Clinics and Services

Share

Aa-+

Cardiovascular Genetics Center

Today, the Montreal Heart Institute (MHI) Cardiovascular Genetics Centre (CGC) is the only centre in Quebec with a unique and exhaustive expertise in the follow-up of individuals that combines clinical expertise and molecular analysis of genetic cardiovascular diseases. The CGC is composed of two sections: the Genetics Clinic and the Molecular Diagnostic Laboratory.

The mission of the Genetics Clinic is to combine innovative strategies for the diagnosis and management of hereditary cardiovascular diseases with applied knowledge in order to promote preventative healthcare.

The mission of the Molecular Diagnostic Laboratory is to offer, on a provincial scale, a molecular diagnosis service for hereditary cardiovascular diseases.

Specifically, the Centre offers:

  • A clinical evaluation of individuals with a hereditary cardiovascular disease (suspected or diagnosed)
  • Genetic evaluation and genetic counselling for patients and their families
  • Molecular genetic analysis for patients and their families
  • Comprehensive treatment of patients affected with a hereditary cardiovascular disease.

Laboratory

The MHI's Molecular Diagnostic Laboratory is proud to announce the implementation of an improved analysis for requests in cardiovascular genetics and familial dyslipidemia.
This new service offer is effective since January 17, 2022.

In addition to the analysis of Single Nucleotide genetic Variations (SNV), small genetic variations (InDel) and Copy Number Variations (CNV), this new service offer now includes a wider range of variants as well as the screening of intronic variants of clinical interest.

News for Cardiogenetics:
The genes targeted in the previous analysis profiles were thoroughly reviewed, updated and improved by a group of Cardiogenetics experts from the Réseau Québécois de Diagnostic Moléculaire (RQDM).

News for Familial Dyslipidemia:
All the associated information will now be compiled in a single laboratory report. The analysis profiles as well as the analyzed genes remain the same for now but will be revised in the coming year.

Refer to the Test Request section below for all required documentation for a test submission.

GENERAL PRESENTATION OF THE LABORATORY

All the activities of the MHI's Molecular Diagnostic Laboratory are carried out in Quebec from permanent facilities located on the first floor of the center block of the Montreal Heart Institute.
In order to fulfill its mission and achieve customers needs and expectations, the laboratory relies on a comprehensive Quality Management System. Since 2019, the Molecular Diagnostic Laboratory is a Medical Laboratory accredited by the Standards Council of Canada (SCC) and complies with the requirements of the international standard ISO 15189:2012 and the accreditation conditions established by the SCC.

Certificate

The Molecular Diagnostic Laboratory participates in many interlaboratory comparison programs of the College of American Pathologists (CAP) and the European Molecular Genetics Quality Network (EMQN). It also carries out the evaluation of its training and professional development programs and ensures personnel takes part in continuing education and skills.

The laboratory is headed by a Clinical Biochemist certified by the Ordre des chimistes du Québec and by the Canadian Academy of Clinical Biochemistry. The members of the team include, among others, a second Clinical Biochemist also certified by the Ordre des chimistes du Québec, three biochemists (M.Sc. Biochemistry) members of the Ordre des chimistes du Québec, a specialist in biological and physical sciences (M.Sc.), two bioinformaticians (M.Sc. bioinformatics), a quality assurance technician, a quality assurance specialist (M.Sc. Biological science), an administrative assistant and four medical technologists members of the Ordre professionnel des technologistes médicaux du Québec.

TEST REQUEST

All documents are available in the Analysis Registry (enter GENA code) at the following addresse:

https://est.omni-assistant.net/icm-ldm/AutoLogin.aspx?User=LDM_ICM_Web

Instructions for Cardiogenetics:
To complete a request, the Consent Form (unchanged) and the Clinical Indications Form* (new) must be provided with the updated Requisition Form.

Instructions for Familial Dyslipidemias:
To complete a request, the Consent Form (unchanged) must be provided with the updated Requisition Form.

