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CC BY 4.0 · Glob Med Genet 2024; 11(01): 036-047
DOI: 10.1055/s-0044-1779469
Review Article

Exploring Health Care Disparities in Genetic Testing and Research for Hereditary Cardiomyopathy: Current State and Future Perspectives

Helen Huang
1   Department of Medicine, School of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Science, Dublin, Ireland
,
Jay Verma
2   Department of Medicine, Maulana Azad Medical College, University of Delhi, Delhi, India
,
Valerie Mok
3   Department of Medicine Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
,
Hareesha R. Bharadwaj
4   Division of Medical Education, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
,
Maen M. Alrawashdeh
1   Department of Medicine, School of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Science, Dublin, Ireland
,
Adarsh Aratikatla
1   Department of Medicine, School of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Science, Dublin, Ireland
,
Sourav Sudan
5   Department of Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
,
Suprateeka Talukder
6   Department of Medicine, Norfolk and Norwich University Hospital, Colney Lane, Norwich, United Kingdom
,
Minatoullah Habaka
1   Department of Medicine, School of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Science, Dublin, Ireland
,
Gary Tse   *
7   Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
8   Department of Medicine, Kent and Medway Medical School, Canterbury, Kent, United Kingdom
9   Department of Medicine, School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, People's Republic of China
,
Mainak Bardhan    *
10   Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, United States
› Author Affiliations Funding None.
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Abstract

Background Hereditary cardiomyopathies are commonly occurring myocardial conditions affecting heart structure and function with a genetic or familial association, but the etiology is often unknown. Cardiomyopathies are linked to significant mortality, requiring robust risk stratification with genetic testing and early diagnosis.

Hypothesis We hypothesized that health care disparities exist in genetic testing for hereditary cardiomyopathies within clinical practice and research studies.

Methods In a narrative fashion, we conducted a literature search with online databases such as PubMed/MEDLINE, Google Scholar, EMBASE, and Science Direct on papers related to hereditary cardiomyopathies. A comprehensive analysis of findings from articles in English on disparities in diagnostics and treatment was grouped into four categories.

Results Racial and ethnic disparities in research study enrollment and health care delivery favor White populations and higher socioeconomic status, resulting in differences in the development and implementation of effective genetic screening. Such disparities have shown to be detrimental, as minorities often suffer from disease progression to heart failure and sudden cardiac death. Barriers related to clinical genetic testing included insurance-related issues and health illiteracy. The underrepresentation of minority populations extends to research methodologies, as testing in ethnic minorities resulted in a significantly lower detection rate and diagnostic yield, as well as a higher likelihood of misclassification of variants.

Conclusions Prioritizing minority-based participatory research programs and screening protocols can address systemic disparities. Diversifying research studies can improve risk stratification strategies and impact clinical practice.

Keywords

hereditary cardiomyopathy - disparities - genetic testing - diversity - ethnic representation

Data Availability

No data available.


Ethical Statement

Not applicable.


Authors' Contribution

Conceptualization of topic and coordination of reading, writing, and editing: H.H., M.B.; reading, writing, and editing of the original draft: all authors; critical revision of the manuscript: H.H., G.T., M.B.; figures and tables: H.H., J.V.; final approval of manuscript: G.T., M.B.


* These contributors share senior authorship.




