Mutations in the lamin A/C gene are variably phenotypically expressed; however, it is unclear whether circulating cardiac biomarkers are helpful in the detection and risk assessment of cardiolaminopathies. We sought to assess (1) clinical characteristics including serum biomarkers: high sensitivity troponin T (hsTnT) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) in clinically stable cardiolaminopathy patients, and (2) outcome among pathogenic/likely pathogenic lamin A/C gene (LMNA) mutation carriers. Our single-centre cohort included 53 patients from 21 families. Clinical, laboratory, follow-up data were analysed. Median follow-up was 1522 days. The earliest abnormality, emerging in the second and third decades of life, was elevated hsTnT (in 12% and in 27% of patients, respectively), followed by the presence of atrioventricular block, heart failure, and malignant ventricular arrhythmia (MVA). In patients with missense vs. other mutations, we found no difference in MVA occurrence and, surprisingly, worse transplant-free survival. Increased levels of both hsTnT and NT-proBNP were strongly associated with MVA occurrence (HR > 13, p ≤ 0.02 in both) in univariable analysis. In multivariable analysis, NT-proBNP level > 150 pg/mL was the only independent indicator of MVA. We conclude that assessment of circulating cardiac biomarkers may help in the detection and risk assessment of cardiolaminopathies.

译文

:lamin A / C基因中的突变是可变表型表达的;然而,尚不清楚循环的心脏生物标志物是否有助于检测和诊断糖尿病。我们寻求评估(1)临床特征,包括血清生物标志物:临床稳定的心律不齐患者中的高敏感性肌钙蛋白T(hsTnT)和N端激素激素钠(NT-proBNP),以及(2)致病性/可能致病性lamin的预后A / C基因(LMNA)突变携带者。我们的单中心队列包括来自21个家庭的53名患者。临床,实验室,随访数据进行了分析。中位随访时间为1522天。最早的异常出现在生命的第二个和第三个十年,其hsTnT升高(分别在12%和27%的患者中),然后出现房室传导阻滞,心力衰竭和恶性室性心律不齐(MVA)。在有错义突变与其他突变的患者中,我们发现MVA的发生没有差异,令人惊讶的是,无移植生存期更差。在单变量分析中,hsTnT和NT-proBNP水平的升高与MVA的发生密切相关(两者均HR> 13,p≤0.02)。在多变量分析中,NT-proBNP水平> 150 pg / mL是MVA的唯一独立指标。我们得出的结论是,对循环心脏生物标志物的评估可能有助于发现和预防糖尿病。

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