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Pathogenicity Assignment of Variants in Genes Associated With Cardiac Channelopathies Evolve Toward Diagnostic Uncertainty.

Publication ,  Journal Article
Rosamilia, MB; Lu, IM; Landstrom, AP
Published in: Circ Genom Precis Med
June 2022

BACKGROUND: Accurately determining variant pathogenicity is critical in the diagnosis of cardiac channelopathies; however, it remains unknown how variant pathogenicity status changes over time. Our aim is to use a comprehensive analysis of ClinVar to understand the mutability of variant evaluation in channelopathy-associated genes to inform clinical decision-making around variant calling. METHODS: We identified 10 genes (RYR2, CASQ2, KCNQ1, KCNH2, SCN5A, CACNA1C, CALM1, CALM2, CALM3, TRDN) strongly associated with cardiac channelopathies, as well as 3 comparison gene sets (disputed long QT syndrome, sudden unexpected death in epilepsy, and all ClinVar). We comprehensively analyzed variant pathogenicity calls over time using the ClinVar database with Rstudio. Analyses focused on the frequency and directionality of clinically meaningful changes in disease association, defined as a change from one of the following three categories to another: likely benign/benign, conflicting evidence of pathogenicity/variant of uncertain significance, and likely pathogenic/pathogenic. RESULTS: In total, among channelopathy-associated genes, there were 9975 variants in ClinVar and 8.4% had a clinically meaningful change in disease association at least once over the past 10 years, as opposed to 4.9% of all ClinVar variants. The 3 channelopathy-associated genes with the most variants undergoing a clinically significant change were KCNQ1 (20.9%), SCN5A (11.2%), and KCNH2 (10.1%). Ten of the 12 included genes had variant evaluations that trended toward diagnostic uncertainty over time. Specifically, channelopathy-associated gene variants with either pathogenic/likely pathogenic or benign/likely benign assignments were 5.6× and 2×, respectively, as likely to be reevaluated to conflicting/variant of uncertain significance compared to the converse. CONCLUSIONS: Over the past 10 years, 8.4% of variants in channelopathy-associated genes have changed pathogenicity status with a decline in overall diagnostic certainty. Ongoing clinical and genetic variant follow-up is needed to account for presence of clinically meaningful change in variant pathogenicity assignment over time.

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Published In

Circ Genom Precis Med

DOI

EISSN

2574-8300

Publication Date

June 2022

Volume

15

Issue

3

Start / End Page

e003491

Location

United States

Related Subject Headings

  • Virulence
  • Uncertainty
  • NAV1.5 Voltage-Gated Sodium Channel
  • KCNQ1 Potassium Channel
  • Humans
  • ERG1 Potassium Channel
  • Channelopathies
  • Arrhythmias, Cardiac
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Rosamilia, M. B., Lu, I. M., & Landstrom, A. P. (2022). Pathogenicity Assignment of Variants in Genes Associated With Cardiac Channelopathies Evolve Toward Diagnostic Uncertainty. Circ Genom Precis Med, 15(3), e003491. https://doi.org/10.1161/CIRCGEN.121.003491
Rosamilia, Michael B., Isa M. Lu, and Andrew P. Landstrom. “Pathogenicity Assignment of Variants in Genes Associated With Cardiac Channelopathies Evolve Toward Diagnostic Uncertainty.Circ Genom Precis Med 15, no. 3 (June 2022): e003491. https://doi.org/10.1161/CIRCGEN.121.003491.
Rosamilia MB, Lu IM, Landstrom AP. Pathogenicity Assignment of Variants in Genes Associated With Cardiac Channelopathies Evolve Toward Diagnostic Uncertainty. Circ Genom Precis Med. 2022 Jun;15(3):e003491.
Rosamilia, Michael B., et al. “Pathogenicity Assignment of Variants in Genes Associated With Cardiac Channelopathies Evolve Toward Diagnostic Uncertainty.Circ Genom Precis Med, vol. 15, no. 3, June 2022, p. e003491. Pubmed, doi:10.1161/CIRCGEN.121.003491.
Rosamilia MB, Lu IM, Landstrom AP. Pathogenicity Assignment of Variants in Genes Associated With Cardiac Channelopathies Evolve Toward Diagnostic Uncertainty. Circ Genom Precis Med. 2022 Jun;15(3):e003491.

Published In

Circ Genom Precis Med

DOI

EISSN

2574-8300

Publication Date

June 2022

Volume

15

Issue

3

Start / End Page

e003491

Location

United States

Related Subject Headings

  • Virulence
  • Uncertainty
  • NAV1.5 Voltage-Gated Sodium Channel
  • KCNQ1 Potassium Channel
  • Humans
  • ERG1 Potassium Channel
  • Channelopathies
  • Arrhythmias, Cardiac