Publication History

Article published online:
01 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 O'Mahony C, Jichi F, Pavlou M. et al; Hypertrophic Cardiomyopathy Outcomes Investigators. A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD). Eur Heart J 2014; 35 (30) 2010-2020
    CrossrefPubMedGoogle Scholar
  • 2 Cadrin-Tourigny J, Bosman LP, Nozza A. et al. A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2019; 40 (23) 1850-1858
    CrossrefPubMedGoogle Scholar
  • 3 Eberly LA, Day SM, Ashley EA. et al. Association of race with disease expression and clinical outcomes among patients with hypertrophic cardiomyopathy. JAMA Cardiol 2020; 5 (01) 83-91
    CrossrefPubMedGoogle Scholar
  • 4 Landry LG, Rehm HL. Association of racial/ethnic categories with the ability of genetic tests to detect a cause of cardiomyopathy. JAMA Cardiol 2018; 3 (04) 341-345
    CrossrefPubMedGoogle Scholar
  • 5 Manrai AK, Funke BH, Rehm HL. et al. Genetic misdiagnoses and the potential for health disparities. N Engl J Med 2016; 375 (07) 655-665
    CrossrefPubMedGoogle Scholar
  • 6 Griffith DM. Precision medicine approaches to health disparities research. Ethn Dis 2020; 30 (Suppl. 01) 129-134
    CrossrefPubMedGoogle Scholar
  • 7 Ciarambino T, Menna G, Sansone G, Giordano M. Cardiomyopathies: an overview. Int J Mol Sci 2021; 22 (14) 7722
    CrossrefPubMedGoogle Scholar
  • 8 Towbin JA. Inherited cardiomyopathies. Circ J 2014; 78 (10) 2347-2356
    CrossrefPubMedGoogle Scholar
  • 9 Marian AJ, Braunwald E. Hypertrophic cardiomyopathy: genetics, pathogenesis, clinical manifestations, diagnosis, and therapy. Circ Res 2017; 121 (07) 749-770
    CrossrefPubMedGoogle Scholar
  • 10 Bai Y, Zheng JP, Lu F. et al. Prevalence, incidence and mortality of hypertrophic cardiomyopathy based on a population cohort of 21.9 million in China. Sci Rep 2022; 12 (01) 18799
    CrossrefPubMedGoogle Scholar
  • 11 Varma PK, Neema PK. Hypertrophic cardiomyopathy: part 1 - introduction, pathology and pathophysiology. Ann Card Anaesth 2014; 17 (02) 118-124
    CrossrefPubMedGoogle Scholar
  • 12 García-Castro M, Coto E, Reguero JR. et al. [Mutations in sarcomeric genes MYH7, MYBPC3, TNNT2, TNNI3, and TPM1 in patients with hypertrophic cardiomyopathy]. Rev Esp Cardiol 2009; 62 (01) 48-56
    CrossrefPubMedGoogle Scholar
  • 13 Viswanathan SK, Sanders HK, McNamara JW. et al. Hypertrophic cardiomyopathy clinical phenotype is independent of gene mutation and mutation dosage. PLoS One 2017; 12 (11) e0187948
    CrossrefPubMedGoogle Scholar
  • 14 Ku L, Feiger J, Taylor M, Mestroni L. Familial Cardiomyopathy Registry. Cardiology patient page. Familial dilated cardiomyopathy. Circulation 2003; 108 (17) e118-e121
    PubMedGoogle Scholar
  • 15 Reichart D, Magnussen C, Zeller T, Blankenberg S. Dilated cardiomyopathy: from epidemiologic to genetic phenotypes: a translational review of current literature. J Intern Med 2019; 286 (04) 362-372
    CrossrefPubMedGoogle Scholar
  • 16 Dellefave L, McNally EM. The genetics of dilated cardiomyopathy. Curr Opin Cardiol 2010; 25 (03) 198-204
    CrossrefPubMedGoogle Scholar
  • 17 Weintraub RG, Semsarian C, Macdonald P. Dilated cardiomyopathy. Lancet 2017; 390 (10092): 400-414
    CrossrefPubMedGoogle Scholar
  • 18 Burke MA, Cook SA, Seidman JG, Seidman CE. Clinical and mechanistic insights into the genetics of cardiomyopathy. J Am Coll Cardiol 2016; 68 (25) 2871-2886
    CrossrefPubMedGoogle Scholar
  • 19 Rapezzi C, Aimo A, Barison A. et al. Restrictive cardiomyopathy: definition and diagnosis. Eur Heart J 2022; 43 (45) 4679-4693
    CrossrefPubMedGoogle Scholar
