Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 78, Issue 11, Pages 1097-1110Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2021.07.017
Keywords
deep learning; genetics; hypertrophic cardiomyopathy; penetrance; cardiovascular magnetic resonance
Categories
Funding
- Medical Research Council, UK [MC-A658-5QEB0]
- National Institute for Health Research Imperial College Biomedical Research Centre
- National Institute for Health Research Royal Brompton Cardiovascular Biomedical Research Unit
- British Heart Foundation [NH/17/1/32725, RG/19/6/34387, RE/18/4/34215]
- Fondation Leducq [16 CVD 03]
- Wellcome Trust [107469/Z/15/Z, 200990/A/16/Z]
- National Heart and Lung Institute Foundation
- Royston Centre for Cardiomyopathy Research
- Rosetrees
- CORDA
- Academy of Medical Sciences [SGL015/1006]
- Mason Medical Research Trust grant
- SmartHeart EPSRC Programme Grant [EP/P001009/1]
- Rosetrees and Stoneygate Imperial College Research Fellowship
- Wellcome Trust [200990/A/16/Z] Funding Source: researchfish
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Rare variants in sarcomere-encoding genes have low penetrance for overt HCM in middle-aged adults, but are associated with an increased risk of heart failure and a weakened cardiomyopathic phenotype.
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/).
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