(Circulation. 1999;99:3161-3164.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
From the Franz Volhard Clinic and Max Delbrück Center for Molecular Medicine, Medical Faculty of the Charité, Humboldt University of Berlin, Germany.
Correspondence to Friedrich C. Luft, Franz Volhard Clinic, Wiltberg Strasse 50, 13122 Berlin, Germany. E-mail luft{at}fvk-berlin.de
| Abstract |
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Methods and ResultsWe found genetic variance on QRS duration, QRS axis, T-wave axis, and QTc. Women had a longer QTc than men. Microsatellite markers were tested in the vicinity of the gene loci for the 5 known LQT genes. We found significant linkage of QTc with the loci for LQT1 on chromosome 11 and LQT4 on chromosome 4 but not to LQT2, LQT3, or LQT5. We also found linkage of the QRS axis with LQT2 and LQT3.
ConclusionsWe suggest that these quantitative trait loci may represent the presence of variations in LQT genes that could be important to the risk for rhythm disturbances in the general population.
Key Words: molecular biology long-QT syndrome intervals genetics electrocardiography
| Introduction |
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| Methods |
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For this linkage study, the DZ pairs were selected and used as ordinary
sib pairs but with the advantage of perfect age matching and reduced
environmental variation affecting the phenotype. The power of
the twin model in elucidation of complex genetic disease has recently
been emphasized by Martin et al.7 The MZ twins were used
to estimate allele frequencies for the markers tested. Zygosity was
verified with the use of 5 polymerase chain reactionamplified
microsatellite markers, as described in detail elsewhere.8
We examined 2 microsatellite markers at the LQT1 locus, 3 at the LQT2
locus, 3 at the LQT3 locus, 5 at the LQT4 locus, and 3 at the LQT5
locus, as shown in Table 1
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We assessed linkage for QTc as a continuous trait.9
Sib-pair analysis to determine linkage does not require
specification of a genetic model. The underlying trait can follow
either mendelian or nonmendelian modes of inheritance. Analysis
was done by use of a structural equation modeling (SEM)
approach,10 as implemented in the MX
package.11 This approach is based on variance
(VAR)-covariance (COV) matrices of sibs weighted by the
probability of sharing 0, 1, or 2 alleles identical by descent
(IBD). Phenotypic variance was decomposed into variance due to genetic
background (A), variance due to the quantitative trait loci (QTL)
effect (Q), and environmental variance (E):
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2 statistic. For each sib pair and each locus,
the proportion of alleles IBD, based on parental genotypes
and independent allele-frequency estimates, was calculated with a
multipoint approach as implemented in MAPMAKER/SIBS.12 The
higher power of the variance-covariancebased analysis
compared with the squared trait differencesbased approach by the
Elston method13 has been shown in a recent simulation
study.14 Because we used a candidate gene approach, we
accepted P<0.01 to test for significant linkage, in
accordance with the criteria defined by Lander and
Kruglyak.15
Parameters of the quantitative genetic models were
estimated by SEM with the MX program developed by Neale.12
The variability of any given phenotype (P) within a population
can be decomposed into genetic influences (A), environmental influences
shared by the twins within a family (C), and effects of random
environment (E):
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2 value.
Statistical analysis was conducted with the SPSS program.
