致病性心肌病相关的基因变异和心房的预后:在18,000名临床试验参与者的结果
Sean J Jurgens1, Giorgio E M Melloni2, Shinwan Kany3
1Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
Journal of the American College of Cardiology
|September 3, 2025
概括
与心肌病相关的罕见遗传变异会增加心力衰竭和心血管死亡的风险. 根据大量临床试验数据,这些遗传标记并没有增加中风风险.
科学领域:
- 心血管遗传学
- 临床心脏病学
- 基因组学
背景情况:
- 心肌病基因的遗传变异是已知的心房动 (AF) 的风险因素.
- 然而,对于携带这些特定基因变异的AF患者的临床结果的数据有限.
- 了解这些关联对于风险分层和患者管理至关重要.
研究的目的:
- 在被诊断为心房的患者中,研究与心肌病相关的罕见致病变体 (CMP- PLP) 的预后意义.
- 分析大量临床试验的结果.
主要方法:
- 在五项跨国试验 (ENGAGE AF,FOURIER,SAVOR,PEGASUS,DECLARE) 中使用外体序列测定来识别CMP- PLP载体,并在EAST- AFNET-4试验中进行复制.
- 使用后勤和考克斯回归模型来评估AF患者与预期结果的关联.
- 这项研究包括17,190名有过肌痛前科的患者,确定了421名 (2. 4%) 的CMP- PLP携带者.
主要成果:
- 携带CMP-PLP的患者心力衰竭史 (OR: 1.66) 的患病率较高,心力衰竭病例住院的风险也较高 (HR: 1. 75).
- 扩张性,高性和心律失常性右心室肌病变体与这些HF结局显著相关.
- 发现与心血管死亡风险增加 (HR: 1.46) 的名义关联,主要由扩张性心肌病变体驱动,但没有观察到与缺血性中风风险的显著关联.
结论:
- 在AF患者中罕见的心肌病基因变异与心力衰竭住院和心血管死亡的风险增加有关.
- 这些基因变异似乎不会增加AF患者中风的风险.
- 这些发现突显了鉴定心肌病相关遗传变异在心房的治疗中的预后重要性.
相关概念视频
Cardiomyopathy III: Hypertrophic Cardiomyopathy
45
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
45
Cardiomyopathy I: Introduction and Classification
50
Cardiomyopathy, or CMP, is a group of diseases affecting the myocardial structure, impairing its ability to pump blood effectively. This condition can lead to arrhythmias, heart failure, or sudden cardiac death.Cardiomyopathies are classified into primary and secondary categories:Primary Cardiomyopathy refers to conditions involving only the heart muscle that are often idiopathic (of unknown cause) or genetic. They primarily affect the myocardium without the involvement of other systemic...
50
Cardiomyopathy II: Dilated Cardiomyopathy
21
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
21
Cardiomyopathy V: Interprofessional Care
32
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
32
Cardiomyopathy IV: Restrictive Cardiomyopathy
27
Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
27
Heart Failure II: Pathophysiology
37
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
37


