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Weigand J, Stephens-Novy S, Sachdeva S, Doan TT, Yasso A, Morris SA. Evidence of cardiomyopathy associated with Marfan syndrome in children. Heart 2024; 110:887-891. [PMID: 38816063 DOI: 10.1136/heartjnl-2024-323922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE Marfan syndrome (MFS)-associated cardiomyopathy, defined as ventricular dilation and dysfunction unexplained by volume loading, is not well defined in children. This study evaluated ventricular size and function in paediatric MFS using cardiac MRI (cMRI). METHODS This retrospective cohort study examined patients with MFS <19 years old at first cMRI. Left ventricular (LV) ejection fraction (EF) <55% was considered abnormal, as were z-scores >2. Combined mitral and aortic regurgitation indexed to LV stroke volume <20% defined absent/mild volume load. Biventricular volumes and EF on serial cMRI studies were compared with normative paediatric cMRI values, with measures converted to z-scores as appropriate. Longitudinal changes in volumes and EF were evaluated by mixed linear regression. Associations between ventricular, aortic and mitral characteristics were evaluated. RESULTS 58 patients (60% male) were evaluated. Median age at initial cMRI was 13.6 years (IQR 10.0-15.8 years). Among patients with absent/mild LV volume load at initial cMRI (n=44, 76%), indexed LV end-diastolic volume (EDV) was significantly increased above normative values (median z-score 1.8, IQR 0.6-3.5, p<0.0001) and LVEF was abnormal in 48% (21/44). In the absence of volume loading, mitral valve prolapse (MVP) was associated with larger ventricular volumes and lower LVEF. Among those with serial cMRIs, LVEF and EDV z-scores did not significantly change over a mean follow-up time between cMRI studies of 1.5 years. CONCLUSION Ventricular dilation and reduced EF are common in children with MFS and occur with no/mild LV volume load, suggesting intrinsic cardiomyopathy. MVP may be associated with cardiomyopathy.
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Affiliation(s)
- Justin Weigand
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Sara Stephens-Novy
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Shagun Sachdeva
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Tam T Doan
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Abigail Yasso
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Shaine A Morris
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Pediatrics, Texas Children's Hospital, Houston, Texas, USA
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Day W, Jayaram RH, Rubin LE, Grauer JN. Total Hip Arthroplasty in Patients Who Have Marfan Syndrome: Adverse Events and 5-Year Revision Rates. J Arthroplasty 2023:S0883-5403(23)01098-7. [PMID: 37952742 DOI: 10.1016/j.arth.2023.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Marfan syndrome is a rare inherited connective tissue disease, which may be present in patients who have advanced hip pathologies that may require total hip arthroplasty (THA). The postoperative course of patients who have Marfan syndrome following THA has not yet been defined. METHODS Adult patients who have and do not have Marfan syndrome and underwent THA were identified in a national database. Patients diagnosed who had infection, trauma, or neoplasms within the 90 days prior to surgery were excluded. Those who have versus those who did not have Marfan syndrome were matched 1:10 based on age, sex, and a comorbidity index. After matching, 144 patients who have Marfan syndrome and 1,440 who do not have Marfan syndrome were identified. The 90-day postoperative adverse events and 5-year revisions were assessed and compared with multivariable analyses and log rank tests, respectively. RESULTS Multivariable analyses demonstrated that Marfan syndrome was independently associated with greater odds of 90-day adverse events: venous thromboembolic events (odds ratio [OR]: 2.9, P = .001), cardiac events (OR: 4.5, P = .034), pneumonia (OR: 3.5, P < .001), and urinary tract infections (OR: 5.2, P < .001). There was no significant difference in 5-year rates of revision. CONCLUSIONS Following THA, Marfan syndrome was independently associated with greater rates of several 90-day adverse events, but not higher 5-year rates of revision. The identified at-risk adverse events may help guide surgeons to improve perioperative care pathways, while having confidence regarding joint survival of THA in this rare disease population.
