Journal
GENETICS IN MEDICINE
Volume 21, Issue 2, Pages 284-292Publisher
SPRINGERNATURE
DOI: 10.1038/s41436-018-0046-0
Keywords
Diagnostic effectiveness; HCM mimics; Hypertrophic cardiomyopathy; Mendelian HCM genetics; NGS
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Funding
- Italian Ministry of Health [RF-2013-02356787, NET-2011-02347173]
- British Heart Foundation [SP/10/10/28431]
- National Institute for Health Research Cardiovascular Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College London
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Purpose: Genetic testing in hypertrophic cardiomyopathy (HCM) has long relied on Sanger sequencing of sarcomeric genes. The advent of next-generation sequencing (NGS) has catalyzed routine testing of additional genes of dubious HCM-causing potential. We used 19 years of genetic testing results to define a reliable set of genes implicated in Mendelian HCM and assess the value of expanded NGS panels. Methods: We dissected genetic testing results from 1,198 single-center HCM probands and devised a widely applicable score to similar to identify which genes yield effective results in the diagnostic setting. Results: Compared with early panels targeting only fully validated sarcomeric HCM genes, expanded NGS panels allow the prompt recognition of probands with HCM-mimicking diseases. Scoring by diagnostic effectiveness highlighted that PLN should also be routinely screened besides historically validated genes for HCM and its mimics. Conclusion: The additive value of expanded panels in HCM genetic testing lies in the systematic screening of genes associated with HCM mimics, requiring different patient management. Only variants in a limited set of genes are highly actionable and interpretable in the clinic, suggesting that larger panels offer limited additional sensitivity. A score estimating the relative effectiveness of a given gene's inclusion in diagnostic panels is proposed.
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