Determinants of incomplete penetrance and variable expressivity in heritable cardiac arrhythmia syndromes.

Determinants of incomplete penetrance and variable expressivity in heritable cardiac arrhythmia syndromes.
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DOI:
10.1016/j.trsl.2012.08.005
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发表时间:
2013-01
期刊:
Translational research : the journal of laboratory and clinical medicine
影响因子:
--
通讯作者:
Ackerman MJ
Ackerman MJ
中科院分区:
其他
文献类型:
--
作者:
Giudicessi JR;Ackerman MJ

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编码离子通道成孔 α 亚基和辅助 β 亚基以及细胞内钙处理蛋白的基因突变共同维持人类心脏的机电功能,是一系列心源性猝死 (SCD) 易遗传性心律失常综合征的潜在致病底物,包括长 QT 综合征 (LQTS)、短 QT 综合征 (SQTS)、布鲁格达综合征 (BrS) 和儿茶酚胺能多形性室性心动过速(CPVT)。与许多孟德尔疾病类似,心脏“通道病”表现出不完全的外显率、可变的表达性和表型重叠,因此同一遗传谱系内的基因型阳性个体呈现出截然不同的临床过程,正如通过心电图异常和心脏事件的数量/类型等表型特征客观评估的那样。在这篇综述中,我们总结了目前对 QT 间期等复杂心电图特征的整体结构的理解,重点关注常见遗传变异在健康心电图参数调节中的作用,以及临床实践中最有可能遇到的遗传性心律失常综合征中不完全外显率和可变表达性的环境和遗传决定因素。
Mutations in genes encoding ion channel pore-forming α-subunits and accessory β-subunits as well as intracellular calcium-handling proteins that collectively maintain the electromechanical function of the human heart serve as the underlying pathogenic substrate for a spectrum of sudden cardiac death (SCD)-predisposing heritable cardiac arrhythmia syndromes, including long QT syndrome (LQTS), short QT syndrome (SQTS), Brugada syndrome (BrS), and catecholaminergic polymorphic ventricular tachycardia (CPVT). Similar to many Mendelian disorders, the cardiac “channelopathies” exhibit incomplete penetrance, variable expressivity, and phenotypic overlap, whereby genotype-positive individuals within the same genetic lineage assume vastly different clinical courses as objectively assessed by phenotypic features such electrocardiographic abnormalities and number/type of cardiac events. In this Review, we summarize the current understanding of the global architecture of complex electrocardiographic traits such as the QT interval, focusing on the role of common genetic variants in the modulation of ECG parameters in health and the environmental and genetic determinants of incomplete penetrance and variable expressivity in the heritable cardiac arrhythmia syndromes most likely to be encountered in clinical practice.
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