Opportunistic Genetic Screening for Familial Hypercholesterolemia in Heart Transplant Patients.

Heart transplantation remains the gold standard for the treatment of advanced heart failure (HF). Identification of the etiology of HF is mandatory, as the specific pathology can determine subsequent treatment. Early identification of familial hypercholesterolemia (FH), the most common genetic disorder associated with premature cardiovascular disease, has a potential important impact on clinical management and public health. We evaluated the genetic information in the genes associated with FH in a cohort of 140 heart-transplanted patients. All patients underwent NGS genetic testing including , and . We identified four carriers of rare pathogenic variants in and . Although all four identified carriers had dyslipidemia, only the one carrying the pathogenic variant c.676T>C was transplanted due to CAD. Another patient with heart valvular disease was carrier of the controversial c.2096C>T. Two additional patients with non-ischemic dilated cardiomyopathy were carriers of variants in (c.4672A>G and c.5600G>A). In our cohort, we identified the genetic cause of FH in patients that otherwise would not have been diagnosed. Opportunistic genetic testing for FH provides important information to perform personalized medicine and risk stratification not only for patients but also for relatives at concealed high cardiovascular risk. Including the gene in standard NGS cardiovascular diagnostics panels should be considered.