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Affiliation(s)
- Wesley Day
- Albert Einstein College of Medicine, Bronx, New York
| | - Rahul H Jayaram
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - Lee E Rubin
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
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Connell PS, Morris SA, Doan TT, Weigand J. Abnormal Left Ventricular Strain Correlates with Left Ventricular Dysfunction but not Aortic Pathology in Marfan Syndrome in Children. Pediatr Cardiol 2023; 44:1536-1545. [PMID: 37505267 DOI: 10.1007/s00246-023-03232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Abstract
Cardiomyopathy is a complication in adults with Marfan syndrome (MFS). Early recognition of MFS patients at high risk of cardiomyopathy could impact monitoring and treatment. Abnormal ventricular strain has been associated with impaired ventricular function among adults with MFS but remains understudied in children. We retrospectively analyzed a cohort of patients with MFS undergoing cardiac magnetic resonance imaging (CMR) performed in 2003-2018 at age < 19 years. Correlations were evaluated between initial global circumferential strain (GCS) and global longitudinal strain (GLS) and the outcomes of left ventricular ejection fraction (LVEF), aortic root z-score, and vertebral artery tortuosity index corrected for height (VTI-h), all measured from CMR, using Spearman correlation. In those with serial CMR, the ability of ventricular strain to predict development of abnormal LVEF within a 5-year period was assessed. A total of 31 subjects were included (median age at initial CMR 13.5 years, Q1Q3 10.7-16.2 years), with 48% (n = 15) having LVEF < 55%. Worse GCS and worse GLS were associated with lower LVEF (ρ = - 0.629, p < 0.001 and ρ = - 0.411, p = 0.030, respectively). A clinical cutoff of GCS = - 34% predicted LVEF < 55% with sensitivity = 80% and specificity = 50%. Neither GCS nor GLS was associated with aortic root z-score (GCS: p = 0.524; GLS: p = 0.624) nor VTI-h (GCS: p = 0.949; GLS: p = 0.593). Of those with LVEF ≥ 55%, initial GCS and GLS did not differ between those with later normal versus abnormal LVEF (GCS: p = 0.505; GLS: p = 0.232). In this cohort, abnormal LV strain was associated with abnormal LVEF, but not with aortic dilation or low LVEF within the 5 years post-CMR.
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Affiliation(s)
- Patrick S Connell
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, 6651 Main St., MC E2060.14, Houston, TX, 77030, USA
| | - Shaine A Morris
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, 6651 Main St., MC E2060.14, Houston, TX, 77030, USA
| | - Tam T Doan
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, 6651 Main St., MC E2060.14, Houston, TX, 77030, USA
| | - Justin Weigand
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, 6651 Main St., MC E2060.14, Houston, TX, 77030, USA.
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Sachan N, Phoon CKL, Zilberberg L, Kugler MC, Ene T, Mintz SB, Murtada SI, Weiss D, Fishman GI, Humphrey JD, Rifkin DB. TGFβ-2 haploinsufficiency causes early death in mice with Marfan syndrome. Matrix Biol 2023; 121:41-55. [PMID: 37217119 PMCID: PMC10527763 DOI: 10.1016/j.matbio.2023.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
To assess the contribution of individual TGF-β isoforms to aortopathy in Marfan syndrome (MFS), we quantified the survival and phenotypes of mice with a combined fibrillin1 (the gene defective in MFS) hypomorphic mutation and a TGF-β1, 2, or 3 heterozygous null mutation. The loss of TGF-β2, and only TGF-β2, resulted in 80% of the double mutant animals dying earlier, by postnatal day 20, than MFS only mice. Death was not from thoracic aortic rupture, as observed in MFS mice, but was associated with hyperplastic aortic valve leaflets, aortic regurgitation, enlarged aortic root, increased heart weight, and impaired lung alveolar septation. Thus, there appears to be a relationship between loss of fibrillin1 and TGF-β2 in the postnatal development of the heart, aorta and lungs.