Instructions for Molecular Autopsies:
To complete a request, the Clinical Indications Form* (new) must be provided with the updated Requisition Form. As before, the Toxicology and Autopsy reports have to be submitted along with the request.

As per our internal policies, any request for molecular analysis must be supervised by a health professional specializing in Cardiovascular Genetics and/or Medical Genetics. Please refer patients to the Cardiovascular Genetics Clinic of the Montreal Heart Institute or another Cardiogenetics Clinic/Genetics Clinic in order to benefit from a complete genetic evaluation.

*or any other equivalent form in the province.

OUR SERVICES

One of the most important laboratories of its kind in Canada, the Molecular Diagnostic Laboratory is in operations since 2006 and issues more than 1000 personalized reports per year. It received in 2021 the Supraregional designation for cardiovascular genetic analyses by the Quebec Ministry of Health and Social Services. In close collaboration with the MHI’s Genetics Clinic, the Molecular Diagnostic Laboratory offers genetic analysis of hereditary cardiovascular pathologies in order to meet the following clinical objectives:

To offer a complete cardiovascular molecular genetic analysis service including the management of the specimen by a highly qualified team:

• Sampling, DNA extraction, sequencing analysis (index case and family member) and personalized classification of each identified variant;
• State-of-the-art protocols and devices while maintaining high quality standards;
• Revision of the variants’ classification;

Turnaround Time:
Proband (gene profile by NGS): < 90 calendar days
Family member (specific variant search): < 28 calendar days

Currently, the Molecular Diagnostics Laboratory offers molecular test profiles for the following genetic cardiovascular diseases:

Inherited cardiomyopathies:
• Hypertrophic cardiomyopathy
• Dilated or arrhythmogenic left ventricle cardiomyopathy
• Arrhythmogenic right ventricular cardiomyopathy
• TTR amyloidosis

Inherited arrhythmias :
• Andersen-Tawil syndrome
• Brugada syndrome
• Long QT syndrome
• Short QT syndrome
• Catecholaminergic polymorphic ventricular tachycardia
• Cardiac conduction defect
• Unexplained sudden cardiac death

Inherited aortopathies :
• Non-syndromic familial aortic aneurysm
• Syndromic aortic aneurysm
• Classic Ehlers-Danlos syndrome
• Vascular Ehlers-Danlos syndrome
• Loeys-Dietz syndrome
• Marfan syndrome

Familial dyslipidemia:
• Familial hyperalphalipoproteinemia
• Familial hyperchylomicronemia
• Sitosterolemia

In addition to the genes listed in the updated queries, since January 17, 2022 the laboratory service offer also includes analysis of these clinically relevant intronic variants:

METHODS

he MHI’s Molecular Diagnostic Laboratory promotes quality. Sequence analyzes are carried out on site by highly qualified personnel in newly equipped laboratories using state-of-the-art equipment.
The analyzes of the Molecular Diagnostic Laboratory of the Montreal Heart Institute are carried out using next-generation sequencing method (NGS). The library preparation is done by capture using personalized probes (Twist Bioscience), according to the Illumina DNA Prep with Enrichment commercial protocol of the Illumina company (not homologated but validated protocol), which allows to minimally target genes involved in cardiomyopathies, arrhythmias and aortopathies established by the RQDM cardiogenetics working group, as well as familial dyslipidemia. The coding exons as well as the intron-exon borders (-10bp on each side of the exon) of these genes, in addition to certain specific intronic variants (indicated in the list of genes analyzed, by gene), are then sequenced with a NextSeq2000 sequencer and analyzed using the Illumina’ s Dragen Bio-IT analysis server. A tertiary analysis then annotates the variants corresponding to the genes of the requested profile. Single nucleotide genetic variations (SNV) or small genetic variations (InDel) are detected by this method with an analytical sensitivity of 99.98% and an analytical specificity greater than 99.99%. Copy number variations (CNV) are detected with a minimum analytical sensitivity of 87% and an analytical specificity of 99.96%.
As needed, direct Sanger sequencing can be used to confirm SNVs/InDels and cover low coverage regions. All reportable CNVs are confirmed by a method described in the interpretation section when applicable.
Positioning and isoform information is assembled on the GRCh38/hg38 v0 reference genome.
Some chromosomal regions are duplicated on the genome with at least 90% homology over more than 1000bp. These segmental duplications affect the quality of alignment and consequently sensitivity and analytical specificity of variant detection during bioinformatics analysis. These regions represent less than 0.36% of all the coding regions of our profiles.

