Restrictive cardiomyopathy: difficulties desminopathy diagnostics

Abstract

The article provides a brief overview of the problems of diagnostics and etiological verification of restrictive cardiomyopathy (RCMP). Multiple causes lead to the restrictive phenotype of intracardiac hemodynamics and diastolic dysfunction of the heart: infiltrative (amyloidosis, sarcoidosis, elastoma, metabolic syndrome, tumor metastasis to the myocardium); endomyocardial (tropical endomyocardial fibrosis, hypereosinophilic syndrome, carcinoid, radiation damage); accumulation diseases (hemochromatosis, Pompe and Gaucher diseases, Fabry disease). RKMP is also characteristic for desminopathy — so-called desmin storage disease. This is a disease caused by mutations in the desmin gene (DES) that determine the development of cardiomyopathy or myofibrillar myopathy, and in some cases cause a combined phenotype of the disease. Desmin belongs to the group of intermediate filaments that maintain the structural and functional integrity of myofibrils. Mutations in DES lead to disruption of the assembly of filaments and a change in the myofibrillar cell lattice, which contributes to an increased vulnerability of myocytes to mechanical stress. The article presents a clinical case of familial desminopathy associated with a new missense R118P mutation of DES gene, characterized by dominant cardiac RCMP phenotype and subclinical manifestations of myofibrillar myopathy.