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Affiliation(s)
- Nalani Sachan
- Department of Cell Biology, NYU Grossman School of Medicine, New York, NY, 10016, USA.
| | - Colin K L Phoon
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Lior Zilberberg
- Department of Cell Biology, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Matthias C Kugler
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Taylor Ene
- Department of Cell Biology, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Shana B Mintz
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Sae-Il Murtada
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA
| | - Dar Weiss
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA
| | - Glenn I Fishman
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA
| | - Daniel B Rifkin
- Department of Cell Biology, NYU Grossman School of Medicine, New York, NY, 10016, USA; Department of Medicine, NYU Grossman School of Medicine, New York, NY, 10016, USA
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Dong ZY, Shao W, Yuan Y, Lin L, Yu X, Cui L, Zhen Z, Gao L. Transseptal approach for catheter ablation of left-sided accessory pathways in children with Marfan syndrome: A case report. World J Clin Cases 2023; 11:2084-2090. [PMID: 36998966 PMCID: PMC10044966 DOI: 10.12998/wjcc.v11.i9.2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/20/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Left-sided accessory pathways (APs) can be accessed with either a transaortic (TA) or transseptal approach (TS). For children with Marfan syndrome (MFS) who have aortic disease, the use of TA can aggravate the disease, making TS the best choice for these patients.
CASE SUMMARY A 10-year-old girl was hospitalized because of intermittent heart palpitations and chest tightness. She was diagnosed with MFS, supraventricular tachycardia, Wolff-Parkinson-White syndrome, and left-sided AP was detected by cardiac electrophysiological. Catheter ablation was successfully performed via TS under the guidance of the Ensite system. During the follow-up, no recurrence or complications occurred.
CONCLUSION The TS for catheter ablation of left-sided APs can be considered in children with MFS. Adequate evaluation and selection of the appropriate puncture site are particularly important.
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Affiliation(s)
- Zi-Yan Dong
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Wei Shao
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Yue Yuan
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Li Lin
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Xia Yu
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Lang Cui
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Zhen Zhen
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Lu Gao
- National Center for Children’s Health, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Arrhythmia and impaired myocardial function in heritable thoracic aortic disease: An international retrospective cohort study. Eur J Med Genet 2022; 65:104503. [DOI: 10.1016/j.ejmg.2022.104503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/31/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022]
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Andersen NH, Hauge EM, Baad-Hansen T, Groth KA, Berglund A, Gravholt CH, Stochholm K. Musculoskeletal diseases in Marfan syndrome: a nationwide registry study. Orphanet J Rare Dis 2022; 17:118. [PMID: 35248143 PMCID: PMC8898450 DOI: 10.1186/s13023-022-02272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/20/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Marfan syndrome is associated with abnormalities in the musculoskeletal system including scoliosis, pectus deformities, protrusio acetabuli, and foot deformities. Over a life span, many patients with Marfan syndrome will need treatment; however, the musculoskeletal morbidity over a life span is not well described. The aim of the present study was to assess the overall burden of musculoskeletal disease in patients with Marfan syndrome.
Materials and methods
A registry-based, nationwide epidemiological study of patients with a Ghent II verified Marfan syndrome diagnosis from 1977 to 2014. Each patient was matched on age, and sex with up to 100 controls from the background population.
Results
We identified 407 patients with Marfan syndrome and 40,700 controls and compared their musculoskeletal diagnoses and surgical treatments using Cox proportional hazards ratio (HR). The risk of a registration of a musculoskeletal diagnosis in patients with Marfan syndrome was significantly increased compared to controls (HR: 1.94 (1.69–2.24). One out of six with Marfan syndrome was registered with scoliosis (HR: 36.7 (27.5–48.9). Scoliosis was more common in women with Marfan syndrome compared to men (HR: 4.30 (1.73–1.08)). One out of 11 were registered with a pectus deformity HR: 40.8 (28.1–59.3), and one out of six with a deformity of the foot. Primarily pes planus (HR: 26.0 (15.2–44.3). The proportion of patients with Marfan syndrome (94/407) that underwent musculoskeletal surgery was also significantly higher (HR: 1.76 (1.43–2.16)). The major areas of surgery were the spine, pectups correction, and surgery of the foot/ankle. Ten patients with Marfan syndrome had elective orthopedic surgery without being recognized and diagnosed with Marfan syndrome until later in life. None of these had scoliosis, pectus deformity or a foot deformity. Among patients with an aortic dissection, the age at dissection was 34.3 years in those with at least one major musculoskeletal abnormality. In patients without a major abnormality the age at dissection was 45.1 years (p < 0.01).
Conclusions
The extent of musculoskeletal disease is quite significant in Marfan syndrome, and many will need corrective surgery during their life span. Surgeons should be aware of undiagnosed patients with Marfan syndrome when treating patients with a Marfan syndrome like-phenotype.
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