The few foreign papers of the last decade have shown the relationship of various pathogenic variants of the ELAC2 gene to heterogeneous phenotypic manifestations, for which the unfavorable prognosis is common, caused by severe cardiomyopathy in the first year of life. The article presents the first clinical observation of a rare variant of the hypertrophic phenotype cardiomyopathy with a fatal outcome in the first year of life, and variants c.887T>C, p.L296P and c.1979A>T, p.K660I of the ELAC2 gene in Russia.The purpose of the work is to present clinical observation of a child with an early manifestation of a hypertrophic phenotype of cardiomyopathy caused by pathogenic variants of the ELAC2 gene.
Aim. To analyze and demonstrate various phenotypes in patients with familial left ventricular noncompaction (LVNC). Materials and methods. In 2013 was created a multicenter registry of LVNC patients. On its basis 30 families with a familial LVNC were selected. Results. 30 LVNC families were selected from the register. From a total of 115 people (probands and relatives) in 71 (61.7%) LVNC was diagnosed (30 probands and 41 relatives with non-compact myocardial criteria). The most common type of remodeling in patients was the dilated type (DT) (n=30), the isolated LVNC with preserved ejection fraction (EF) was slightly less common (n=23), and the hypertrophic type (GT) was detected in 8 patients. 4 patients were diagnosed with the isolated LVNC with a reduced EF. 3 patients were with a combination of non-compact myocardium with congenital heart disease and with a combination of DT and GT (DT+GT). During the analysis of cases a combination of different phenotypes in the same family was observed. The largest number of families was diagnosed with a combination of DT and the isolated LVNC with preserved EF. The development of cardiovascular complications was associated with DT. Conclusion. Family cases of LVNC had different types of myocardial remodeling and variants of clinical course. In one family a combination of different types of left ventricular remodeling is possible. DT is associated with the most severe clinical manifestations. The clinical picture of the isolated LVNC with preserved EF, is the most favorable, but in rare cases, serious clinical manifestations were observed.
The article presents the examination of three generations of a family with diagnosed left ventricular noncompaction (LVNC) and various phenotypic manifestations of the disease (isolated, hypertrophic and dilated type of LVNC). As a result of a molecular genetics tests, a previously undescribed single nucleotide deletion in the PRDM16 gene was revealed in all family members with the LVNC phenotype, leading to a frameshift mutation in exon 9 and the formation of a premature termination codon. This gene encodes a transcription factor responsible for after-birth suppressing the expression of genes involved in prenatal and postnatal development. Despite the presence of previous studies showing the relationship of the PRDM16 gene with LVNC development, currently there are insufficient data to prove the pathogenicity of the identified variant. However, the segregation of the symptomatic variant in three generations supports the association of the identified variant with LVNC. With the accumulation of information about changes in PRDM16 in patients with cardiomyopathies, it is possible to change the status of this gene and clarify its contribution to primary heart diseases.
PRKAG2 syndrome is a rare genetic disease that isinherited in an autosomal dominant fashion and is caused by mutationsin the PRKAG2 gene. Clinical symptoms include early onset, ventricular preexcitation, cardiac hypertrophy, and progressive atrioventricular block. The PRKAG2 syndrome is characterized by genetic heterogeneity, which makes early detection difficult; genophenotypic correlations have been documented. In this article, we provide an overview of the literature data and experience from the cardiology department of the National Medical Research Center for Children’s Health of the Russian Ministry of Health in the diagnosis and management of patients with PRKAG2 syndrome, and present the clinical and genetic characteristics of the p.R302Q and p.H383R variants of the PRKAG2 gene.
Danon disease is a rare hereditary disease with predominant damage to the heart and skeletal muscles. Danon disease is referred to lysosomal storage disorders with severe, progressive course and it often leads to an early mortality. The main cause of Danon disease is the mutations in the LAMP2 gene in the Xq24–q25 chromosome region. Danon disease has X-linked dominant nature of inheritance; women have a milder phenotype with older heart damage. For the first time the disease was described in boys with cardiomyopathy, severe skeletal myopathy and intellectual deficiency. The article presents up-to-date review on Danon disease and case reports of the cardiology department of the National Medical Research Center for Children’s Health, where 5 male patients were observed from 2014 to 2020, and the average age at diagnosis – 13,2 years. During the lab examination three patients demonstrated a significant increase of the heart failure marker (NT-proBNP) – more than 5 thousand pg/ml, the intracellular enzymes was more than 2,5 norms in 4 patients. The Wolff–Parkinson–White phenomenon is recorded in all patients on the ECG. Echocardiography in one patient showed a rare combination of myocardial hypertrophy and non-compact left ventricular myocardium. 2 patients had a combination of hypertrophic and dilated phenotypes with a reduced ejection fraction on Echo and severe myocardial fibrosis on MRI of the heart, which clinically manifested with chronic heart failure refractory to drug therapy, which required heart transplantation.
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