Adjustment of phenotypic values for sex and age was done by multiple
linear regression with the unstandardized residuals as the corrected
phenotypes. In case of significant deviations from a normal
distribution, the appropriate transformations were applied before
analysis. | Results |
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| Discussion |
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Twin studies have been used previously to examine the effect of genetic variance on ECG parameters. Hanson et al3 were able to study MZ and DZ twins reared apart and showed that PR interval, QRS duration, QRS axis, QTc, and ventricular rate indicated a significant contribution of genetic effects, ranging from 30% to 60%. Although their analysis is different from the analysis we used, the heritability estimates are similar. Hanson et al3 were then able to compare data from twins reared apart and twins reared together and observed little difference in terms of ECG parameters. They provided firm evidence that genetic factors are of real importance in determining the basic physiological measures responsible for ECG components. Our MZ-DZ twin comparisons strongly support their conclusion. We were also able to confirm the finding that men have a shorter QTc interval than women of the same age.6 17
DZ twins are a particularly powerful sib-pair model because of identical ages and a shared environment, at least in childhood. Interestingly, a QTL for a closely defined reading disability has been described on chromosome 6, by means of sib-pair analysis including DZ twins.18 In that study, the power of DZ twins in the sib-pair analysis was aptly demonstrated; DZ twin sib pairs exhibited a lod score twice that of nontwin affected siblings. This result would suggest that the sample size can be sharply reduced without a loss of power when DZ twin siblings are examined. The usefulness of DZ twins in the quantitative sib-pair linkage analysis approach to genes relevant to cardiovascular disease was recently demonstrated by Austin et al,19 who found linkage between the microsomal triglyceride-transfer protein gene locus and plasma triglyceride concentrations, and also by Knoblauch et al,20 who found linkage between the macrophage scavenger receptor gene locus and HDL-cholesterol concentrations. In previous studies, we found linkage between the ACE gene locus5 and the IGF-1 gene locus21 and echocardiographically determined parameters of heart size in these same twin subjects.
Congenital LQT is an autosomal-dominant genetic disorder of cardiac
electrical repolarization caused by mutations of
6
genes.2 Four LQT genes have been identified:
KVLQT1, HERG, and Min K encode for
cardiac potassium channels, whereas SCN5A encodes for the
cardiac sodium channel. Altered ion-channel function produces
prolongation of the action potential and propensity to torsade de
pointes ventricular tachycardia. A fifth gene
locus has been shown on chromosome 4; however, the gene has not yet
been cloned.22 The discovery of linkage to this locus
in normal individuals could conceivably be useful in narrowing the
region containing the responsible gene. The entire genomic structure of
3 LQT genes, including KVLQT1, has been described, allowing
genetic screening to identify individuals at risk for this
disorder.23 Shimizu and Antzelevitch24
examined the cellular basis for the ECG features of LQT1. They used a
specific blocker of the IKs channel and
prolonged the QT interval and action potential duration in an in vitro
model. Our data would suggest that IKs
channel activity is heritable, perhaps via variation in
KVLQT1. After puberty, women with LQT are at greater risk
for arrhythmias than men.25 In our
analysis, we found no sex-specific genetic effects on linkage
with LQT loci; however, our numbers may not have been sufficient to
identify a difference.
We were surprised to find strong evidence for linkage between the QRS vector and LQT2, as well as LQT3, whereas neither LQT2 or LQT3 was linked to QTc. The first locus contains HERG, whereas the second contains SCN5A. We are not aware of specific QRS-axis aberrations in LQT patients except while they experience polymorphic ventricular tachycardia.26 El-Sherif et al27 recently observed a localized circuit that varied its location and orientation from beat to beat, which serves to explain the transition of the QRS axis during polymorphic ventricular tachycardia in LQT. The presence of LQT ion channels in the conduction system might be consistent with genetic linkage with certain channel loci and the QRS axis normally. We observed a significant genetic effect on the QRS axis in the MZ-DZ twin comparison. The HERG locus was also linked to the T-wave axis. Phenotypic T-wave patterns are often abnormal in LQT .28
The phenotype of LQT varies depending on the specific mutation involved.29 Phenotypic heterogeneity is also caused by variable penetrance and expressivity. We believe that our identification of the KVLQT1 locus as a QTL for QTc and 2 other LQT loci as QTLs for the QRS axis in normal, healthy individuals has direct clinical implications. For instance, the structure of KVLQT1, HERG, SCN5A, and the gene on chromosome 4, when it is cloned, will enable a strategy of multiplex sequencing in these individuals and their parents.30 Allelic variants having a functional bearing on QTc or QRS axis can be identified in these healthy persons, which can then be tested in patients with congestive heart failure at risk for developing cardiac arrhythmias. For example, an allelic variant in the ß2-adrenergic receptor gene, which strongly influences survival in heart failure patients, was recently described.31 Prospective strategies to influence QTc, thereby avoiding cardiac arrhythmias, could then be applied.32
| Acknowledgments |
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Received December 15, 1998; revision received March 29, 1999; accepted March 30, 1999.
