TY - JOUR AB - Background: Alcoholic cardiomyopathy (ACM) is defined by a dilated and impaired left ventricle due to chronic excess alcohol consumption. It is largely unknown what factors determine cardiac toxicity on exposure to alcohol.Objectives: We sought to evaluate the role of variation in cardiomyopathy-associated genes in the pathophysiology of ACM, and to examine the effects of alcohol intake and genotype on DCM severity.Methods: We characterized 141 ACM cases, 716 dilated cardiomyopathy (DCM) cases and 445 healthy volunteers. We compared the prevalence of rare, protein-altering variants in 9 genes associated with inherited DCM. We evaluated the effect of genotype and alcohol-consumption on phenotype in DCM.Results: Variants in well-characterized DCM-causing genes were more prevalent in patients with ACM than controls (13.5% vs 2.9%; P=1.2e-05), but similar between patients with ACM and DCM (19.4%; P=0.12) and with a predominant burden of Titin-truncating variants (TTNtv, 9.9%). Separately, we identified an interaction between TTN genotype and excess alcohol consumption in a cohort of DCM patients not meeting ACM criteria. On multivariate analysis, DCM patients with a TTNtv who consumed excess alcohol had an 8.7% absolute reduction in ejection fraction (95% CI -2.3 to -15.1, P<0.007) compared with those without TTNtv and excess alcohol consumption. The presence of TTNtv did not predict phenotype, outcome or functional recovery on treatment in ACM patients. Conclusions: TTNtv represent a prevalent genetic predisposition for ACM, and are also associated with a worse LVEF in DCM patients who consume alcohol above recommended levels. Familial evaluation and genetic testing should be considered in patients presenting with ACM. AU - Ware,JS AU - Amor-Salamanca,A AU - Tayal,U AU - Govind,R AU - Serrano,I AU - Salazar-Mendiguchia,J AU - Garcia-Pinilla,JM AU - Pascual-Figal,DA AU - Nunez,J AU - Guzzo-Merello,G AU - Gonzalez-Vioque,E AU - Bardaji,A AU - Manito,N AU - Lopez-Garrido,MA AU - Padron-Barthe,L AU - Edwards,E AU - Whiffin,N AU - Walsh,R AU - Buchan,RJ AU - Midwinter,W AU - Wilk,A AU - Prasad,S AU - Pantazis,A AU - Baski,J AU - O'Regan,DP AU - Alsonso-Pulpon,A AU - Cook,SA AU - Lara-Pezzi,E AU - Barton,PJ AU - Garcia-Pavia,P DO - 10.1016/j.jacc.2018.03.462 EP - 2302 PY - 2018/// SN - 0735-1097 SP - 2293 TI - A genetic etiology for alcohol-induced cardiac toxicity T2 - Journal of the American College of Cardiology UR - http://dx.doi.org/10.1016/j.jacc.2018.03.462 UR - http://hdl.handle.net/10044/1/58376 VL - 71 ER -