38±3岁,45%为女性)中,我们比较了发现队列(40例MYBPC3和31例MYH7)和验证队列(缬沙坦减轻早期肉瘤性HCM的疾病演变);54例MYBPC3和41例MYH7), 44例健康对照。在发现、验证和合并队列中,MYBPC3的LVETI低于对照组,而MYH7 LVH+患者的LVETI高于对照组(合并:MYBPC3 381±19 ms vs. MYH7 437±38 ms, P)。结论:数据表明,MYBPC3和MYH7的变异会导致不同的生物物理后果,可以通过测量患者的LVETI来检测。这些发现可能对针对肌节功能的治疗反应的潜在基因型特异性差异有影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Lower left ventricular ejection time in MYBPC3 variant carriers with overt or subclinical hypertrophic cardiomyopathy

Lower left ventricular ejection time in MYBPC3 variant carriers with overt or subclinical hypertrophic cardiomyopathy

Aims

Hypertrophic cardiomyopathy (HCM) is an inherited cardiomyopathy often caused by pathogenic variants in MYBPC3 and MYH7, encoding myosin-binding protein C3 and myosin heavy chain 7, respectively. These variants can cause increased actin–myosin crossbridge cycling, resulting in ventricular hypercontractility, but mice lacking Mybpc3 exhibited reduced left ventricular ejection time (LVET) as a sign of systolic dysfunction. In this study, we tested whether LVET is specifically altered in patients carrying MYBPC3 variants by retrospective echocardiographic analysis in two genotype-defined HCM cohorts.

Methods

LVET was measured by echocardiography and adjusted for heart rate [LVET index (LVETI)] in 166 patients. Variant carriers were stratified for the presence (LVH+) or absence of left ventricular hypertrophy with septal thickness of ≥13 mm (LVH−). Multivariate analysis of variance (MANOVA) was used to identify differences in LVETI between variant carriers and controls with LVETI as the dependent variable, adjusted for sex, age, left ventricular ejection fraction (LVEF), interventricular septal diameter in diastole (IVSd), diastolic dysfunction, left ventricular outflow tract (LVOT) gradient at rest and medication history as confounders.

Results

In a total of 166 patients carrying MYBPC3 or MYH7 pathogenic variants (38 ± 3 years, 45% female), we compared the discovery cohort (40 MYBPC3 and 31 MYH7) and the validation cohort (‘Valsartan in Attenuating Disease Evolution in Early Sarcomeric HCM’; 54 MYBPC3 and 41 MYH7) with 44 healthy controls. LVETI was lower in MYBPC3 and higher in MYH7 LVH+ patients than in controls in the discovery, validation and pooled cohorts (pooled: MYBPC3 381 ± 19 ms vs. MYH7 437 ± 38 ms, P < 0.001; MYBPC3 vs. controls 411 ± 15 ms, P < 0.001; and MYH7 vs. controls, P < 0.001). Similar findings were seen in LVH− (pooled: MYBPC3 380 ± 16 ms vs. MYH7 437 ± 39 ms, P < 0.001; MYBPC3 vs. controls, P < 0.001). While MYH7 variants were all missense as expected, 87% of the MYBPC3 variants were truncating (including nonsense variants, out-of-frame deletion and splice site variants) and 13% were non-truncating (missense and in-frame deletion). LVETI did not differ between the groups and was significantly lower than the control in both.

Conclusions

The data suggest that variants in MYBPC3 and MYH7 result in distinct biophysical consequences, which can be detected by measuring LVETI in patients. The findings may have implications for potential genotype-specific differences in response to therapies targeting sarcomere function.

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来源期刊
ESC Heart Failure
ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine
CiteScore
7.00
自引率
7.90%
发文量
461
审稿时长
12 weeks
期刊介绍: ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.
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