| References |
|---|
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|
|---|
2. Vincent GM. The molecular genetics of the long QT syndrome: genes causing fainting and sudden death. Annu Rev Med. 1998;49:263274.[Medline] [Order article via Infotrieve]
3. Hanson B, Tuna N, Bouchard T, Heston L, Eckert E, Lykken D, Segal N, Rich S. Genetic factors in the electrocardiogram and heart rate of twins reared apart and together. Am J Cardiol. 1989;63:606609.[Medline] [Order article via Infotrieve]
4. Busjahn A, Faulhaber H-D, Viken RJ, Rose RJ, Luft FC. Genetic influences on blood pressure with the cold pressor test: a twin study. J Hypertens. 1996;14:11951199.[Medline] [Order article via Infotrieve]
5.
Busjahn A, Knoblauch J, Knoblauch M, Bohlender J, Menz
M, Faulhaber H-D, Becker A, Schuster H, Luft FC.
Angiotensin converting enzyme and
angiotensinogen gene polymorphisms, plasma levels, and
left ventricular size: a twin study.
Hypertension. 1997;29:165170.
6. Bazett HC. An analysis of the time relationship of electrocardiograms. Heart. 1920;7:353370.
7. Martin N, Boomsma D, Machin G. A twin-pronged attack on complex traits. Nat Genet. 1997;17:387392.[Medline] [Order article via Infotrieve]
8. Becker A, Busjahn A, Faulhaber H-D, Bähring S, Schuster H, Luft FC. Automated zygosity determination with microsatellites. J Reprod Med. 1997;42:260266.[Medline] [Order article via Infotrieve]
9. Wu D-A, Bu X, Warden CH, Shen DDC, Jeng C-Y, Sheu WHH, Fuh MMT, Katsuya T, Dzau VJ, Reaven GM, Lusis AJ, Rotter JI, Chen Y-DI. Quantitative trait locus mapping of human blood pressure to a genetic region at or near the lipoprotein lipase gene locus on chromosome 8p22. J Clin Invest. 1996;97:21112118.[Medline] [Order article via Infotrieve]
10. Eaves LJ, Neale MC, Maes H. Multivariate multipoint linkage analysis of quantitative trait loci. Behav Genet. 1996;26:519525.[Medline] [Order article via Infotrieve]
11. Neale MC. Mx: Statistical Modeling. 4th ed. Medical College of Virginia, Richmond, Va: Department of Psychiatry; 1997.
12. Kruglyak L, Lander ES. Complete multipoint sib-pair analysis of qualitative and quantitative traits. Am J Hum Genet. 1995;57:439454.[Medline] [Order article via Infotrieve]
13. S.A.G.E: Statistical Analysis for Genetic Epidemiology [computer program]. Release 2.2. Cleveland, Ohio: Department of Epidemiology and Biostatistics, Case Western Reserve University; 1996.
14. Fulker DW, Cherny SS. An improved multipoint sib-pair analysis of quantitative traits. Behav Genet. 1996;26:527532.[Medline] [Order article via Infotrieve]
15. Lander ES, Kruglyak L. Genetic dissection of complex traits: guidelines for interpreting and reporting linkage results. Nat Genet. 1995;11:241246.[Medline] [Order article via Infotrieve]
16. Neale MC, Cardon LR. Methodology for Genetic Studies of Twins and Families. Dordrecht, Netherlands: Kluwer Academic Publishers; 1992:496.
17. Ebert SN, Liu XK, Woosley RL. Female gender as a risk factor for drug-induced cardiac arrhythmias: evaluation of clinical and experimental evidence. J Womens Health. 1998;7:547557.[Medline] [Order article via Infotrieve]
18.
Cardon LR, Smith SD, Fulker DW, Kimberling WJ,
Pennington BF, DeFries JC. Quantitative trait locus for reading
disability on chromosome 6. Science. 1994;266:276279.