  • 20 Morales A, Hershberger R. Chapter 56—Genetic testing. In: Jefferies JL. et al., eds. Heart Failure in the Child and Young Adult. Boston: Academic Press;; 2018: 743-748
    Google Scholar
  • 21 Muchtar E, Blauwet LA, Gertz MA. Restrictive cardiomyopathy: genetics, pathogenesis, clinical manifestations, diagnosis, and therapy. Circ Res 2017; 121 (07) 819-837
    CrossrefPubMedGoogle Scholar
  • 22 Neagoe O, Ciobanu A, Diaconu R, Mirea O, Donoiu I, Militaru C. A rare case of familial restrictive cardiomyopathy, with mutations in MYH7 and ABCC9 genes. Discoveries (Craiova) 2019; 7 (03) e99
    CrossrefPubMedGoogle Scholar
  • 23 van der Voorn SM, Te Riele ASJM, Basso C, Calkins H, Remme CA, van Veen TAB. Arrhythmogenic cardiomyopathy: pathogenesis, pro-arrhythmic remodelling, and novel approaches for risk stratification and therapy. Cardiovasc Res 2020; 116 (09) 1571-1584
    CrossrefPubMedGoogle Scholar
  • 24 Maron MS, Rowin EJ, Olivotto I. et al. Contemporary natural history and management of nonobstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 2016; 67 (12) 1399-1409
    CrossrefPubMedGoogle Scholar
  • 25 McKoy G, Protonotarios N, Crosby A. et al. Identification of a deletion in plakoglobin in arrhythmogenic right ventricular cardiomyopathy with palmoplantar keratoderma and woolly hair (Naxos disease). Lancet 2000; 355 (9221) 2119-2124
    CrossrefPubMedGoogle Scholar
  • 26 Ross SB, Jones K, Blanch B. et al. A systematic review and meta-analysis of the prevalence of left ventricular non-compaction in adults. Eur Heart J 2020; 41 (14) 1428-1436
    CrossrefPubMedGoogle Scholar
  • 27 Finsterer J, Stöllberger C, Towbin JA. Left ventricular noncompaction cardiomyopathy: cardiac, neuromuscular, and genetic factors. Nat Rev Cardiol 2017; 14 (04) 224-237
    CrossrefPubMedGoogle Scholar
  • 28 Towbin JA, Lorts A, Jefferies JL. Left ventricular non-compaction cardiomyopathy. Lancet 2015; 386 (9995) 813-825
    CrossrefPubMedGoogle Scholar
  • 29 Pérez-Serra A, Toro R, Sarquella-Brugada G. et al. Genetic basis of dilated cardiomyopathy. Int J Cardiol 2016; 224: 461-472
    CrossrefPubMedGoogle Scholar
  • 30 Kimura A. Molecular basis of hereditary cardiomyopathy: abnormalities in calcium sensitivity, stretch response, stress response and beyond. J Hum Genet 2010; 55 (02) 81-90
    CrossrefPubMedGoogle Scholar
  • 31 Chen SN, Mestroni L, Taylor MRG. Genetics of dilated cardiomyopathy. Curr Opin Cardiol 2021; 36 (03) 288-294
    CrossrefPubMedGoogle Scholar
  • 32 Tadros R, Francis C, Xu X. et al. Shared genetic pathways contribute to risk of hypertrophic and dilated cardiomyopathies with opposite directions of effect. Nat Genet 2021; 53 (02) 128-134
    CrossrefPubMedGoogle Scholar
  • 33 Pirruccello JP, Di Achille P, Nauffal V. et al; BioBank Japan Project. Genetic analysis of right heart structure and function in 40,000 people. Nat Genet 2022; 54 (06) 792-803
    CrossrefPubMedGoogle Scholar
  • 34 Aung N, Lopes LR, van Duijvenboden S. et al. Genome-wide analysis of left ventricular maximum wall thickness in the UK biobank cohort reveals a shared genetic background with hypertrophic cardiomyopathy. Circ Genom Precis Med 2023; 16 (01) e003716
    CrossrefPubMedGoogle Scholar
  • 35 Garnier S, Harakalova M, Weiss S. et al. Genome-wide association analysis in dilated cardiomyopathy reveals two new players in systolic heart failure on chromosomes 3p25.1 and 22q11.23. Eur Heart J 2021; 42 (20) 2000-2011
    CrossrefPubMedGoogle Scholar
  • 36 Liu CF, Ni Y, Thachil V, Morley M, Moravec CS, Tang WHW. Differential expression of members of SOX family of transcription factors in failing human hearts. Transl Res 2022; 242: 66-78
