title: Next-generation sequencing for diagnosis of thoracic aortic aneurysms and dissections: diagnostic yield, novel mutations and genotype phenotype correlations.
abstract: Thoracic aortic aneurysms and dissections (TAAD) are silent but possibly lethal condition with up to 40 % of cases being hereditary. Genetic background is heterogeneous. Recently next-generation sequencing enabled efficient and cost-effective examination of gene panels. Aim of the study was to define the diagnostic yield of NGS in the 51 TAAD patients and to look for genotype-phenotype correlations within families of the patients with TAAD.
  
  
  
  51 unrelated TAAD patients were examined by either whole exome sequencing or TruSight One sequencing panel. We analyzed rare variants in 10 established thoracic aortic aneurysms-associated genes. Whenever possible, we looked for co-segregation in the families. Kaplan-Meier survival curve was constructed to compare the event-free survival depending on genotype. Aortic events were defined as acute aortic dissection or first planned aortic surgery.
  
  
  
  In 21 TAAD patients we found 22 rare variants, 6 (27.3 %) of these were previously reported, and 16 (73.7 %) were novel. Based on segregation data, functional analysis and software estimations we assumed that three of novel variants were causative, nine likely causative. Remaining four were classified as of unknown significance (2) and likely benign (2). In all, 9 (17.6 %) of 51 probands had a positive result when considering variants classified as causative only and 18 (35.3 %) if likely causative were also included. Genotype-positive probands (n = 18) showed shorter mean event free survival (41 years, CI 35-46) than reference group, i.e. those (n = 29) without any plausible variant identified (51 years, CI 45-57, p = 0.0083). This effect was also found when the 'genotype-positive' group was restricted to probands with 'likely causative' variants (p = 0.0092) which further supports pathogenicity of these variants. The mean event free survival was particularly low (37 years, CI 27-47) among the probands with defects in the TGF beta signaling (p = 0.0033 vs. the reference group).
  
  
  
  This study broadens the spectrum of genetic background of thoracic aneurysms and dissections and supports its potential role as a prognostic factor in the patients with the disease.
authors.affiliation: Molecular Biology Laboratory, Institute of Cardiology, Warsaw, Poland.
authors.forename: J K
authors.initials: JK
authors.lastname: Poninska
authors.affiliation: Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland. zbilinska@ikard.pl.
authors.forename: Z T
authors.initials: ZT
authors.lastname: Bilinska
authors.affiliation: Molecular Biology Laboratory, Institute of Cardiology, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Franaszczyk
authors.affiliation: Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland.
authors.forename: E
authors.initials: E
authors.lastname: Michalak
authors.affiliation: Department of Medical Genetics, Centre of Biostructure, Medical University of Warsaw, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Rydzanicz
authors.affiliation: Department of Cardiac Surgery and Transplantation, Institute of Cardiology, Warsaw, Poland.
authors.forename: E
authors.initials: E
authors.lastname: Szpakowski
authors.affiliation: Department of Genetics, Institute of Physiology and Pathology of Hearing, Warsaw, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Pollak
authors.affiliation: Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland.
authors.forename: B
authors.initials: B
authors.lastname: Milanowska
authors.affiliation: Molecular Biology Laboratory, Institute of Cardiology, Warsaw, Poland.
authors.forename: G
authors.initials: G
authors.lastname: Truszkowska
authors.affiliation: Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Chmielewski
authors.affiliation: Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Sioma
authors.affiliation: Department of Hypertension, Institute of Cardiology, Warsaw, Poland.
authors.forename: H
authors.initials: H
authors.lastname: Janaszek-Sitkowska
authors.affiliation: Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Klisiewicz
authors.affiliation: Department of Radiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: I
authors.initials: I
authors.lastname: Michalowska
authors.affiliation: Department of Hypertension, Institute of Cardiology, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Makowiecka-Ciesla
authors.affiliation: Department of Cardiac Surgery and Transplantation, Institute of Cardiology, Warsaw, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Kolsut
authors.affiliation: Department of Medical Genetics, Centre of Biostructure, Medical University of Warsaw, Warsaw, Poland.|Department of Genetics, Institute of Physiology and Pathology of Hearing, Warsaw, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Stawinski
authors.affiliation: Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland.
authors.forename: B
authors.initials: B
authors.lastname: Foss-Nieradko
authors.affiliation: Molecular Biology Laboratory, Institute of Cardiology, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Szperl
authors.affiliation: Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Grzybowski
authors.affiliation: Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Hoffman
authors.affiliation: Department of Hypertension, Institute of Cardiology, Warsaw, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Januszewicz
authors.affiliation: Department of Cardiac Surgery and Transplantation, Institute of Cardiology, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Kusmierczyk
authors.affiliation: Department of Medical Genetics, Centre of Biostructure, Medical University of Warsaw, Warsaw, Poland. rploski@wp.pl.
authors.forename: R
authors.initials: R
authors.lastname: Ploski
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis* / Q000235:genetics*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis* / Q000235:genetics*; D004252:DNA Mutational Analysis; D003952:Diagnostic Imaging; D005260:Female; D056726:Genetic Association Studies; D006579:Heterozygote; D059014:High-Throughput Nucleotide Sequencing / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009154:Mutation / Q000235:genetics*; D010375:Pedigree
keywords: Diagnosis; Loeys–Dietz syndrome; Marfan syndrome; Next-generation sequencing; Shprintzen–Goldberg syndrome; Thoracic aortic aneurysm and dissections