Tayal, Upasana; Newsome, Simon; Buchan, Rachel; Whiffin, Nicola; Halliday, Brian; Lota, Amrit; Roberts, Angharad; Baksi, A John; Voges, Inga; Midwinter, Will; +12 more... Wilk, Alijca; Govind, Risha; Walsh, Roddy; Daubeney, Piers; Jarman, Julian WE; Baruah, Resham; Frenneaux, Michael; Barton, Paul J; Pennell, Dudley; Ware, James S; Prasad, Sanjay K; Cook, Stuart A; (2017) Phenotype and Clinical Outcomes of Titin Cardiomyopathy. Journal of the American College of Cardiology, 70 (18). pp. 2264-2274. ISSN 0735-1097 DOI: https://doi.org/10.1016/j.jacc.2017.08.063
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Abstract
BACKGROUND: Improved understanding of dilated cardiomyopathy (DCM) due to titin truncation (TTNtv) may help guide patient stratification. OBJECTIVES: The purpose of this study was to establish relationships among TTNtv genotype, cardiac phenotype, and outcomes in DCM. METHODS: In this prospective, observational cohort study, DCM patients underwent clinical evaluation, late gadolinium enhancement cardiovascular magnetic resonance, TTN sequencing, and adjudicated follow-up blinded to genotype for the primary composite endpoint of cardiovascular death, and major arrhythmic and major heart failure events. RESULTS: Of 716 subjects recruited (mean age 53.5 ± 14.3 years; 469 men [65.5%]; 577 [80.6%] New York Heart Association function class I/II), 83 (11.6%) had TTNtv. Patients with TTNtv were younger at enrollment (49.0 years vs. 54.1 years; p = 0.002) and had lower indexed left ventricular mass (5.1 g/m2 reduction; padjusted = 0.03) compared with patients without TTNtv. There was no difference in biventricular ejection fraction between TTNtv+/- groups. Overall, 78 of 604 patients (12.9%) met the primary endpoint (median follow-up 3.9 years; interquartile range: 2.0 to 5.8 years), including 9 of 71 patients with TTNtv (12.7%) and 69 of 533 (12.9%) without. There was no difference in the composite primary outcome of cardiovascular death, heart failure, or arrhythmic events, for patients with or without TTNtv (hazard ratio adjusted for primary endpoint: 0.92 [95% confidence interval: 0.45 to 1.87]; p = 0.82). CONCLUSIONS: In this large, prospective, genotype-phenotype study of ambulatory DCM patients, we show that prognostic factors for all-cause DCM also predict outcome in TTNtv DCM, and that TTNtv DCM does not appear to be associated with worse medium-term prognosis.
Item Type | Article |
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Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Medical Statistics |
PubMed ID | 29073955 |
ISI | 413444900009 |
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