Frequency and clinical expression of cardiac troponin I mutations in 748 consecutive families with hypertrophic cardiomyopathy
Jens Mogensen, MD, PhD*,*,
Ross T. Murphy, MD*,
Toru Kubo, MD*, ,
Ajay Bahl, MD*,
James C. Moon, MD ,
Ib C. Klausen, MD,
Perry M. Elliott, MD* and
William J. McKenna, MD*
* Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom
Department of Medicine and Geriatrics, Kochi Medical School, Kochi, Japan
Department of Cardiology, Skejby University Hospital, Aarhus, Denmark
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Figure 1 Distribution of mutations and amino acid polymorphisms in TNNI3 identified in the present study. The initial 280 patients with hypertrophic cardiomyopathy underwent mutation analysis in all protein-encoding exons of TNNI3 whereas the remaining 468 were investigated in exons 5, 7, and 8 only. Novel mutations are in italics. Exons are indicated by boxes, and interaction sites with other thin filament proteins are indicated with different patterns. Dotted patterns = troponin T-binding domain, residue 61 to 112; small slash pattern = troponin C-binding domain, residue, 113 to 164; large slash pattern = actin-binding domain, residue 130 to 148; 173 to 181.
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Figure 2 Pedigrees of hypertrophic cardiomyopathy (HCM) families with TNNI3 mutations. Squares = male family members; circles = female family members; symbols with slash = deceased individuals; open symbols = unaffected individuals; solid symbols = individuals affected; question mark = unknown clinical status; plus sign = presence of mutation; minus sign = absence of mutation. No clinical data were available in H375, II:6, but she was assumed to have HCM due to the fact that she was an obligate mutation carrier and had symptoms of disease preceding her unexplained sudden death.
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Figure 3 Cine cardiac magnetic resonance (CMR) images of hypertrophic cardiomyopathy (HCM) patients with TNNI3 mutations (30). A wide range of HCM was present including: (A) asymmetrical anteroseptal hypertrophy (Arg162Gln), (B) apical hypertrophy (Arg162Gln), (C) midcavity obstruction (Arg145Trp), (D) extreme biventricular hypertrophy (Arg141Gln), (E) "end-stage dilation" (Arg186Gln), and (F) restrictive cardiomyopathy in a child six years of age (de novo Lys178Glu) as recently reported (did not participate in this study) (32). CMR images: (A and B) From left to right: four-chamber, basal short-axis, and apical short-axis, all in diastole; (C to F) four-chamber systole, four-chamber diastole, short-axis diastole. (A and B) first image = four-chamber view, diastole; second image = cross-sectional view, papillary muscle level, diastole; third image = cross-sectional view, apical level, diastole. (D to F) first image = four-chamber view, systole; second image = four-chamber view, diastole; third image = papillary muscle level, diastole. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.
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Figure 4 Electrocardiograms of asymptomatic mutation carriers with normal left ventricular (LV) wall thickness on echocardiography. (A) H136, III:2 age 17 years: Q waves in III, V4 through V6; LV hypertrophy. (B) H15, III:2, age 36 years: left axis; Q waves in II, III, aVF; ST-segment abnormalities in II, III, V2 through V6. (C) H25, II:3, age 72 years: left axis; ST-segment abnormalities in I, aVL, V5 through V6; intraventricular conduction delay, V3 through V4.
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Figure 5 Phenotypic status and age at first clinical evaluation of all individuals identified with TNNI3 mutations including probands and clinically affected and unaffected mutation carriers. The mean age at first clinical evaluation of affected individuals (probands + affected relatives) was 39.9 years (standard deviation: 17.7) and for unaffected relatives 39.6 years (standard deviation: 18.2). Solid bars = probands; checkered bars = affected relatives with hypertrophic cardiomyopathy; open bars = unaffected relatives.
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