Clinical Impact of Genetic Testing for Long QT Syndrome - Evidence From a Nationwide LQTS Registry in Japan.
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Aiba Takeshi, Ohno Seiko, Takegami Misa, Kato Yoshiaki, Sakaguchi Heima, Shimamoto Keiko, Sonoda Keiko, Ida Kazufumi, Sumitomo Naokata, Nabeshima Taisuke, Murakami Takashi, Ninomiya Yumiko, Kato Koichi, Fukuyama Megumi, Makiyama Takeru, Hayashi Kenshi, Ohta Kunio, Morita Hiroshi, Nakajima Tadashi, Kaneko Yoshiaki, Yagihara Nobue, Otsuki Sou, Kosho Tomoki, Yoshida Yoko, Takamuro Motoki, Ueno Michihiko, Takahashi Tatsunori, Inden Yasuya, Hayabuchi Yasunobu, Muraji Shota, Watanabe Shigeo, Nishimura Kunihiro, Asano Yoshihiro, Horigome Hitoshi, Yoshinaga Masao, Horie Minoru, Shimizu Wataru, Kusano Kengo
Аннотация
METHODS AND RESULTS: Total 3,851 patients (proband: 2,316 [60%]; female: 2,283 [59%]; median age: 14 years [interquartile range 9-36 years]) diagnosed with LQTS (LQTS score ≥3.5, QTc ≥500 ms, pathogenic variants in LQTS-associated genes, or unexplored syncope with QTc 480-499 ms) were enrolled in this study. Of these patients, 1,146 (29.8%) experienced syncope and 322 (8.5%) experienced ventricular fibrillation (VF) or cardiopulmonary arrest (CPA) at ≤70 years of age. Genetic testing using a next-generation sequencing panel and/or Sanger sequencing was performed for 3,770 (98%) patients, genotype was then identified in the following LQTS-associated genes: KCNQ1 (45%), KCNH2 (34%), SCN5A (8%), KCNE1 (0.1%), KCNE2 (0.03%), KCNJ2 (2.7%), CACNA1C (1.2%), and CALM1,2 (0.3%). Forty-seven (1.2%) patients had double or compound heterozygous variants in LQTS-associated genes, whereas the genotype remained unknown in 220 (5.8%) patients. When comparing phenotype with genotype, QTc was significantly longer in CALM1,2 patients than in others except for CACNA1C, whereas QTc was almost normal in KCNJ2 patients. The incidence of the first cardiac event (syncope, VF/CPA) differed among the genotypes, and prognosis was significantly worse for CALM1,2 patients.
CONCLUSIONS: Comprehensive genetic testing, including non-major LQTS genes, is important for diagnosis and risk stratification of LQTS.