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Determining the Likelihood of Variant Pathogenicity Using Amino Acid-level Signal-to-Noise Analysis of Genetic Variation
Published on: January 16, 2019
Genetic Testing in Hypertrophic Cardiomyopathy
Catherine G Ireland1, Carolyn Y Ho1
1Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Insights
Genetic testing aids hypertrophic cardiomyopathy (HCM) diagnosis and management by identifying causative variants. This genetic information is crucial for accurate diagnosis, family screening, and personalized patient care.
Area of Science:
- Cardiovascular Genetics
- Molecular Diagnostics
Background:
- Hypertrophic cardiomyopathy (HCM) diagnosis and management benefit significantly from genetic testing.
- Identifying causative genetic variants is key to understanding disease mechanisms and inheritance patterns.
Purpose of the Study:
- To outline the role and utility of genetic testing in hypertrophic cardiomyopathy (HCM).
- To discuss the implications of genetic testing for patient diagnosis, family screening, and clinical management.
Main Methods:
- Review of current genetic testing methodologies for HCM.
- Analysis of variant identification rates and their clinical significance.
- Discussion of genetic counseling and interpretation of results.
Main Results:
- Modern genetic testing identifies causative variants in 30% to over 60% of HCM patients.
- Test positivity is influenced by patient characteristics, such as family history.
- Positive results clarify diagnosis and facilitate targeted family screening.
Conclusions:
- Genetic testing is an essential tool for diagnosing and managing HCM patients and their families.
- Interpreting genetic test results requires expertise and multidisciplinary collaboration.
- Predictive testing in at-risk family members aids in risk stratification and screening decisions.
Abstract:
Genetic testing is an important tool in the diagnosis and management of patients and families with hypertrophic cardiomyopathy (HCM). Modern testing can identify causative variants in 30 to >60% of patients, with probability of a positive test varying with baseline characteristics such as known family history of HCM. Patients diagnosed with HCM should be offered genetic counseling and genetic testing as appropriate. Standard multigene panels evaluate sarcomeric genes known to cause HCM as well as genetic conditions that can mimic HCM but require different management. Positive genetic testing (finding a pathogenic or likely pathogenic variant) helps to clarify diagnosis and assists in family screening. If there is high confidence that an identified variant is the cause of HCM, at-risk family members can pursue predictive testing to determine if they are truly at risk or if they can be dismissed from serial screening based on whether they inherited the family's causative variant. Interpreting test results can be complex, and providers should make use of multidisciplinary teams as well as evidence-based resources to obtain the best possible understanding of pathogenicity.
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