19. Austin MA, Talmud PJ, Luong L-A, Haddad L, Day INM, Newman B, Edwards LK, Krauss RM, Humphries SE. Candidate-gene studies of the atherogenic lipoprotein phenotype: a sib-pair linkage analysis of DZ women twins. Am J Hum Genet. 1998;62:406419.[Medline] [Order article via Infotrieve]
20.
Knoblauch H, Busjahn A, Münter S, Nagy Z,
Faulhaber H-D, Schuster H, Luft FC. Heritability analysis of
lipids and three gene loci in twins link the macrophage
scavenger receptor to high-density lipoprotein cholesterol
concentrations. Arterioscler Thromb Vasc Biol. 1997;17:20542060.
21. Nagy Z, Busjahn A, Bähring S, Faulhaber H-D, Gohlke H-R, Knoblauch H, Rosenthal M, Müller-Myhsok B, Schuster H, Luft FC. Quantitative trait loci for blood pressure exist near the IGF-1, the Liddle syndrome, the angiotensin II-receptor gene, and the renin loci in man. J Am Soc Nephrol. 1999. In press.
22. Schott JJ, Charpentier F, Peltier S, Foley P, Drouin E, Bouhour JB, Donnelly P, Vergnaud G, Bachner L, Moisan JP. Mapping of a gene for long QT syndrome to chromosome 4q2527. Am J Hum Genet. 1995;57:11141122.[Medline] [Order article via Infotrieve]
23. Splawski I, Shen J, Timothy KW, Vincent GM, Lehmann MH, Keating MT. Genomic structure of three long QT syndrome genes: KVLQT1, HERG, and KCNE1. Genomics. 1998;51:8697.[Medline] [Order article via Infotrieve]
24.
Shimizu W, Antzelevitch C. Cellular basis for the ECG
features of the LQT1 form of the long-QT syndrome.
Circulation. 1998;98:23142322.
25.
Locati EH, Zareba W, Moss AJ, Schwartz PJ, Vincent GM,
Lehmann MH, Towbin JA, Priori SG, Napolitano C, Robinson JL, Andrews M,
Timothy K, Hall WH. Age- and sex-related differences in clinical
manifestations in patients with congenital long-QT syndrome: findings
from the International LQTS Registry. Circulation. 1998;97:22372244.
26.
Roden DM, Lazzara R, Rosen M, Schwartz PJ, Towbin J,
Vincent GM, for the SADS Foundation Task Force on LQTS. Multiple
mechanisms in the long-QT syndrome. Circulation. 1996;94:19962012.
27.
El-Sherif N, Chinushi M, Caref EB, Restivo M.
Electrophysiological mechanism of the
characteristic electrocardiographic morphology of torsade de pointes
tachyarrhythmias in the long-QT syndrome.
Circulation. 1997;96:43924399.
28.
Moss AJ, Zareba W, Benhorin J, Locati EH, Hall WJ,
Robinson JL, Schwartz PJ, Towbin JA, Vincent GM, Lehmann MH, Keating
MT, MacCluer JW, Timothy KW. ECG T-wave patterns in genetically
distinct forms of the hereditary long QT syndrome.
Circulation. 1995;92:29292934.
29.
Zareba W, Moss AJ, Schwartz PJ, Vincent GM, Robinson
JL, Prior SG, Benhorin J, Locati EH, Towbin JA, Keating MT, Lehmann MH,
Hall WJ. Influence of genotype on the clinical course of
the long-QT syndrome: International Long-QT Syndrome Registry Research
Group. N Engl J Med. 1998;339:960965.
30. Wendel B, Hoehe MR. The human mu opioid receptor gene: 5' regulatory and intronic sequences. J Mol Med. 1998;76:461463.[Medline] [Order article via Infotrieve]
31. Liggett SB, Wagoner LE, Craft LL, Hornung RW, Hoit BD, McIntosh TC, Walsh RA. The ILe 164 ß2-adrenergic receptor polymorphism adversely affects the outcome of congestive heart failure. J Clin Invest. 1998;102:15341539.[Medline] [Order article via Infotrieve]
32.
Choy AM, Lang CC, Chomsky DM, Rayos GH, Wilson JR,
Roden DM. Normalization of acquired QT prolongation in humans by
intravenous potassium. Circulation. 1997;96:21492154.
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