Abstract:
OBJECTIVES:The aim of this study was to investigate the clinical expression of adenosine monophosphate-activated protein kinase (AMPK) gene mutations (PRKAG2) in adenosine monophosphate (AMP) kinase disease based on 12 years follow-up of known mutation carriers and to define the prevalence of PRKAG2 mutations in hypertrophic cardiomyopathy (HCM). BACKGROUND:Adenosine monophosphate-activated protein kinase gene mutations cause HCM with Wolff-Parkinson-White syndrome and conduction disease. METHODS:Clinical evaluation of 44 patients with known AMP kinase disease was analyzed. Mutation analysis of PRKAG2 was performed by fluorescent single-strand confirmation polymorphism analysis and direct sequencing of abnormal conformers in 200 patients with HCM. RESULTS:Only one additional mutation was identified. The mean age at clinical diagnosis in the 45 gene carriers was 24 years (median 20 years, range 9 to 55 years). Symptoms of palpitation, dypspnea, chest pain, or syncope were present in 31 (69%) gene carriers; 7 (15%) complained of myalgia and had clinical evidence of proximal myopathy. Skeletal muscle biopsy showed excess mitochondria and ragged red fibers with minimal glycogen accumulation. Disease penetrance defined by typical electrocardiogram abnormalities was 100% by age 18 years. Thirty-two of 41 adults (78%) had left ventricular hypertrophy (LVH) on echocardiography, and progressive LVH was documented during follow-up. Survival was 91% at a mean follow-up of 12.2 years. Progressive conduction disease required pacemaker implantation in 17 of 45 (38%) at a mean age of 38 years. CONCLUSIONS:The AMP kinase disease is uncommon in HCM and is characterized by progressive conduction disease and cardiac hypertrophy and includes extracardiac manifestations such as a skeletal myopathy, consistent with a systemic metabolic storage disease. Defects in adenosine triphosphate utilization or in specific cellular substrates, rather than mere passive deposition of amylopectin, may account for these clinical features.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Murphy RT,Mogensen J,McGarry K,Bahl A,Evans A,Osman E,Syrris P,Gorman G,Farrell M,Holton JL,Hanna MG,Hughes S,Elliott PM,Macrae CA,McKenna WJdoi
10.1016/j.jacc.2004.11.053subject
Has Abstractpub_date
2005-03-15 00:00:00pages
922-30issue
6eissn
0735-1097issn
1558-3597pii
S0735-1097(04)02500-8journal_volume
45pub_type
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abstract:OBJECTIVES:This study analyzes the long-term course of patients with typical angina pectoris or anginalike chest pain and normal coronary angiographic findings. BACKGROUND:In previous studies of such patients the rate of occurrence of typical coronary events during follow-up has differed widely, depending on the durat...
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doi:10.1016/0735-1097(94)00519-v
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更新日期:2006-11-21 00:00:00
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更新日期:1997-08-01 00:00:00
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更新日期:1986-01-01 00:00:00