FBN1 gene mutation characteristics and clinical features for the prediction of mitral valve disease progression

BackgroundUntil today, FBN1 gene mutation characteristics were not compared with clinical features for the prediction of mitral valve disease progression.MethodsTherefore, we conducted a study of 116 patients (53 men, 63 women aged 33 ± 15 years) with a causative FBN1 gene mutation and ≤ moderate mitral valve regurgitation at baseline.ResultsDuring 7.4 ± 6.8 years 30 patients developed progression of mitral valve regurgitation ≥ 1 grade (primary endpoint), and 26 patients required mitral valve surgery (secondary endpoint). Cox regression analysis identified an association of atrial fibrillation (hazard ratio (HR) = 2.703; 95% confidence interval (CI) 1.013-7.211; P = .047), left ventricular ejection fraction (HR = .970; 95%CI .944-.997; P = .032), indexed end-diastolic left ventricular diameter (HR = 15.165; 95%CI 4.498-51.128; P < .001), indexed left atrial diameter (HR = 1.107; 95%CI 1.045-1.173; P = .001), tricuspid valve prolapse (HR = 2.599; 95%CI 1.243-5.437; P = .011), posterior leaflet prolapse (HR = 1.075; 95%CI 1.023-1.130; P = .009), and posterior leaflet thickening (HR = 3.368; 95%CI 1.265-8.968; P = .015) with progression of mitral valve disease, whereas none of the FBN1 gene mutation characteristics were associated with progression of mitral valve disease. However, Cox regression analysis identified a marginal relationship of FBN1 gene mutations located both in a transforming-growth-factor beta-binding protein-like (TGFb-BP) domain (HR = 3.453; 95%CI .982-12.143; P = .053), and in the calcium-binding epidermal growth factor-like (cbEGF) domain (HR = 2.909; 95%CI .957-8.848; P = .060) with mitral valve surgery, a finding that was corroborated by Kaplan-Meier analysis (P = .014; and P = .041, respectively).ConclusionClinical features were better predictors of mitral valve disease progression than FBN1 gene mutation characteristics.