Genetic variation in the alternative splicing regulator RBM20 is associated with dilated cardiomyopathy

Abstract

Background: Dilated cardiomyopathy (DCM) is a leading cause of heart failure and death. The etiology of DCM is genetically heterogeneous.

Objectives: We sought to define the prevalence of mutations in the RNA splicing protein RBM20 in a large cohort with DCM and to determine whether genetic variation in RBM20 is associated with clinical outcomes.

Methods: Subjects included in the Genetic Risk Assessment of Defibrillator Events (GRADE) study were aged at least 18 years, had an ejection fraction of ≤30%, and an implantable cardioverter-defibrillator (ICD). The coding region and splice junctions of RBM20 were screened in subjects with DCM; 2 common polymorphisms in RBM20, rs942077 and rs35141404, were genotyped in all GRADE subjects.

Results: A total of 1465 subjects were enrolled in the GRADE study, and 283 with DCM were screened for RBM20 mutations. The mean age of subjects with DCM was 58 ± 13 years, 64% were males, and the mean follow-up time was 24.2 ± 17.1 months after ICD placement. RBM20 mutations were identified in 8 subjects with DCM (2.8%). Mutation carriers had a similar survival, transplantation rate, and frequency of ICD therapy compared with nonmutation carriers. Three of 8 subjects with RBM20 mutations (37.5%) had atrial fibrillation (AF), whereas 19 subjects without mutations (7.4%) had AF (P = .02). Among all GRADE subjects, rs35141404 was associated with AF (minor allele odds ratio = 0.62; 95% confidence interval = 0.44-0.86; P = .006). In the subset of GRADE subjects with DCM, rs35141404 was associated with AF (minor allele odds ratio = 0.58; P = .047).

Conclusions: Mutations in RBM20 were observed in approximately 3% of subjects with DCM. There were no differences in survival, transplantation rate, and frequency of ICD therapy in mutation carriers.

Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Topology and location of RBM20 mutations in GRADE subjects with dilated cardiomyopathy.

Figure 2

Outcomes in RBM20 mutation carriers with DCM. A. Kaplan-Meier plots for freedom from appropriate ICD shocks in DCM subjects with or without a mutation in RBM20 after 36 months of follow-up. B. Kaplan-Meier plots for survival in DCM subjects with or without a mutation in RBM20 after 36 months of follow-up. None of the comparisons were statistically significant.

Figure 3

Relation between outcomes in the entire GRADE cohort and SNPs rs35141404 or rs942077. Kaplan-Meier plots for freedom from appropriate ICD shocks in the entire GRADE cohort after 60 months of follow-up for rs35141404 (A) or rs942077 (C). Kaplan-Meier plots for survival in the entire GRADE cohort after 60 months of follow-up in rs35141404 (B) or rs942077 (D). None of the comparisons were statistically significant.