a-    Background

Hypertrophic cardiomyopathy (HCM, OMIM#192600) is a well-known primary disease of the myocardium. HCM is defined by unexplained ventricular hypertrophy with preferential hypertrophy of the septum and anterior left ventricular wall in the absence of a detectable cause.

This disorder has a prevalence within the general population of one in 500, or 0.2%. It follows a heterogeneous autosomal dominant inheritance pattern and often develops during childhood and adolescence. Individuals with the disease may develop myocardial ischemia, arrhythmia or heart failure. Notably, HCM is the most common cause of sudden cardiac death in young adults and athletes.

Genes encoding for cardiac sarcome proteins accounts for up to 60% of cases of HCM. The remaining causes include other genetic syndromes (mostly inherited metabolic and neuromuscular disorders) and non-genetic factors mimicking the genetic form of the disease.

b-   How does it work ?

• Stage 1: Patient identification
  Discussion of personnal and family history
  Eplanation of genetic testing options
• Stage 2: Sample submission
  The patient’s sample and necessary paperwork are sent to the laboratory
• Stage 3: Genetic testing
  At the laboratory, genetic testing for most genes includes next-generation sequencing and/or exon aray analysis
• Stage 4: Genetic test results
  Contains information on the results of the genetic test and available medical management options.
  The final report is sent to the ordering HPC, Health and Prevention Center specialist
• Stage 5: Post-test discussion
  HPC, Health and Prevention Center specialist discusses the test resutls, medical management options, and implication for family members with the patient

c-   To whom it is recommended?

Clinical indication

This test is indicated for:

• Diagnosis confirmation and refinement of a patient with a definite or suspected cardiomyopathy
• Predictive diagnosis in asymptomatic relatives

Patient Eligibility

• Individuals with a suspected or confirmed diagnosis of HCM
• Individuals with a family history of sudden death
• Individuals with left ventricular thickening and suspected HCM
• Athletes with ventricular hypertrophy
• Genetic study of family members for abnormalities identified in index cases

d-    Why choose this assay?

Test Benefits & Risk Management

Benefits of this test are:

• The diagnosis confirmation and refinement of a patient supposedly affected by HCM, e.g. discrimination between HCM and other causes of left ventricular (LV) hypertrophy, including hypertension, “athlete’s heart” and other metabolic or infiltrative storage disorders with LV hypertrophy that can mimic clinically diagnosed HCM (Fabry disease, Noonan disease, Danon disease, etc.).
  An early identification, would allow an earlier treatment of these different conditions.
• The subsequent identification of affected relatives in families where a causative HCM mutation has already been found. This would allow an earlier management of at-risk members and avoid unnecessary further screening of non-carriers.

Risk management includes, but is not limited to: 

• Monitoring of the disease: Regular cardiologic evaluation is advised to detect clinical signs of HCM and to estimate the risk of sudden cardiac death.
• Lifestyle changes: Intense physical activity (e.g., burst activities, sprinting), or systematic isometric exercise (e.g., heavy lifting) will be discouraged.
• Implantable cardiac defibrillators (ICDs) for secondary or primary prevention in patients at right risk of sudden cardiac death.
• A range of drugs exists to manage specific symptoms. For instance, drugs appropriate to control heart failure symptoms, such as beta-blockers, which may be used to relieve palpitation and calcium antagonists, which can similarly reduce palpitations and chest pains.
• Surgical septal myectomy, which removes some of the thickened muscle from the septum thereby relieving obstruction or alcohol septal ablation for progressive and drug-refractory heart failure caused by left ventricular outflow tract (LVOT) obstruction.
• Heart transplantation for systolic (or less frequently intractable diastolic) dysfunction associated with severe unrelenting symptoms.
• Drug therapy (Disopyramide, amiodarone, dronedarone) or possibly radiofrequency ablation or surgical maze procedure for atrial fibrillation.

 e–   What is investigated?

Panel composition

Gene	MIM Gene	Related disease
ACTC1	102540	HCM, DCM, LVNC
GLA	300644	Fabry disease
MYBPC3	600958	HCM, DCM, LVNC
MYH7	160760	HCM, DCM, LVNC
MYL2	160781	HCM
MYL3	160790	HCM
PRKAG2	602743	Glycogen storage disease of heart, leathal congenital, HCM
PTPN11	176876	Noonan syndrome, Leopard syndrome
TNNI3	191044	HCM, DCM, LVNC, RCM
TNNT2	191045	HCM, DCM, LVNC, RCM
TPM1	191010	HCM, DCM, LVNC

HCM: Hypertrophic cardiomyopathy; DCM: Dilated cardiomyopathy; LVNC: Left ventricular non-compaction; RCM: Restictive cardiomyopathy

Technical Details

Methodology

• Targeted capture of all coding exons and exon-intron boundaries followed by NGS.

TAT

 6 weeks on average. Urgent testing is available upon request.

Cost CHF 5’700.00