Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio.
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
J Card Fail. 2018 May;24(5):281-302. doi: 10.1016/j.cardfail.2018.03.004. Epub 2018 Mar 19.
This guideline describes the approach and expertise needed for the genetic evaluation of cardiomyopathy. First published in 2009 by the Heart Failure Society of America (HFSA), the guideline has now been updated in collaboration with the American College of Medical Genetics and Genomics (ACMG). The writing group, composed of cardiologists and genetics professionals with expertise in adult and pediatric cardiomyopathy, reflects the emergence and increased clinical activity devoted to cardiovascular genetic medicine. The genetic evaluation of cardiomyopathy is a rapidly emerging key clinical priority, because high-throughput sequencing is now feasible for clinical testing and conventional interventions can improve survival, reduce morbidity, and enhance quality of life. Moreover, specific interventions may be guided by genetic analysis. A systematic approach is recommended: always a comprehensive family history; an expert phenotypic evaluation of the proband and at-risk family members to confirm a diagnosis and guide genetic test selection and interpretation; referral to expert centers as needed; genetic testing, with pre- and post-test genetic counseling; and specific guidance as indicated for drug and device therapies. The evaluation of infants and children demands special expertise. The approach to managing secondary and incidental sequence findings as recommended by the ACMG is provided.
本指南描述了进行心肌病遗传评估所需的方法和专业知识。该指南最初由美国心力衰竭学会(HFSA)于 2009 年发布,现已与美国医学遗传学与基因组学学院(ACMG)合作进行了更新。该写作小组由在成人和儿科心肌病方面具有专业知识的心脏病专家和遗传专家组成,反映了心血管遗传医学的出现和临床活动的增加。心肌病的遗传评估是一个迅速成为关键临床重点的领域,因为高通量测序现在可用于临床检测,常规干预可以提高生存率、降低发病率并提高生活质量。此外,特定的干预措施可能可以通过基因分析来指导。建议采用系统的方法:始终进行全面的家族史调查;对先证者和有风险的家庭成员进行专家表型评估,以确认诊断并指导遗传检测选择和解释;根据需要转介至专家中心;进行遗传检测,并在检测前后提供遗传咨询;根据需要为药物和器械治疗提供具体指导。对婴儿和儿童的评估需要特殊的专业知识。本指南提供了 ACMG 推荐的管理继发性和偶发性序列发现的方法。