Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950, Barcelona, Spain.
Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ, Amsterdam, The Netherlands.
Int J Legal Med. 2023 Mar;137(2):345-351. doi: 10.1007/s00414-023-02951-0. Epub 2023 Jan 25.
Sudden death cases in the young population remain without a conclusive cause of decease in almost 40% of cases. In these situations, cardiac arrhythmia of genetic origin is suspected as the most plausible cause of death. Molecular autopsy may reveal a genetic defect in up to 20% of families. Most than 80% of rare variants remain classified with an ambiguous role, impeding a useful clinical translation. Our aim was to update rare variants originally classified as of unknown significance to clarify their role. Our cohort included fifty-one post-mortem samples of young cases who died suddenly and without a definite cause of death. Five years ago, molecular autopsy identified at least one rare genetic alteration classified then as ambiguous following the American College of Medical Genetics and Genomics' recommendations. We have reclassified the same rare variants including novel data. About 10% of ambiguous variants change to benign/likely benign mainly because of improved population frequencies. Excluding cases who died before one year of age, almost 21% of rare ambiguous variants change to benign/likely benign. This fact makes it important to discard these rare variants as a cause of sudden unexplained death, avoiding anxiety in relatives' carriers. Twenty-five percent of the remaining variants show a tendency to suspicious deleterious role, highlighting clinical follow-up of carriers. Periodical reclassification of rare variants originally classified as ambiguous is crucial, at least updating frequencies every 5 years. This action aids to increase accuracy to enable and conclude a cause of death as well as translation into the clinic.
在年轻人的猝死病例中,仍有近 40%的病例死因无法明确。在这些情况下,怀疑遗传起源的心律失常是最合理的死亡原因。分子尸检可能会在多达 20%的家庭中发现遗传缺陷。超过 80%的罕见变异仍然被归类为作用不明,阻碍了其在临床上的有效应用。我们的目的是更新最初被归类为意义不明的罕见变异,以阐明其作用。我们的队列包括 51 例死后样本,这些年轻人突然死亡,且死因不明。五年前,分子尸检确定了至少一种罕见的遗传改变,根据美国医学遗传学与基因组学学院的建议,这些改变被归类为意义不明。我们重新分类了相同的罕见变异,包括新的数据。大约 10%的意义不明的变异变为良性/可能良性,主要是因为人群频率的提高。排除在一岁前死亡的病例后,近 21%的罕见意义不明的变异变为良性/可能良性。这一事实使得将这些罕见变异排除为不明原因猝死的原因变得非常重要,从而避免了亲属携带者的焦虑。其余变异的 25%显示出可疑的有害作用倾向,突出了携带者的临床随访。对最初被归类为意义不明的罕见变异进行定期重新分类至关重要,至少每 5 年更新一次频率。这一行动有助于提高准确性,从而确定死因并将其转化为临床实践。