Dilated Cardiomyopathy 1A

A condition that produces weakness and structural alterations in the heart muscle. It results in an enlargement of the left ventricle making the heart unable to pump enough blood.

Dilated cardiomyopathy is one of the most common causes of heart failure and the most common indication for heart transplantation worldwide with a prevalence of 40 cases per 100,000 people. Dilated cardiomyopathy can have a genetic cause and can also originate from exposure to toxins, infections, metabolic/endocrine disturbances, autoimmunity or the presence of neuromuscular diseases such as Duchenne.

More than 60 genes have been linked to dilated cardiomyopathy, among which MYH7, TNNT2, TNNI3, TTN, DSP, LMNA and SCN5A are the most frequently found to be altered in patients. Dilated cardiomyopathy 1A is caused by the presence of pathogenic variants in the LMNA gene and is characterized by cardiac dilatation and reduced cardiac function.aca and a reduction in systolic function, accompanied by arrhythmias and a decrease in myocardial contractile force.

Symptoms

The symptoms of LMNA-associated dilated heart disease manifest themselves mainly in adults from 20-30 years of age, although there are studies that indicate that alterations can be observed in the electrocardiograms of patients as young as 7 years of age. Arrhythmias or other symptoms such as heart failure, progressive cardiac conduction defect and embolism of a left ventricular mural thrombus are usually observed. There are people who may be asymptomatic and it is detected that they present this pathology in other controls in which electrocardiograms are performed. With the progression of the disease, sudden cardiac death may occur.

Disease management

Current treatment of LMNA gene-related cardiomyopathy follows the general recommendations for the treatment of heart failure, including the use of beta-blocking drugs, ACE inhibitors or angiotensin receptor blockers. In terminal stages of heart failure, heart transplantation or implantation of ventricular assist devices may be necessary. To treat arrhythmias and prevent sudden cardiac death, an implantable cardioverter defibrillator may be used.

Although not much data is available, it is recommended that athletes with LMNA mutations should not participate in competitive sports, except for those of low intensity.

Genes analyzed

LMNA

Bibliography

Chen SN, Sbaizero O, Taylor MRG, Mestroni L.Lamin A/C Cardiomyopathy: Implications for Treatment. Curr Cardiol Rep. 2019 Nov 26;21(12):160.

Hershberger RE, Jordan E. LMNA-Related Dilated Cardiomyopathy. 2008 Jun 12 [updated 2022 Mar 17]. In: Adam MP, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, Gripp KW, Amemiya A, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2022.

Japp AG, Gulati A, Cook SA, Cowie MR, Prasad SK.The Diagnosis and Evaluation of Dilated Cardiomyopathy. J Am Coll Cardiol. 2016 Jun 28;67(25):2996-3010.

Reichart D, Magnussen C, Zeller T, et al.Dilated cardiomyopathy: from epidemiologic to genetic phenotypes: A translational review of current literature. J Intern Med. 2019 Oct;286(4):362-372.

Weintraub RG, Semsarian C, Macdonald P. Dilated cardiomyopathy. Lancet. 2017 Jul 22;390(10092):400-414.

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