    CrossrefPubMedGoogle Scholar
  • 37 Marian AJ. Molecular genetic basis of hypertrophic cardiomyopathy. Circ Res 2021; 128 (10) 1533-1553
    CrossrefPubMedGoogle Scholar
  • 38 Melas M, Beltsios ET, Adamou A, Koumarelas K, McBride KL. Molecular diagnosis of hypertrophic cardiomyopathy (HCM): in the heart of cardiac disease. J Clin Med 2022; 12 (01) 225
    CrossrefPubMedGoogle Scholar
  • 39 Walsh R, Offerhaus JA, Tadros R, Bezzina CR. Minor hypertrophic cardiomyopathy genes, major insights into the genetics of cardiomyopathies. Nat Rev Cardiol 2022; 19 (03) 151-167
    CrossrefPubMedGoogle Scholar
  • 40 Gyftopoulos A, Chen YJ, Wang L. et al. Identification of novel genetic variants and comorbidities associated with ICD-10-based diagnosis of hypertrophic cardiomyopathy using the UK biobank cohort. Front Genet 2022; 13: 866042
    CrossrefPubMedGoogle Scholar
  • 41 Chintanaphol M, Orgil BO, Alberson NR, Towbin JA, Purevjav E. Restrictive cardiomyopathy: from genetics and clinical overview to animal modeling. Rev Cardiovasc Med 2022; 23 (03) 108
    CrossrefPubMedGoogle Scholar
  • 42 Sunkak S, Kiraz A, Argun M, Erdoğan İ. Restrictive cardiomyopathy with ring chromosome 6 anomaly in a child. Anatol J Cardiol 2021; 25 (10) 745-746
    CrossrefPubMedGoogle Scholar
  • 43 Fu J, Sun DM, Zhang Y, Huang YF, He Q, Zhang J. [A case of restrictive cardiomyopathy associated with new TPM1 gene mutation]. Zhonghua Er Ke Za Zhi 2022; 60 (10) 1077-1078
    PubMedGoogle Scholar
  • 44 Odak M, Douedi S, Mararenko A. et al. Arrhythmogenic right ventricular cardiomyopathy: the role of genetics in diagnosis, management, and screening. Cardiol Res 2022; 13 (04) 177-184
    CrossrefPubMedGoogle Scholar
  • 45 Kyriakopoulou E. et al. Therapeutic efficacy of AAV-mediated restoration of PKP2 in arrhythmogenic cardiomyopathy. Nat Cardiovasc Res 2023; 2 (12) 1262-1276
    CrossrefPubMedGoogle Scholar
  • 46 Nagueh SF, Bhatt R, Vivo RP. et al. Echocardiographic evaluation of hemodynamics in patients with decompensated systolic heart failure. Circ Cardiovasc Imaging 2011; 4 (03) 220-227
    CrossrefPubMedGoogle Scholar
  • 47 Thomas DE, Wheeler R, Yousef ZR, Masani ND. The role of echocardiography in guiding management in dilated cardiomyopathy. Eur J Echocardiogr 2009; 10 (08) iii15-iii21
    CrossrefPubMedGoogle Scholar
  • 48 Assomull RG, Prasad SK, Lyne J. et al. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol 2006; 48 (10) 1977-1985
    CrossrefPubMedGoogle Scholar
  • 49 Corrado D, Perazzolo Marra M, Zorzi A. et al. Diagnosis of arrhythmogenic cardiomyopathy: the Padua criteria. Int J Cardiol 2020; 319: 106-114
    CrossrefPubMedGoogle Scholar
  • 50 Adabag AS, Maron BJ, Appelbaum E. et al. Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance. J Am Coll Cardiol 2008; 51 (14) 1369-1374
    CrossrefPubMedGoogle Scholar
  • 51 Mathew J, Zahavich L, Lafreniere-Roula M. et al. Utility of genetics for risk stratification in pediatric hypertrophic cardiomyopathy. Clin Genet 2018; 93 (02) 310-319
    CrossrefPubMedGoogle Scholar
  • 52 Papadopoulou E, Bouzarelou D, Tsaousis G. et al. Application of next generation sequencing in cardiology: current and future precision medicine implications. Front Cardiovasc Med 2023; 10: 1202381
    CrossrefPubMedGoogle Scholar
  • 53 Di Marco A, Brown PF, Bradley J. et al. Improved risk stratification for ventricular arrhythmias and sudden death in patients with nonischemic dilated cardiomyopathy. J Am Coll Cardiol 2021; 77 (23) 2890-2905
    CrossrefPubMedGoogle Scholar
