Genotype-phenotype analysis and natural history of left ventricular hypertrophy in LEOPARD syndrome

Giuseppe Limongelli, Anna Sarkozy, Giuseppe Pacileo, Paolo Calabrò, Maria Cristina Digilio, Valeria Maddaloni, Giulia Gagliardi, Giovanni Di Salvo, Maria Iacomino, Bruno Marino, Bruno Dallapiccola, Raffaele Calabrò

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Abstract

Because it is unclear whether the genotype may influence the clinical course in patients with LEOPARD syndrome (LS), we analyzed clinical and molecular predictors of adverse cardiac events in patients with left ventricular hypertrophy (LVH). A comprehensive cardiovascular evaluation, including baseline electrocardiogram, echocardiography, exercise test and 24 hr Holter monitoring at the time of clinical diagnosis and during follow-up was conducted on 24 patients referred to our departments. Phenotypical examination and diagnosis were performed by expert clinical geneticists. The entire PTPN11 and RAF1 coding regions were screened for mutations by DHPLC analysis, followed by sequencing. Patients without PTPN11 mutations (34%) showed a higher frequency of family history of sudden death (P = 0.007), increased left atrial dimensions (P = 0.05), bradyarrhythmias (P = 0.04), episodes of supraventricular tachycardias (P = 0.06), atrial fibrillation (P = 0.009), and nonsustained ventricular tachycardias (P = 0.05) during Holter monitoring. Six patients (25%) had adverse cardiac events during follow-up (including sudden deaths, resuscitated cardiac arrest, septal myectomy, and heart failure). LVH, New York Heart Association Class, left ventricular outflow tract obstruction, and nonsustained ventricular tachycardias were associated to adverse cardiac events. Of note, three patients with mutations in exon 13 showed a severe obstructive cardiomyopathy, with serious cardiac complications during follow-up (heart failure, septal myectomy, and sudden death). In conclusion, patients with LVH associated with LS seem to carry a relatively high risk of adverse (arrhythmic and nonarrhythmic) events. Further genotype-phenotype studies are warranted to fully elucidate the impact of the genotype on the natural history of patients with LS and LVH.

Original languageEnglish
Pages (from-to)620-628
Number of pages9
JournalAmerican Journal of Medical Genetics, Part A
Volume146
Issue number5
DOIs
Publication statusPublished - Mar 1 2008

Fingerprint

LEOPARD Syndrome
Left Ventricular Hypertrophy
Genotype
Phenotype
Sudden Death
Ambulatory Electrocardiography
Ventricular Tachycardia
Mutation
Heart Failure
Ventricular Outflow Obstruction
Supraventricular Tachycardia
Bradycardia
Heart Arrest
Natural History
Cardiomyopathies
Exercise Test
Atrial Fibrillation
Echocardiography
Exons
Electrocardiography

Keywords

  • Clinical outcome
  • Left ventricular hypertrophy
  • LEOPARD syndrome
  • PTPN11 mutations

ASJC Scopus subject areas

  • Genetics(clinical)
  • Genetics
  • Medicine(all)

Cite this

Genotype-phenotype analysis and natural history of left ventricular hypertrophy in LEOPARD syndrome. / Limongelli, Giuseppe; Sarkozy, Anna; Pacileo, Giuseppe; Calabrò, Paolo; Digilio, Maria Cristina; Maddaloni, Valeria; Gagliardi, Giulia; Di Salvo, Giovanni; Iacomino, Maria; Marino, Bruno; Dallapiccola, Bruno; Calabrò, Raffaele.

In: American Journal of Medical Genetics, Part A, Vol. 146, No. 5, 01.03.2008, p. 620-628.

Research output: Contribution to journalArticle

Limongelli, G, Sarkozy, A, Pacileo, G, Calabrò, P, Digilio, MC, Maddaloni, V, Gagliardi, G, Di Salvo, G, Iacomino, M, Marino, B, Dallapiccola, B & Calabrò, R 2008, 'Genotype-phenotype analysis and natural history of left ventricular hypertrophy in LEOPARD syndrome', American Journal of Medical Genetics, Part A, vol. 146, no. 5, pp. 620-628. https://doi.org/10.1002/ajmg.a.32206
Limongelli, Giuseppe ; Sarkozy, Anna ; Pacileo, Giuseppe ; Calabrò, Paolo ; Digilio, Maria Cristina ; Maddaloni, Valeria ; Gagliardi, Giulia ; Di Salvo, Giovanni ; Iacomino, Maria ; Marino, Bruno ; Dallapiccola, Bruno ; Calabrò, Raffaele. / Genotype-phenotype analysis and natural history of left ventricular hypertrophy in LEOPARD syndrome. In: American Journal of Medical Genetics, Part A. 2008 ; Vol. 146, No. 5. pp. 620-628.
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abstract = "Because it is unclear whether the genotype may influence the clinical course in patients with LEOPARD syndrome (LS), we analyzed clinical and molecular predictors of adverse cardiac events in patients with left ventricular hypertrophy (LVH). A comprehensive cardiovascular evaluation, including baseline electrocardiogram, echocardiography, exercise test and 24 hr Holter monitoring at the time of clinical diagnosis and during follow-up was conducted on 24 patients referred to our departments. Phenotypical examination and diagnosis were performed by expert clinical geneticists. The entire PTPN11 and RAF1 coding regions were screened for mutations by DHPLC analysis, followed by sequencing. Patients without PTPN11 mutations (34{\%}) showed a higher frequency of family history of sudden death (P = 0.007), increased left atrial dimensions (P = 0.05), bradyarrhythmias (P = 0.04), episodes of supraventricular tachycardias (P = 0.06), atrial fibrillation (P = 0.009), and nonsustained ventricular tachycardias (P = 0.05) during Holter monitoring. Six patients (25{\%}) had adverse cardiac events during follow-up (including sudden deaths, resuscitated cardiac arrest, septal myectomy, and heart failure). LVH, New York Heart Association Class, left ventricular outflow tract obstruction, and nonsustained ventricular tachycardias were associated to adverse cardiac events. Of note, three patients with mutations in exon 13 showed a severe obstructive cardiomyopathy, with serious cardiac complications during follow-up (heart failure, septal myectomy, and sudden death). In conclusion, patients with LVH associated with LS seem to carry a relatively high risk of adverse (arrhythmic and nonarrhythmic) events. Further genotype-phenotype studies are warranted to fully elucidate the impact of the genotype on the natural history of patients with LS and LVH.",
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