Ventricular pre-excitation and cardiac hypertrophy mimicking hypertrophic cardiomyopathy in a Turkish family with a novel PRKAG2 mutation.

BACKGROUND: Mutations in PRKAG2, the gene for the gamma2 regulatory subunit of AMP-activated protein kinase, cause cardiac hypertrophy and electrophysiological abnormalities. We identified a novel mutation in PRKAG2 causing familial ventricular pre-excitation and severe cardiac hypertrophy.

METHODS AND RESULTS: We studied 30 members of one family and 120 healthy controls. Molecular analysis of PRKAG2 gene revealed one missense mutation in exon 14 which was confirmed by restriction enzyme digestion. We identified a G to A transition, resulting in a Glu506Lys substitution in the PRKAG2 gene in 8 of the family members, who all had cardiac hypertrophy and ventricular pre-excitation. High incidence of right ventricular hypertrophy and left ventricular outflow tract obstruction are other prominent features of this novel PRKAG2 mutation. Family members without mutation had no cardiac disease. The 120 unrelated healthy individuals did not show this mutation.

CONCLUSIONS: Coexistence of unexplained ventricular hypertrophy and pre-excitation should prompt the diagnosis of PRKAG2 mutations and these patients should be referred for genetic analysis. The possible alteration of AMP-activated protein kinase activity due to genetic defects in PRKAG2 may serve as a template for developing more specific therapies in the treatment of patients with this mutation.