  • 54 Køber L, Thune JJ, Nielsen JC. et al; DANISH Investigators. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med 2016; 375 (13) 1221-1230
    CrossrefPubMedGoogle Scholar
  • 55 Del Mestre E, Pio Loco Detto Gava C, Paldino A. et al. Arrhythmic risk stratification in non-ischaemic dilated cardiomyopathy. Eur Heart J Suppl 2023; 25 (Suppl B): B144-B148
    CrossrefPubMedGoogle Scholar
  • 56 Stafford F, Thomson K, Butters A, Ingles J. Hypertrophic cardiomyopathy: genetic testing and risk stratification. Curr Cardiol Rep 2021; 23 (02) 9
    CrossrefPubMedGoogle Scholar
  • 57 Cimiotti D, Budde H, Hassoun R, Jaquet K. Genetic restrictive cardiomyopathy: causes and consequences-an integrative approach. Int J Mol Sci 2021; 22 (02) 558
    CrossrefPubMedGoogle Scholar
  • 58 Liu Y, Chen H, Shou W. Potential common pathogenic pathways for the left ventricular noncompaction cardiomyopathy (LVNC). Pediatr Cardiol 2018; 39 (06) 1099-1106
    CrossrefPubMedGoogle Scholar
  • 59 Gatzoulis KA. et al. The role of genetics in risk stratification strategy of dilated cardiomyopathy. Rev Cardiovasc Med 2022;23(09):
    Google Scholar
  • 60 Sheikh N, Papadakis M, Panoulas VF. et al. Comparison of hypertrophic cardiomyopathy in Afro-Caribbean versus white patients in the UK. Heart 2016; 102 (22) 1797-1804
    CrossrefPubMedGoogle Scholar
  • 61 Arabadjian ME, Yu G, Sherrid MV, Dickson VV. Disease expression and outcomes in black and white adults with hypertrophic cardiomyopathy. J Am Heart Assoc 2021; 10 (17) e019978
    CrossrefPubMedGoogle Scholar
  • 62 Burns J, Jean-Pierre P. Disparities in the diagnosis of hypertrophic obstructive cardiomyopathy: a narrative review of current literature. Cardiol Res Pract 2018; 2018: 3750879
    CrossrefPubMedGoogle Scholar
  • 63 Coughlin SS. Toward the primary prevention of idiopathic dilated cardiomyopathy. J Natl Med Assoc 1991; 83 (11) 949-950
    PubMedGoogle Scholar
  • 64 Coughlin SS, Labenberg JR, Tefft MC. Black-white differences in idiopathic dilated cardiomyopathy: the Washington DC dilated Cardiomyopathy Study. Epidemiology 1993; 4 (02) 165-172
    CrossrefPubMedGoogle Scholar
  • 65 Can AD, Coughlin SS. Addressing health disparities in idiopathic dilated cardiomyopathy. Jacobs J Community Med 2017; 3 (01) 026
    PubMedGoogle Scholar
  • 66 Christensen S, Mogelvang R, Heitmann M, Prescott E. Level of education and risk of heart failure: a prospective cohort study with echocardiography evaluation. Eur Heart J 2011; 32 (04) 450-458
    CrossrefPubMedGoogle Scholar
  • 67 Schultz WM, Kelli HM, Lisko JC. et al. Socioeconomic status and cardiovascular outcomes: challenges and interventions. Circulation 2018; 137 (20) 2166-2178
    CrossrefPubMedGoogle Scholar
  • 68 Thomas A, Papoutsidakis N, Spatz E. et al. Access and outcomes among hypertrophic cardiomyopathy patients in a large integrated health system. J Am Heart Assoc 2020; 9 (03) e014095
    CrossrefPubMedGoogle Scholar
  • 69 Brown KN. et al. Restrictive cardiomyopathy. In: StatPearls. Treasure Island (FL):: StatPearls Publishing LLC;; 2023
    Google Scholar
  • 70 Srivastava S, Yavari M, Al-Abcha A, Banga S, Abela G. Ventricular non-compaction review. Heart Fail Rev 2022; 27 (04) 1063-1076
    CrossrefPubMedGoogle Scholar
  • 71 Wadhera RK, Joynt KE. Insurance and cardiovascular health: time for evidence to trump politics. Circulation 2017; 135 (21) 1988-1990
    CrossrefPubMedGoogle Scholar
  • 72 Metayer C, Coughlin SS, McCarthy EP. Marital status as a predictor of survival in idiopathic dilated cardiomyopathy: the Washington, DC dilated cardiomyopathy study. Eur J Epidemiol 1996; 12 (06) 573-582
