Nasonova S N, Meshkov A N, Zhirov I V, Osmolovskaya Y F, Shoshina A A, Gagloev A V, Dzhumaniiazova I H, Zelenova E A, Erema V V, Gusakova M S, Ivanov M V, Terekhov M V, Kashtanova D A, Nekrasova A I, Mitrofanov S I, Shingaliev A S, Yudin V S, Keskinov A A, Gomyranova N V, Chubykina U V, Ezhov M V, Tereshchenko S N, Yudin S M, Boytsov S A
Chazov National Medical Research Center of Cardiology.
National Research Center for Therapy and Preventive Medicine.
Ter Arkh. 2024 Oct 10;96(9):901-908. doi: 10.26442/00403660.2024.09.202852.
Dilated cardiomyopathy (DCM) is a leading cause of heart failure, sudden cardiac death, and heart transplantation in young patients. The causes of DCM are varied and include genetic factors and metabolic, infectious, toxic and others factors. Today it is known that germline mutations in more than 98 genes can be associated with the occurrence of DCM. However, the penetrance of these genes often depends on a combination of factors, including modifiable ones, i.e. those that change under the influence of the environment. About 20-25% of genetically determined forms of DCM are due to mutations in the titin gene (). Titin is the largest protein in the body, which is an important component of the sarcomer. Although titin is the largest protein in the human body, its role in the physiology of heart and disease is not yet fully understood. However, a mutation in the gene may later represent a potential therapeutic target for genetic and acquired cardiomyopathy. Thus, the analysis of clinical cases of cardiomyopathy in patients with identified mutations in the gene is of great scientific interest. The article presents a clinical case of manifestation of DCM in patient with a revealed pathogenic variant of mutation in the gene and reverse left ventricular remodeling of the against the background of optimal therapy of heart failure in a subsequent outpatient observation.
扩张型心肌病(DCM)是年轻患者心力衰竭、心源性猝死和心脏移植的主要原因。DCM的病因多种多样,包括遗传因素以及代谢、感染、中毒等因素。如今已知超过98个基因的种系突变可能与DCM的发生有关。然而,这些基因的外显率通常取决于多种因素的组合,包括可改变的因素,即在环境影响下会发生变化的因素。约20% - 25%的遗传决定型DCM是由肌联蛋白基因()突变引起的。肌联蛋白是体内最大的蛋白质,是肌节的重要组成部分。尽管肌联蛋白是人体中最大的蛋白质,但其在心脏生理学和疾病中的作用尚未完全明确。然而,该基因的突变可能日后成为遗传和获得性心肌病的潜在治疗靶点。因此,对已鉴定出该基因突变的患者的心肌病临床病例进行分析具有重大科学意义。本文介绍了一名患者DCM表现的临床病例,该患者在基因中发现了致病突变变体,并在随后的门诊观察中,在心力衰竭的最佳治疗背景下出现了左心室逆向重塑。