Phenotype/Genotype Relationship in Left Ventricular Noncompaction: Ion Channel Gene Mutations Are Associated With Preserved Left Ventricular Systolic Function and Biventricular Noncompaction Phenotype/Genotype of Noncompaction

Background: Few data exist concerning genotype-phenotype relationships in left ventricular noncompaction (LVNC). Methods and Results: From a multicenter French Registry, we report the genetic and clinical spectrum of 95 patients with LVNC, and their genotype-phenotype relationship. Among the 95 LVNC, 45 had at least 1 mutation, including 14 cases of mutation in ion channel genes. In a complementary analysis including 16 additional patients with ion channel gene mutations, for a total of 30 patients with ion channel gene mutation, we found that those patients had higher median LV ejection fraction (60% vs 40%; P <.001) and more biventricular noncompaction (53.1% vs 18.5%; P <.001) than the 81 other patients with LVNC. Among them, both the 19 patients with an HCN4 mutation and the 11 patients with an RYR2 mutation presented with a higher LV ejection fraction and more frequent biventricular noncompaction than the 81 patients with LVNC but with no mutation in the ion channel gene, but only patients with HCN4 mutation presented with a lower heart rate. Conclusions: Ion channel gene mutations should be searched systematically in patients with LVNC associated with either bradycardia or biventricular noncompaction, particularly when LV systolic function is preserved. Identifying causative mutations is of utmost importance for genetic counselling of at-risk relatives of patients affected by LVNC.

Automated summary

The study revealed the importance of genotype-phenotype relationship in patients with LVNC, particularly in those with ion channel gene mutations. Patients with ion channel gene mutations presented higher LV ejection fraction and more frequent biventricular noncompaction compared to those without mutations, highlighting the significance of identifying causative mutations for genetic counseling and management of the disease.