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Precision Cardiovascular Medicine: State of Genetic Testing
Authors:John R. Giudicessi  Iftikhar J. Kullo  Michael J. Ackerman
Affiliation:1. Department of Internal Medicine, Internal Medicine Residency Program, Clinician-Investigator Training Program, Mayo Clinic, Rochester, MN;2. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN;3. Gonda Vascular Center, Mayo Clinic, Rochester, MN;4. Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN;5. Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN;6. Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN
Abstract:In the 15 years following the release of the first complete human genome sequences, our understanding of rare and common genetic variation as determinants of cardiovascular disease susceptibility, prognosis, and therapeutic response has grown exponentially. As such, the use of genomics to enhance the care of patients with cardiovascular diseases has garnered increased attention from clinicians, researchers, and regulatory agencies eager to realize the promise of precision genomic medicine. However, owing to a large burden of “complex” common diseases, emphasis on evidence-based practice, and a degree of unfamiliarity/discomfort with the language of genomic medicine, the development and implementation of genomics-guided approaches designed to further individualize the clinical management of a variety of cardiovascular disorders remains a challenge. In this review, we detail a practical approach to genetic testing initiation and interpretation as well as review the current state of cardiovascular genetic and pharmacogenomic testing in the context of relevant society and regulatory agency recommendations/guidelines.
Keywords:ACM  arrhythmogenic cardiomyopathy  ACMG  American College of Medical Genetics and Genomics  AF  atrial fibrillation  BrS  Brugada syndrome  CHD  coronary heart disease  CPVT  catecholaminergic polymorphic ventricular tachycardia  CVD  cardiovascular disease  DCM  dilated cardiomyopathy  EHRA  European Heart Rhythm Association  FH  familial hypercholesterolemia  GRS  genetic risk score  GWAS  genome-wide association study  HCM  hypertrophic cardiomyopathy  HRS  Heart Rhythm Society  LDL-C  low-density lipoprotein cholesterol  LQTS  long QT syndrome  LVNC  left ventricular noncompaction  MFS  Marfan syndrome  RCM  restrictive cardiomyopathy  RCT  randomized controlled trial  SCD  sudden cardiac death  SNP  single-nucleotide polymorphism  SUDY  sudden unexplained death in the young  VUS  variant of unknown/uncertain significance  WEMA  whole-exome sequencing–based molecular autopsy  WES  whole-exome sequencing
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