The following table summarizes the regions corresponding to segmental duplications among our profiles:

Chromosome

RESULTS INTERPRETATION

All observed variants are reviewed in the literature and annotated using several recognized databases such as ClinVar, gnomAD (genome Aggregation Database), dbSNP) or any other relevant sources of information. An evaluation of the in silico effect of variants on the associated protein is also carried out. The final variant classification is performed according to the criteria of the American College of Medical Genetics and Genomics (ACMG) (PMID: 25741868, 2015).
Although the analysis reports do not mention genetic variants normally present in the population (polymorphisms) or not linked to the disease, they may be reported later whenever future research demonstrates a deleterious effect of these variants. All data is kept secure and accessible for this eventuality.
Since the creation of the laboratory in 2006, the literature review and interpretations have been carried out by a qualified team, which expertise was developed on site and cannot be found anywhere else. The team actively participates in a continuous training program and ensures a sustained technological watch. All results are professionally validated by two certified clinical biochemists.

THE CLINICAL LABORATORY TEAMS

Dr. Julie Amyot, Clinical Biochemist, Ph.D., C.S.P.Q., F.C.A.C.B., Laboratory Director
Dr. Benjamin Neveu, Clinical Biochemist, Ph.D., C.S.P.Q.
Catherine Barahona-Dussault, M.Sc. Biochemist
Guillaume Sylvain-Drolet, M.Sc. Biochemist
Valérie-Anne Codina-Fauteux, M.Sc. Biochemist
Diana Margarita Victoria Morón, M.Sc. Specialist in Health Biological and Physical Sciences
Sandra Therrien-Laperrière, M.Sc. Bioinformatician
Valérie Hay, M.Sc. Bioinformatician
Nathalie Lefebvre, Medical Technologist
Marie-Claude Tessier, Medical Technologist
Sadia Ouarezki, Medical Technologist
Fariza Djerroud, Administrative Assistant
Yllmira Darova, Quality Assurance Technician
Valérie Normand, M.Sc. Quality Assurance Specialist

For more informations

For more information, please contact our team:

Molecular diagnostic laboratory
Room C-1760
Montreal Heart Institute
5000 Belanger Street
Montreal (Quebec) H1T 1C8
514-376-3330 ext. 3712
ldm@icm-mhi.org

Genetic clinic

We offer diagnostic and therapeutic services for the following conditions :

  • hypertrophic cardiomyopathy
  • familial dilated cardiomyopathy
  • arrhythmogenic right ventricle cardiomyopathy
  • left ventricle non-compaction cardiomyopathy
  • long QT syndrome
  • Brugada syndrome (medical information)
  • sudden family death
  • Marfan syndrome
  • Loeys-Dietz syndrome
  • Andersen-Tawil syndrome
  • Ehlers-Danlos syndrome, Type IV
  • family aortic aneurysm
  • Polymorphic catecholergic ventricular tachycardia (TVPC)
  • amyloidosis

Genetic medical team :

  • Laura Robb, genetic counselor
  • Johannie Gagnon, genetic counselor  
  • Evelyne Naas, clinical nurse
  • Karine St-Arnaud, clinical nurse


For more informations

Institut de Cardiologie de Montréal
5000, rue Bélanger
Montréal (Québec)
H1T 1C8

Phone : 514 376-3330 poste 2498

Fax : 514-593-2158