Case2: 63 year old woman, diagnosed with HCM

DiseaseAssertion: Individual carried the MYL2 p.Ala13Thr, TTN, and ALPK3 variants.

FamilyInfo: Yes, son and daughter and husband was all diagnosed.

ParentalTesting: Yes with screening by ECG and Echocardiography; underwent 12-lead electrocardiography (ECG), echocardiography (M-mode, 2D, and Doppler), and cardiac magnetic resonance imaging (CMR).

CasePresentingHPOs: HP:0004383, HP:0005144, HP:0001962, HP:0001279, HP:0001278, HP:0031295, HP:0040284, HP:0011703, HP:0025275

CaseHPOFreeText: Echocardiographic findings of a hyperdynamic left ventricle and an interventricular septal thickness of 19 mm. She had a history of brief episodes of palpitations and one episode of syncope a few years earlier, which was thought to be due to orthostatic hypotension. A 12-lead ECG was notable for possible left atrial enlargement. A 30-day rhythm monitoring showed rare ventricular ectopic beats and episodes of sinus tachycardia. CMR showed a normal LV wall thickness and function and minimal patchy mid myocardial hyperenhancement in the basal inferior and infero-lateral wall.

CaseNotHPOs: HP:0000822, HP:0001639, HP:0032092

CaseNotHPOFreeText: No history of systemic arterial hypertension, valvular disease, or other conditions to explain cardiac hypertrophy. No LVOT obstruction.

CasePreviousTesting: Whole exome sequencing (WES)

Genotyping Method: Sanger sequencing

FunctionalAnalysis: NR

Variant:NM_000432.4:c.37G>A

ClinVar:14064

CAID:CA010242

gnomAD: gnomAD v2 12:111356964 C / T , gnomAD v3 12:110919160 C / T ,gmonAD v4 chr12-110919160-C-T

AdditionalInfo:NR

Case1: A 44-year old male of European (non-Finnish) ancestry.

DiseaseAssertion: Disease, with the MYL2 p.Ala13Thr variant.

FamilyInfo: Mother, father, and sister was diagnosed at different ages; they all had it.

ParentalTesting: Yes with screening by ECG and Echocardiography; underwent 12-lead electrocardiography (ECG), echocardiography (M-mode, 2D, and Doppler), and cardiac magnetic resonance imaging (CMR).

CasePresentingHPOs:HP:0100749, HP:0002094, HP:0031664, HP:0033678, HP:0011703, HP:0001712, HP:0031296,HP:0020034, HP:0031656

CaseHPOFreeText: Presented 3 years ago with persistent but mild chest pain and dyspnea. presence of II/VI mid-systolic murmur that increased with the Valsalva maneuver. Cardiac enzymes were negative for acute coronary syndromes. A 12-lead ECG was notable for sinus tachycardia at the rate of 104 bpm and evidence of left ventricular hypertrophy (LVH) with repolarization abnormalities. Myocardial stress perfusion tomography showed homogeneous distribution of the radiotracer in the myocardium. An echocardiogram showed a hyperdynamic left ventricle with moderate asymmetric septal hypertrophy, a maximum wall thickness of 1.8 cm. There was a resting left ventricular outflow tract (LVOT) gradient of 20 mmHg that increased to 40 mmHg upon Valsalva maneuver. CMR findings were notable for septal hypertrophy and diffuse patchy hyperenhancement, involving multiple myocardial walls. increasing dyspnea with a mild level of physical activity and chest pain. Evidence of LVH with repolarization abnormalities on a 12-lead ECG and a hyperdynamic left ventricle with a septal thickness of 2 cm, systolic anterior motion of mitral leaflets, mild to moderate mitral regurgitation, and an LVOT gradient of 100 mmHg on echocardiography (Figure 3A). Underwent surgical myectomy, which led to resolution of LVOT gradient and symptoms.

CaseNotHPOs: HP:0011675, HP:0011703

CaseNotHPOFreeText: Not show significant cardiac arrhythmias except for periods of sinus tachycardia at rest.

CasePreviousTesting: Whole exome sequencing (WES)

Genotyping Method: Sanger sequencing

FunctionalAnalysis: May affect cardiac contractile function and actin filament velocity, But NR about the MYL2 p.Ala13Thr variant.

Variant: NM_000432.4:c.37G>A

ClinVar:14064

CAID: CA010242

gnomAD: gnomAD v2 12:111356964 C / T , gnomAD v3 12:110919160 C / T gmonAD v4 chr12-110919160-C-T

AdditionalInfo: NR