J Am Coll Cardiol. 2018 Nov 13;72(20):2471-2481. doi: 10.1016/j.jacc.2018.08.2181.
Dilated Cardiomyopathy Due to BLC2-Associated Athanogene 3 (BAG3) Mutations.
Domínguez F1, Cuenca S2, Bilińska Z3, Toro R4, Villard E5, Barriales-Villa R6, Ochoa JP7, Asselbergs F8, Sammani A9, Franaszczyk M10, Akhtar M11, Coronado-Albi MJ12, Rangel-Sousa D13, Rodriguez-Palomares JF14, Jiménez-Jáimez J15, Garcia-Pinilla JM16, Ripoll-Vera T17, Mogollón-Jiménez MV18, Fontalba-Romero A19, Garcia-Medina D20, Palomino-Doza J21, de Gonzalo-Calvo D22, Cicerchia M23, Salazar-Mendiguchia J23, Salas C24, Pankuweit S25, Hey TM26, Mogensen J26, Barton PJ27, Charron P5, Elliott P11, Garcia-Pavia P28; European Genetic Cardiomyopathies Initiative Investigators.
The BAG3 (BLC2-associated athanogene 3) gene codes for an antiapoptotic protein located on the sarcomere Z-disc. Mutations in BAG3 are associated with dilated cardiomyopathy (DCM), but only a small number of cases have been reported to date, and the natural history of BAG3 cardiomyopathy is poorly understood.
This study sought to describe the phenotype and prognosis of BAG3 mutations in a large multicenter DCM cohort.
The study cohort comprised 129 individuals with a BAG3 mutation (62% males, 35.1 ± 15.0 years of age) followed at 18 European centers. Localization of BAG3 in cardiac tissue was analyzed in patients with truncating BAG3 mutations using immunohistochemistry.
At first evaluation, 57.4% of patients had DCM. After a median follow-up of 38 months (interquartile range: 7 to 95 months), 68.4% of patients had DCM and 26.1% who were initially phenotype-negative developed DCM. Disease penetrance in individuals >40 years of age was 80% at last evaluation, and there was a trend towards an earlier onset of DCM in men (age 34.6 ± 13.2 years vs. 40.7 ± 12.2 years; p = 0.053). The incidence of adverse cardiac events (death, left ventricular assist device, heart transplantation, and sustained ventricular arrhythmia) was 5.1% per year among individuals with DCM. Male sex, decreased left ventricular ejection fraction. and increased left ventricular end-diastolic diameter were associated with adverse cardiac events. Myocardial tissue from patients with a BAG3 mutation showed myofibril disarray and a relocation of BAG3 protein in the sarcomeric Z-disc.
DCM caused by mutations in BAG3 is characterized by high penetrance in carriers >40 years of age and a high risk of progressive heart failure. Male sex, decreased left ventricular ejection fraction, and enlarged left ventricular end-diastolic diameter are associated with adverse outcomes in patients with BAG3 mutations.
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BAG3; dilated cardiomyopathy; genetics; prognosis