Recurrent germline mutations as genetic markers for aortic root dilatation in bicuspid aortic valve patients
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ORIGINAL ARTICLE
Recurrent germline mutations as genetic markers for aortic root dilatation in bicuspid aortic valve patients Boting Wu5 · Jun Li1,3 · Yongshi Wang1,2 · Yunfeng Cheng4 · Chunsheng Wang1,3 · Xianhong Shu1,2 Received: 14 April 2020 / Accepted: 2 October 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Bicuspid aortic valve (BAV) is characterized by elevated risk of aortic dilatation and aneurysm. Although genetic susceptibility is suspected to influence on the development of BAV aortopathy, clinical application of genetic markers still needs validation in BAV entities with strictly defined phenotypic features. The ‘root phenotype’ represents a young, male predominant, and severely aortic regurgitant BAV population prone to aortic root dilatation. The present study launched a two-step genetic survey to evaluate the clinical significance of germline genetic markers in BAV patients. The whole-exome sequencing (WES) cohort consisted of 13 BAV patients with ‘root phenotype’ under the age of 40 years. We identified 28 different heterozygous missense mutations in 19 genes from the WES cohort, among which six variants (COL1A2 R882C, COL5A1 I1161F, ACVRL1 R218W, NOTCH1 P1227S, MYLK S243W, MYLK D717Y) were identified as pathogenic variants via unanimous agreement of in silico prediction tool analysis, and three variants (C1R I345L, TGFBR2 V216I, FBN2 G475V) were identified as recurrent variants. The panel of nine genetic markers was tested in an independent validation cohort of 154 BAV patients consecutively included from January to May 2018 in our institution. The validation cohort demonstrated 71.4% male predominance and the average age of 57 ± 13 years, among which 26.6% showed aortic root dilatation and 66.9% ascending aortic dilatation. Genetic markers were found in 32 patients, including 18 with C1R I345L, 11 with TGFBR2 V216I, 2 with FBN2 G475V, and 1 with both TGFBR2 V216I and MYLK D717Y. BAV patients carrying these genetic markers demonstrated younger age [(51 ± 12) vs. (58 ± 13) years, P = 0.014], more moderate to severe aortic regurgitation (56.2% vs. 33.6%, P = 0.019), elevated prevalence of mitral valve prolapse (9.4% vs. 0.8%, P = 0.028) and aortic root dilatation (62.5% vs. 17.2%, P 40 mm as well as larger diameter at the sinus of Valsalva than that at tubular ascending aorta [7]. Exclusion criteria included Marfan syndrome, Loeys-Dietz syndrome (LDS), infective endocarditis, and additional congenital cardiac defects (namely coarctation of the aorta, tetralogy of Fallot, ventricular septal defect,
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supra-aortic stenosis, and others). Eventually, a total 13 BAV patients constituted our WES cohort, whose demographic features were summarized in Table 1. The validation cohort consisted of 154 BAV patients consecutively recruited from January to May 2018, who were admitted into our institution for valvular or aortic ailments requiring surgical attention. Schematic representation of the finding and validating procedure was displayed in Fig. 1. The control cohort consisted of 100
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