Variant Interpretation for Dilated Cardiomyopathy
Ana Morales, Daniel D. Kinnamon, Elizabeth Jordan, Julia Platt, Matteo Vatta, Michael O. Dorschner, Carl A. Starkey, Jonathan O. Mead, Tomohiko Ai, Wylie Burke, Julie M. Gastier‐Foster, Gail P. Jarvik, Heidi L. Rehm, Deborah A. Nickerson, Ray E. Hershberger, Deborah J. Bowen, Garrie J. Haas, William T. Abraham, Philip F. Binkley, Ayesha Hasan, Jennifer Host, Brent C. Lampert, Sakima A. Smith, Gordon S. Huggins, David DeNofrio, Michael S. Kiernan, Daniel Fishbein, Richard K. Cheng, Todd Dardas, Wayne C. Levy, Claudius Mahr, Sofia Carolina Masri, April Stempien‐Otero, Stephen S. Gottlieb, Matthew T. Wheeler, Euan A. Ashley, Mark Hofmeyer, W.H. Wilson Tang, Randall Starling, Anjali Owens, Kenneth Marguilies, Thomas P. Cappola, Lee R. Goldberg, Rhondalyn C. McLean, Charles K. Moore, Robert C. Long, Javier Jimenez Carcamo, Barry Trachtenberg, G. Ashrith, Arvind Bhimarahj, Nancy K. Sweitzer, Palak Shah, Brian D. Lowes, Douglas Stoller, Frank W. Smart, Alanna A. Morris, Jane E. Wilcox, Stephan Pan, Gregory A. Ewald, Keith D. Aaronson, Jessica Wang, Salpy V. Pamboukian, Daniel P. Judge, E. Kransdorf, Sonia Garg, Patrice Desvigne Nickens, James Troendle, Yi‐Ping Fu, Lucia A. Hindorff
Abstract
Background: The hypothesis of the Dilated Cardiomyopathy Precision Medicine Study is that most dilated cardiomyopathy has a genetic basis. The study returns results to probands and, when indicated, to relatives. While both the American College of Medical Genetics and Genomics/Association for Molecular Pathology and ClinGen’s MYH7 -cardiomyopathy specifications provide relevant guidance for variant interpretation, further gene- and disease-specific considerations were required for dilated cardiomyopathy. To this end, we tailored the ClinGen MYH7 -cardiomyopathy variant interpretation framework; the specifications implemented for the study are presented here. Methods: Modifications were created and approved by an external Variant Adjudication Oversight Committee. After a pilot using 81 probands, further adjustments were made, resulting in 27 criteria (9 modifications of the ClinGen MYH7 framework and reintroduction of 2 American College of Medical Genetics and Genomics/Association of Molecular Pathology criteria that were deemed not applicable by the ClinGen MYH7 working group). Results: These criteria were applied to 2059 variants in a test set of 97 probands. Variants were classified as benign (n=1702), likely benign (n=33), uncertain significance (n=71), likely pathogenic (likely pathogenic; n=12), and pathogenic (P; n=3). Only 2/15 likely pathogenic/P variants were identified in Non-Hispanic African ancestry probands. Conclusions: We tailored the ClinGen MYH7 criteria for our study. Our preliminary data show that 15/97 (15.5%) probands have likely pathogenic/P variants, most of which were identified in probands of Non-Hispanic European ancestry. We anticipate continued evolution of our approach, one that will be informed by new insights on variant interpretation and a greater understanding of the genetic architecture of dilated cardiomyopathy. Clinical Trial Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03037632