Phenotypic Expression, Natural History, and Risk Stratification of Cardiomyopathy Caused by Filamin C Truncating Variants

Author:

Gigli Marta1,Stolfo Davide12ORCID,Graw Sharon L.3,Merlo Marco1,Gregorio Caterina45,Nee Chen Suet3,Dal Ferro Matteo1,PaldinoMD Alessia1,De Angelis Giulia1ORCID,Brun Francesca1,Jirikowic Jean3,Salcedo Ernesto E.3,Turja Sylvia3,Fatkin Diane67ORCID,Johnson Renee6,van Tintelen J. Peter89,Te Riele Anneline S.J.M.89,Wilde Arthur A.M.10,Lakdawala Neal K.11,Picard Kermshlise11,Miani Daniela12,Muser Daniele12,Maria Severini Giovanni13ORCID,Calkins Hugh14ORCID,James Cynthia A.14,Murray Brittney14,Tichnell Crystal14,Parikh Victoria N.15,Ashley Euan A.15ORCID,Reuter Chloe15ORCID,Song Jiangping16,Judge Daniel P.17,McKenna William J.18,Taylor Matthew R.G.3ORCID,Sinagra Gianfranco1,Mestroni Luisa3ORCID

Affiliation:

1. Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy (M.G., D.S., M.M., M.D.F., A.P., G.D.A., F.B., G.S.).

2. Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (D.S.).

3. Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora (S.G., S.N.C., J.J., E.E.S., S.T., M.R.G.T., L.M.).

4. Biostatistics Unit, Department of Medical Sciences, University of Trieste, Italy (C.G.).

5. MOX-Modeling and Scientific Computing Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy (C.G.).

6. Molecular Cardiology Division, Victor Chang Cardiac Research Institute, and St Vincent’s Clinical School, Faculty of Medicine, UNSW Sydney, Australia (D.F., R.J.).

7. Cardiology Department, St Vincent’s Hospital, Sydney, Australia (D.F.).

8. Division of Medicine, Department of Genetics and Cardiology, University Medical Center, Utrecht, the Netherlands (J.P.v.T., A.S.J.M.T.R.).

9. Netherlands Heart Institute, Utrecht (J.P.v.T., A.S.J.M.T.R.).

10. Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, the Netherlands (A.W.).

11. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.K.L., K.P.).

12. University Hospital of Udine, Italy (D. Miani, D. Muser).

13. Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy (G.M.S.).

14. Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD (H.C., C.A.J., B.M., C.T.).

15. Stanford Center for Inherited Cardiovascular Disease, CA (V.N.P., E.A.A., C.R.).

16. National Center for Cardiovascular Diseases in Beijing, China (J.S.).

17. Medical University of South Carolina, Charleston (D.J.).

18. Institute of Cardiovascular Science, University College of London, United Kingdom (W.J.M.).

Abstract

Background: Filamin C truncating variants ( FLNCtv ) cause a form of arrhythmogenic cardiomyopathy: the mode of presentation, natural history, and risk stratification of FLNCtv remain incompletely explored. We aimed to develop a risk profile for refractory heart failure and life-threatening arrhythmias in a multicenter cohort of FLNCtv carriers. Methods: FLNCtv carriers were identified from 10 tertiary care centers for genetic cardiomyopathies. Clinical and outcome data were compiled. Composite outcomes were all-cause mortality/heart transplantation/left ventricle assist device (D/HT/LVAD), nonarrhythmic death/HT/LVAD, and sudden cardiac death/major ventricular arrhythmias. Previously established cohorts of 46 patients with LMNA and 60 with DSP -related arrhythmogenic cardiomyopathies were used for prognostic comparison. Results: Eighty-five patients carrying FLNCtv were included (42±15 years, 53% men, 45% probands). Phenotypes were heterogeneous at presentation: 49% dilated cardiomyopathy, 25% arrhythmogenic left dominant cardiomyopathy, 3% arrhythmogenic right ventricular cardiomyopathy. Left ventricular ejection fraction was <50% in 64% of carriers and 34% had right ventricular fractional area changes (RVFAC=(right ventricular end-diastolic area – right ventricular end-systolic area)/right ventricular end-diastolic area) <35%. During follow-up (median time 61 months), 19 (22%) carriers experienced D/HT/LVAD, 13 (15%) experienced nonarrhythmic death/HT/LVAD, and 23 (27%) experienced sudden cardiac death/major ventricular arrhythmias. The sudden cardiac death/major ventricular arrhythmias incidence of FLNCtv carriers did not significantly differ from LMNA carriers and DSP carriers. In FLNCtv carriers, left ventricular ejection fraction was associated with the risk of D/HT/LVAD and nonarrhythmic death/HT/LVAD. Conclusions: Among patients referred to tertiary referral centers, FLNCtv arrhythmogenic cardiomyopathy is phenotypically heterogeneous and characterized by a high risk of life-threatening arrhythmias, which does not seem to be associated with the severity of left ventricular dysfunction.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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