    CrossrefPubMedGoogle Scholar
  • 73 Ingles J, Johnson R, Sarina T. et al. Social determinants of health in the setting of hypertrophic cardiomyopathy. Int J Cardiol 2015; 184: 743-749
    CrossrefPubMedGoogle Scholar
  • 74 Musunuru K, Hershberger RE, Day SM. et al; American Heart Association Council on Genomic and Precision Medicine; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Genetic testing for inherited cardiovascular diseases: a scientific statement from the American Heart Association. Circ Genom Precis Med 2020; 13 (04) e000067
    CrossrefPubMedGoogle Scholar
  • 75 Shaboodien G, Spracklen TF, Kamuli S, Ndibangwi P, Van Niekerk C, Ntusi NAB. Genetics of inherited cardiomyopathies in Africa. Cardiovasc Diagn Ther 2020; 10 (02) 262-278
    CrossrefPubMedGoogle Scholar
  • 76 Stafford F, Krishnan N, Richardson E. et al. The role of genetic testing in diagnosis and care of inherited cardiac conditions in a specialised multidisciplinary clinic. Genome Med 2022; 14 (01) 145
    CrossrefPubMedGoogle Scholar
  • 77 Dellefave-Castillo LM, Cirino AL, Callis TE. et al. Assessment of the diagnostic yield of combined cardiomyopathy and arrhythmia genetic testing. JAMA Cardiol 2022; 7 (09) 966-974
    CrossrefPubMedGoogle Scholar
  • 78 Christiaans I, Kok TM, van Langen IM. et al. Obtaining insurance after DNA diagnostics: a survey among hypertrophic cardiomyopathy mutation carriers. Eur J Hum Genet 2010; 18 (02) 251-253
    CrossrefPubMedGoogle Scholar
  • 79 Spoonamore KG, Johnson NM. Who pays? Coverage challenges for cardiovascular genetic testing in U.S. patients. Front Cardiovasc Med 2016; 3: 14
    CrossrefPubMedGoogle Scholar
  • 80 Christian S, Cirino A, Hansen B. et al. Diagnostic validity and clinical utility of genetic testing for hypertrophic cardiomyopathy: a systematic review and meta-analysis. Open Heart 2022; 9 (01) e001815
    CrossrefPubMedGoogle Scholar
  • 81 Hershberger RE, Givertz MM, Ho CY. et al. Genetic evaluation of cardiomyopathy-a Heart Failure Society of America practice guideline. J Card Fail 2018; 24 (05) 281-302
    CrossrefPubMedGoogle Scholar
  • 82 Kontorovich AR. Approaches to genetic screening in cardiomyopathies: practical guidance for clinicians. JACC Heart Fail 2023; 11 (02) 133-142
    CrossrefPubMedGoogle Scholar
  • 83 Golden SD, Earp JA. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav 2012; 39 (03) 364-372
    CrossrefPubMedGoogle Scholar
  • 84 Saulsberry K, Terry SF. The need to build trust: a perspective on disparities in genetic testing. Genet Test Mol Biomarkers 2013; 17 (09) 647-648
    CrossrefPubMedGoogle Scholar
  • 85 Mudd-Martin G, Cirino AL, Barcelona V. et al; American Heart Association Council on Genomic and Precision Medicine; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Considerations for cardiovascular genetic and genomic research with marginalized racial and ethnic groups and indigenous peoples: a scientific statement from the American Heart Association. Circ Genom Precis Med 2021; 14 (04) e000084
    CrossrefPubMedGoogle Scholar
  • 86 Marian AJ. Hypertrophic cardiomyopathy: from genetics to treatment. Eur J Clin Invest 2010; 40 (04) 360-369
    CrossrefPubMedGoogle Scholar
  • 87 Gopal DP, Chetty U, O'Donnell P, Gajria C, Blackadder-Weinstein J. Implicit bias in healthcare: clinical practice, research and decision making. Future Healthc J 2021; 8 (01) 40-48
    CrossrefPubMedGoogle Scholar
  • 88 Dye BA, Duran DG, Murray DM. et al. The importance of evaluating health disparities research. Am J Public Health 2019; 109 (S1): S34-S40
    CrossrefPubMedGoogle Scholar