Genome-Wide Analysis of Left Ventricular Image-Derived Phenotypes Identifies Fourteen Loci Associated With Cardiac Morphogenesis and Heart Failure Development.

Nay Aung,Joao A.C Lima,Claudia P Cabrera,David A Bluemke,Chaojie Yang,Evan Tzanis,Steffen E Petersen,Stefan K Piechnik,Helen R Warren,Ani W Manichaikul,Patricia B Munroe,Kent D Taylor,Jose D Vargas,Stefan Neubauer,Michael R Barnes,Kenneth Fung,Jerome I Rotter

doi:10.1161/circulationaha.119.041161

Abstract

The genetic basis of left ventricular (LV) image-derived phenotypes, which play a vital role in the diagnosis, management, and risk stratification of cardiovascular diseases, is unclear at present. The LV parameters were measured from the cardiovascular magnetic resonance studies of the UK Biobank. Genotyping was done using Affymetrix arrays, augmented by imputation. We performed genome-wide association studies of 6 LV traits-LV end-diastolic volume, LV end-systolic volume, LV stroke volume, LV ejection fraction, LV mass, and LV mass to end-diastolic volume ratio. The replication analysis was performed in the MESA study (Multi-Ethnic Study of Atherosclerosis). We identified the candidate genes at genome-wide significant loci based on the evidence from extensive bioinformatic analyses. Polygenic risk scores were constructed from the summary statistics of LV genome-wide association studies to predict the heart failure events. The study comprised 16 923 European UK Biobank participants (mean age 62.5 years; 45.8% men) without prevalent myocardial infarction or heart failure. We discovered 14 genome-wide significant loci (3 loci each for LV end-diastolic volume, LV end-systolic volume, and LV mass to end-diastolic volume ratio; 4 loci for LV ejection fraction, and 1 locus for LV mass) at a stringent P<1×10-8. Three loci were replicated at Bonferroni significance and 7 loci at nominal significance (P<0.05 with concordant direction of effect) in the MESA study (n=4383). Follow-up bioinformatic analyses identified 28 candidate genes that were enriched in the cardiac developmental pathways and regulation of the LV contractile mechanism. Eight genes (TTN, BAG3, GRK5, HSPB7, MTSS1, ALPK3, NMB, and MMP11) supported by at least 2 independent lines of in silico evidence were implicated in the cardiac morphogenesis and heart failure development. The polygenic risk scores of LV phenotypes were predictive of heart failure in a holdout UK Biobank sample of 3106 cases and 224 134 controls (odds ratio 1.41, 95% CI 1.26 - 1.58, for the top quintile versus the bottom quintile of the LV end-systolic volume risk score). We report 14 genetic loci and indicate several candidate genes that not only enhance our understanding of the genetic architecture of prognostically important LV phenotypes but also shed light on potential novel therapeutic targets for LV remodeling.

Highlights

Heart failure is a clinically heterogeneous condition associated with a substantial mortality, morbidity and economic burden to the society[1]
Eight genes (TTN, BAG3, GRK5, HSPB7, MTSS1, ALPK3, NMB and MMP11) supported by at least two independent lines of in-silico evidence were implicated in the cardiac morphogenesis and heart failure development
The polygenic risk scores (PRSs) of left ventricular (LV) phenotypes were predictive of heart failure in a hold-out UK Biobank sample of 3,106 cases and 224,134 controls

Summary

Introduction

Heart failure is a clinically heterogeneous condition associated with a substantial mortality, morbidity and economic burden to the society[1]. Previous large-scale genetic association studies of LV imaging phenotypes[2,3] were hampered by the lack of a standardised measurement protocol in the phenotyping process and reliance on two-dimensional echocardiography (ECHO) with inherent dependency on geometric assumptions and adequate acoustic window. These shortcomings can be overcome by using the individual-level data from a single large study such as the UK Biobank, which provides accurate and reproducible imaging phenotypes from cardiovascular magnetic resonance (CMR) imaging, considered to be a reference standard for the assessment of cardiac morphology[4]. The genetic basis of left ventricular (LV) image-derived phenotypes, which play a vital role in the diagnosis, management and risk stratification of cardiovascular diseases, is unclear at present

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Conclusion