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J Am Coll Cardiol. 2015 Sep 22;66(12):1313-23. doi: 10.1016/j.jacc.2015.07.023.

Prognostic Relevance of Gene-Environment Interactions in Patients With Dilated Cardiomyopathy: Applying the MOGE(S) Classification.

Author information

1
Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands. Electronic address: mark.hazebroek@mumc.nl.
2
Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
3
Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, the Netherlands.
4
Department of Pathology, Maastricht University Medical Centre, Maastricht, the Netherlands.
5
Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
6
Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands; ICIN, Netherlands Heart Institute, Utrecht, the Netherlands.

Abstract

BACKGROUND:

The multifactorial pathogenesis leading to dilated cardiomyopathy (DCM) makes stratification difficult. The recent MOGE(S) (morphofunctional, organ involvement, genetic or familial, etiology, stage) classification addresses this issue.

OBJECTIVES:

The purpose of this study was to investigate the applicability and prognostic relevance of the MOGE(S) classification in patients with DCM.

METHODS:

This study used patients from the Maastricht Cardiomyopathy Registry in the Netherlands and excluded patients with ischemic, valvular, hypertensive, and congenital heart disease. All other patients underwent a complete diagnostic work-up, including genetic evaluation and endomyocardial biopsy.

RESULTS:

A total of 213 consecutive patients with DCM were included: organ involvement was demonstrated in 35 (16%) and genetic or familial DCM in 70 (33%) patients, including 16 (8%) patients with a pathogenic mutation. At least 1 cause was found in 155 (73%) patients, of whom 48 (23%) had more than 1 possible cause. Left ventricular reverse remodeling was more common in patients with nongenetic or nonfamilial DCM than in patients with genetic or familial DCM (40% vs. 25%; p = 0.04). After a median follow-up of 47 months, organ involvement and higher New York Heart Association functional class were associated with adverse outcome (p < 0.001 and p = 0.02, respectively). Genetic or familial DCM per se was of no prognostic significance, but when it was accompanied by additional etiologic-environmental factors such as significant viral load, immune-mediated factors, rhythm disturbances, or toxic triggers, a worse outcome was revealed (p = 0.03). A higher presence of MOGE(S) attributes (≥2 vs. ≤1 attributes) showed an adverse outcome (p = 0.007).

CONCLUSIONS:

The MOGE(S) classification in DCM is applicable, and each attribute or the gene-environment interaction is associated with outcome. Importantly, the presence of multiple attributes was a strong predictor of adverse outcome. Finally, adaptation of the MOGE(S) involving multiple possible etiologies is recommended.

KEYWORDS:

autoimmune; etiology; toxic; virus

PMID:
26383716
DOI:
10.1016/j.jacc.2015.07.023
[Indexed for MEDLINE]
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