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Forholdet mellem udviklingen i landdistriktskommunerne og bykommunerne – mellem centre og periferi – får stigende opmærksomhed i den offentlige debat og på de politiske dagsordner. Det har således også været et centralt tema i debatten op til det seneste folketingsvalg.

INTRODUCTION: Whether detailed genetic information contributes to risk stratification of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains uncertain. Pathogenic genetic variants in some genes seem to carry a higher risk for arrhythmia and earlier disease onset than others, but comparisons between variants in the same gene have not been done. Combined Annotation Dependent Depletion (CADD) score is a bioinformatics tool that measures the pathogenicity of each genetic variant. We hypothesized that a higher CADD score is associated with arrhythmic events and earlier age at ARVC manifestations in individuals carrying pathogenic or likely pathogenic genetic variants in plakophilin-2 (PKP2). METHODS: CADD scores were calculated using the data from pooled Scandinavian and North American ARVC cohorts, and their association with cardiac events defined as ventricular tachycardia/ventricular fibrillation (VT/VF) or syncope and age at definite ARVC diagnosis were assessed. RESULTS: In total, 33 unique genetic variants were reported in 179 patients (90 males, 71 probands, 96 with definite ARVC diagnosis at a median age of 35 years). Cardiac events were reported in 76 individuals (43%), of whom 53 had sustained VT/VF (35%). The CADD score was neither associated with age at cardiac events (HR 1.002, 95% CI: 0.953-1.054, p = 0.933) nor with age at definite ARVC diagnosis (HR 0.992, 95% CI: 0.947-1.039, p = 0.731). CONCLUSION: No correlation was found between CADD scores and clinical manifestations of ARVC, indicating that the score has no additional risk stratification value among carriers of pathogenic or likely pathogenic PKP2 genetic variants. ; Funding agencies: This work was supported by Region Östergötland (ALF) undergrant LIO-609681 and by FORSS (Medical Research Council ofSoutheast Sweden) under grant FORSS/572421 and FORSS/307961.Pyotr G. Platonov is supported by The Swedish Heart-Lung Foundation and governmental funding of clinical research (ALF). Henrik K. Jensen is supported by the Novo Nordisk Foundation (NNF18OC0031258). Wojciech Zareba is supported by NIH Grant(1R01HL116906) (Mechanisms, Genotypes and Clinical Phenotypes of Arrhythmogenic Cardiomyopathy).