IntroductionDilated cardiomyopathy (DCM; OMIM 115200) is a debilitating primary cardiac muscle disease with a 5-year mortality approaching 50% following diagnosis.1,2 Whether familial or sporadic, DCM shows remarkably high genetic heterogeneity. 3,4 To date, the molecular basis of most of DCM cases remains unknown despite the fact that mutations in more than 30 genes have been shown to be disease causing or disease associated. 5,6 Because of this marked locus heterogeneity, the fraction of DCM patients who have a mutation in any one gene is small, and ranged from 0.3% to 5.9% in our recent resequencing studies. [7][8][9][10] Most of the genes with mutations causing DCM encode for sarcomeric proteins involved in contraction, or cytoskeletal proteins important for cell structure or force transduction. 5,6 Exceptions to this include a mutation identifi ed in the eye absent transcription factor 4 (EYA4) in a family with both DCM and sensorineural hearing loss, 11 and mutations in the genes encoding presenilin 1 and 2 ( PSEN1 and PSEN2 ) that we recently identifi ed in DCM families.10 Although the pathogenic mechanisms of EYA4 and the presenilins in DCM remain to be defi ned, both are known to play regulatory roles in the heart even though they are neither essential structural components nor contractile proteins.A recent genetic linkage and gene-mapping study demonstrated that mutations in RBM20 , a ribonucleic acid (RNA)-binding protein gene, cause DCM.12 Th is discovery is intriguing in several aspects. To our knowledge, this is the fi rst report to suggest that a genetic abnormality of an RNA-binding protein can lead to cardiomyopathy.13 It is also noteworthy that RBM20 mutations were associated with severe cases of DCM with high mortality and patients needing heart transplantation. Moreover, the fi ve mutations identifi ed in the fi rst report were concentrated in a small region of RBM20, spanning only fi ve amino acids, and encoded by a single exon. 12To further evaluate the role of RBM20 in DCM pathogenesis and the DCM clinical characteristics caused by RBM20 mutations, we genetically screened a cohort of 312 DCM probands, and their family members when a mutation was identifi ed. We found six unique mutations in six unrelated probands, four of which were novel. Th ese results expand the RBM20 mutation spectrum in DCM and further emphasize the importance of RBM20 in the myocardial disease. Materials and Methods Clinical evaluationWritten, informed consent was obtained from all subjects, and the Institutional Review Boards at the Oregon Health & Science University and the University of Miami approved the study. Th e investigation included 312 probands (290 Caucasians, of whom 7 were of Hispanic descent; 16 African-Americans, 3 Asians and 3 Native Americans/Alaskan Natives) and used methods of clinical categorization of DCM as previously described.14 Clinical data were obtained through our own evaluations, which included minimally a history and physical examination, an electrocardiogram (ECG) and an echocardiogram...

Task-specific resistance training increased the overall ability and decreased the rise time required to perform a series of bed- and chair-rise tasks. The actual rise-time improvement was clinically small but may be useful over the long term. Future studies might consider adapting this exercise program and the focus on trunk function to a frailer cohort, such as in rehabilitation settings. In these settings, the less challenging rise tasks (such as rising from an elevated chair) and the ability to perform intermediate tasks (such as hip bridging) may become important intermediate rehabilitation goals.

Purpose HER2-targeted therapies have substantially improved the outcome of patients with breast cancer, however, they can be associated with cardiac toxicity. Guidelines recommend holding HER2-targeted therapies until resolution of cardiac dysfunction. SAFE-HEaRt is the first trial that prospectively tests whether these therapies can be safely administered without interruptions in patients with cardiac dysfunction. Methods Patients with stage I–IV HER2-positive breast cancer candidates for trastuzumab, pertuzumab or ado-trastuzumab emtansine (TDM-1), with left ventricular ejection fraction (LVEF) 40–49% and no symptoms of heart failure (HF) were enrolled. All patients underwent cardiology visits, serial echocardiograms and received beta blockers and ACE inhibitors unless contraindicated. The primary endpoint was completion of the planned HER2-targeted therapies without developing either a cardiac event (CE) defined as HF, myocardial infarction, arrhythmia or cardiac death or significant asymptomatic worsening of LVEF. The study was considered successful if planned oncology therapy completion rate was at least 30%. Results Of 31 enrolled patients, 30 were evaluable. Fifteen patients were treated with trastuzumab, 14 with trastuzumab and pertuzumab, and 2 with TDM-1. Mean LVEF was 45% at baseline and 46% at the end of treatment. Twenty-seven patients (90%) completed the planned HER2-targeted therapies. Two patients experienced a CE and 1 had an asymptomatic worsening of LVEF to ≤ 35%. Conclusion This study provides safety data of HER2-targeted therapies in patients with breast cancer and reduced LVEF while receiving cardioprotective medications and close cardiac monitoring. Our results demonstrate the importance of collaboration between cardiology and oncology providers to allow for delivery of optimal oncologic care to this unique population. Electronic supplementary material The online version of this article (10.1007/s10549-019-05191-2) contains supplementary material, which is available to authorized users.

Key PointsQuestionWhat is the prevalence of familial disease among patients with idiopathic dilated cardiomyopathy (DCM) and the lifetime risk of DCM for their first-degree family members by race and ethnicity?FindingsIn this family-based, cross-sectional study of 1220 patients with DCM and their 1693 family members, the estimated familial DCM prevalence was 29.7% and the estimated DCM risk by age 80 years in family members was 19%.MeaningThese findings suggest substantial prevalence of familial DCM among patients and elevated lifetime risk of DCM among their first-degree family members.

Lowering HOB height and seat height increased bed and chair rise task difficulty, particularly when hand use was restricted. Restricting hand use in low HOB height or lowered seat height conditions may help to identify older adults with declining rise ability. Yet, many of those who could not rise under "without hands" conditions could rise under "with hands" conditions, suggesting that dependency on hand use may be a marker of progressive rise impairment but may not predict day-to-day natural milieu rise performance. Intertask differences in performance time may be statistically significant but are clinically small. Given the relationship between self-reported ADL disability and rise performance, impaired rise performance may be considered a marker for ADL disability. These bed and chair rise tasks can serve as outcomes for an intervention to improve bed and chair rise ability and might also be used in future studies to quantify improvements or declines in function over time, to refine physical therapy protocols, and to examine the effect of bed and chair design modifications on bed and chai