Open this publication in new window or tab >> Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy .
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Division of Cardiology, Department of Medicine, School of Clinical Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China.
Division of Cardiology, University of California, San Francisco, CA, USA; Department of Research and Development, AMPS-LLC, NewYork, NY, USA.
Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA.
Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Department of Cardiothoracic and Vascular Sciences—Translational Cardiology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia, Italy.
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2026 (English) In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 47, no 36, p. 5189-5199Article in journal (Refereed) Published
Abstract [en] Background and Aims: Modifier genes may cause different clinical phenotypes in patients with long QT syndrome (LQTS) carrying the same pathogenic variant. Variants in the MTMR4 gene have been previously associated, via patient-specific cardiomyocytes derived from induced pluripotent stem cells, with variable arrhythmic risk in a family with the p.Y111C-LQT1 mutation. This study aimed to evaluate the broader clinical impact of MTMR4 variants in patients with LQT1 and LQT2.
Methods: A total of 1192 LQTS patients were analysed: 638 with LQT1, 432 with LQT2, and 122 Swedish carriers of the p.Y111C-LQT1 variant. The association between MTMR4 variants and clinical severity was assessed by comparing patients with severe symptoms (cardiac arrest or syncope on beta-blockers) vs asymptomatic or mildly symptomatic individuals. ECG parameters, including Tpeak-Tend and T-wave heterogeneity, were also evaluated.
Results: In the LQT1 cohort, there was a significant decreasing pattern for cardiac events across MTMR4 genotypes (AA:15.9%, Aa:11.6%, aa:6.3%), while an opposite trend was apparent in the LQT2 cohort (AA:16.5%, Aa:18.2%, aa:27.6%). No pattern was apparent in the Swedish cohort. In the combined LQT1 cohort, the aa genotype was found in 15% of 702 mild/asymptomatic vs 1.7% of 58 with severe symptoms (P = .002). Vice versa, in LQT2, aa was more frequent in severe cases (24.1% vs 11.9%, P = .014). QTc was not associated with MTMR4, but the repolarization markers supported a gene-specific directionality of arrhythmic risk.
Conclusions: The MTMR4 minor allele in homozygosis exerts a gene-specific and opposite impact on arrhythmic risk in LQTS. This finding should influence risk stratification in clinical practice.
Place, publisher, year, edition, pages
Oxford University Press, 2026
Keywords Long QT syndrome, Arrhythmias, Sudden cardiac death, Induced pluripotent stem cell-derived cardiomyocytes, NEDD4L, MTMR4
National Category
Cardiology and Cardiovascular Disease Medical Genetics and Genomics
Identifiers urn:nbn:se:umu:diva-259586 (URN) 10.1093/eurheartj/ehag294 (DOI) 001763828500001 () 42128250 (PubMedID) 2-s2.0-105051194513 (Scopus ID)
2026-10-072026-10-072026-10-07 Bibliographically approved