In subjects with heart failure, genetic variation will affect clinical outcomes and the response to therapy. Heart failure is a polygenic disorder, and the impact of specific genetic polymorphisms will be influenced by genetic background. For several genes critical to heart failure pathogenesis, the prevalence of adverse alleles differs significantly between white and black cohorts. The current proposal will enroll one thousand subjects with heart failure due to systolic dysfunction including 500 white subjects and 500 black subjects, and will examine the impact of racial differences in genetic background on left ventricular function and clinical outcomes.
Specific Aim 1 will evaluate the impact of genetic background on left ventricular ejection fraction (LVEF) and LV diastolic diameter in 500 black subjects with chronic heart failure and a matched cohort of 500 white subjects. The proposal will focus on adverse alleles of key heart failure mediators including the ACE deletion, aldosterone synthase promoter -344C, NOS3 Asp298, and betal Arg389 variants.
Specific Aim 2 will investigate the impact of the adverse alleles from aim 1 on survival in the overall cohort and separately in the black and white subsets.
Specific aim 3 will explore gene-gene interactions to examine whether the impact of the ACE D allele is modified by coinheritance of the GNB3 T haplotype. This polymorphism is linked to increased alpha adrenergic activation and low plasma renin and is far more prevalent in black cohorts.
Specific Aim 3 will explore in the black heart failure cohort the use of Mapping by Admixture Linkage Disequilibrium (MALD), which utilizes comparisons of genomic DMA of African and European orgin, to determine the potential contributions of genomics to apparent racial differences in remodeling and heart failure outcomes. This proposal will address an important clinical question and will provide an ideal program for mentoring young investigators in the methodologies involved in genetics outcomes research.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Special Emphasis Panel (ZHL1-CSR-R (O1))
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Scott, Jane
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University of Pittsburgh
Internal Medicine/Medicine
Schools of Medicine
United States
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Nagatomo, Yuji; McNamara, Dennis M; Alexis, Jeffrey D et al. (2017) Myocardial Recovery in Patients With Systolic Heart Failure and Autoantibodies Against ?1-Adrenergic Receptors. J Am Coll Cardiol 69:968-977
Nayak, Aditi; Neill, Colin; Kormos, Robert L et al. (2017) Chemokine receptor patterns and right heart failure in mechanical circulatory support. J Heart Lung Transplant 36:657-665
Sheppard, Richard; Hsich, Eileen; Damp, Julie et al. (2016) GNB3 C825T Polymorphism and Myocardial Recovery in Peripartum Cardiomyopathy: Results of the Multicenter Investigations of Pregnancy-Associated Cardiomyopathy Study. Circ Heart Fail 9:e002683
McNamara, Dennis M; Taylor, Anne L; Tam, S William et al. (2014) G-protein beta-3 subunit genotype predicts enhanced benefit of fixed-dose isosorbide dinitrate and hydralazine: results of A-HeFT. JACC Heart Fail 2:551-7
McTiernan, Charles F; Ramani, Ravi; Burkhead, Benjamin et al. (2012) The methionine 196 arginine polymorphism of the TNF receptor 2 gene (TNFRSF1B) is not associated with worse outcomes in heart failure. Cytokine 60:838-42
Cooper, Leslie T; Mather, Paul J; Alexis, Jeffrey D et al. (2012) Myocardial recovery in peripartum cardiomyopathy: prospective comparison with recent onset cardiomyopathy in men and nonperipartum women. J Card Fail 18:28-33
Sheppard, Richard; Mather, Paul J; Alexis, Jeffrey D et al. (2012) Implantable cardiac defibrillators and sudden death in recent onset nonischemic cardiomyopathy: results from IMAC2. J Card Fail 18:675-81
Refaat, Marwan M; Tanaka, Toshikazu; Kormos, Robert L et al. (2012) Survival benefit of implantable cardioverter-defibrillators in left ventricular assist device-supported heart failure patients. J Card Fail 18:140-5
McNamara, Dennis M; Starling, Randall C; Cooper, Leslie T et al. (2011) Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study. J Am Coll Cardiol 58:1112-8
McNamara, Dennis M; London, Barry (2010) GWAS applied to heart failure: bigger will be better...eventually. Circ Cardiovasc Genet 3:226-8

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