1
|
Edouard T, Picot MC, Bajanca F, Huguet H, Guitarte A, Langeois M, Chesneau B, Van Kien PK, Garrigue E, Dulac Y, Amedro P. Health-related quality of life in children and adolescents with Marfan syndrome or related disorders: a controlled cross-sectional study. Orphanet J Rare Dis 2024; 19:180. [PMID: 38685042 PMCID: PMC11059743 DOI: 10.1186/s13023-024-03191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND This cross-sectional controlled study aims to assess health-related quality of life (HRQoL) of children and adolescents with a molecular diagnosis of Marfan syndrome (MFS) or related disorders and to evaluate the factors associated with HRQoL in this population. Sixty-three children with MFS and 124 age- and sex-matched healthy children were recruited. HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL™) generic questionnaire. The correlation between HRQoL scores and the different continuous parameters (age, body mass index, disease severity, systemic score, aortic sinus diameter, and aerobic physical capacity) was evaluated using Pearson's or Spearman's coefficient. A multiple linear regression analysis was performed on the two health summary self-reported PedsQL™ scores (physical and psychosocial) to identify the factors associated with HRQoL in the MFS group. RESULTS Except for emotional functioning, all other domains of HRQoL (psychosocial and physical health, social and school functions) were significantly lower in children with MFS compared to matched healthy children. In the MFS group, the physical health summary score was significantly lower in female than in male patients (self-report: absolute difference [95%CI] = -8.7 [-17.0; -0.47], P = 0.04; proxy-report: absolute difference [95%CI] = -8.6 [-17.3; 0.02], P = 0.05) and also negatively correlated with the systemic score (self-report: R = -0.24, P = 0.06; proxy-report: R = -0.29, P = 0.03) and with the height Z-score (proxy-report: R = -0.29, P = 0.03). There was no significant difference in the physical health summary scores between the different genetic subgroups. In the subgroup of 27 patients who performed a cardiopulmonary exercise test, self- and proxy-reported physical health summary scores were highly correlated with their aerobic physical capacity assessed by peak oxygen consumption (VO2max) and ventilatory anaerobic threshold (VAT). In the multivariate analysis, the most important independent predictors of decreased physical health were increased height, decreased body mass index, decreased VAT and use of prophylactic therapy. CONCLUSIONS This study reports an impaired HRQoL in children and adolescents with MFS or related conditions, in comparison with matched healthy children. Educational and rehabilitation programs must be developed and evaluated to improve exercise capacity and HRQoL in these patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT03236571 . Registered 28 July 2017.
Collapse
Affiliation(s)
- Thomas Edouard
- Reference Center for Marfan Syndrome and Related Diseases, Children's Hospital, Toulouse University Hospital, RESTORE, INSERM U1301, Paul Sabatier University, Toulouse, France.
- Endocrine, Bone Diseases, and Genetics Unit, Children's Hospital, Toulouse University Hospital, 330 Avenue de Grande-Bretagne TSA 70034, Toulouse Cedex 9, 31059, France.
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France
| | - Fernanda Bajanca
- Reference Center for Marfan Syndrome and Related Diseases, Children's Hospital, Toulouse University Hospital, RESTORE, INSERM U1301, Paul Sabatier University, Toulouse, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France
| | - Aitor Guitarte
- Reference Center for Marfan Syndrome and Related Diseases, Children's Hospital, Toulouse University Hospital, RESTORE, INSERM U1301, Paul Sabatier University, Toulouse, France
| | - Maud Langeois
- Reference Center for Marfan Syndrome and Related Diseases, Children's Hospital, Toulouse University Hospital, RESTORE, INSERM U1301, Paul Sabatier University, Toulouse, France
| | - Bertrand Chesneau
- Reference Center for Marfan Syndrome and Related Diseases, Children's Hospital, Toulouse University Hospital, RESTORE, INSERM U1301, Paul Sabatier University, Toulouse, France
| | | | - Eric Garrigue
- Reference Center for Marfan Syndrome and Related Diseases, Children's Hospital, Toulouse University Hospital, RESTORE, INSERM U1301, Paul Sabatier University, Toulouse, France
| | - Yves Dulac
- Reference Center for Marfan Syndrome and Related Diseases, Children's Hospital, Toulouse University Hospital, RESTORE, INSERM U1301, Paul Sabatier University, Toulouse, France
| | - Pascal Amedro
- Department of Pediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, IHU Liryc, INSERM 1045, University of Bordeaux, Bordeaux, France
| |
Collapse
|
2
|
Jenabzadeh T, Bohner L, Köppe J, Kleinheinz J, Hanisch M, Oelerich O. Temporomandibular disorders in individuals with Marfan syndrome: an exploratory analysis. Head Face Med 2024; 20:26. [PMID: 38659050 PMCID: PMC11040890 DOI: 10.1186/s13005-024-00427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND This study aims to analyze to what extent patients with Marfan syndrome (MFS) are affected by temporomandibular disorders (TMD) and its impact on oral health-related quality of life (OHRQoL). To collect data, an online questionnaire was created to recruit participants from Germany, Austria, and Switzerland through social media and support groups. The questionnaire consists of free-text questions, the German versions of the Oral Health Impact Profile (OHIP-G14), the Depression Anxiety Stress Scale (DASS), and the Graded Chronic Pain Status (GCPS). RESULTS A total of 76 participants with diagnosed MFS were included. Of these, 65.8% showed TMD symptoms, the most common being pain or stiffness of the masticatory muscles in the jaw angle (50.0%). Only 14.5% of the participants were already diagnosed with TMD. Of the participants with an increased likelihood of a depression disorder, 76.9% showed TMD symptoms. Of those with a critical score for an anxiety disorder, 90.9% showed TMD symptoms. 73.3% of participants with TMD symptoms reached the critical score for a stress disorder. TMD symptoms were associated with a higher risk for chronic pain. In the median, participants with TMD showed statistically notably higher OHIP-G14 scores than participants without TMD (11.5 [IQR 17] vs. 1 [IQR 3] points, p ≤ 0.001). CONCLUSION TMD symptoms had a noticeable impact on OHRQoL in patients with MFS, i.e., chronic pain and psychological impairment. TMD seems underdiagnosed, and more research is needed to prevent the associated chronification of pain and psychological burden to improve the OHRQoL.
Collapse
Affiliation(s)
- Termeh Jenabzadeh
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, 48149, Münster, Germany
| | - Lauren Bohner
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, 48149, Münster, Germany
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstraße 56, D-48149, Münster, Germany
| | - Johannes Kleinheinz
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, 48149, Münster, Germany
| | - Marcel Hanisch
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, 48149, Münster, Germany
| | - Ole Oelerich
- Department of Prosthodontics, University Hospital Münster, D-48149, Münster, Germany.
| |
Collapse
|
3
|
Curry T, Barrameda ME, Thomas TC, Esfandiarei M. In vivo phenotypic vascular dysfunction extends beyond the aorta in a mouse model for fibrillin-1 (Fbn1) mutation. Sci Rep 2024; 14:5779. [PMID: 38461168 PMCID: PMC10924961 DOI: 10.1038/s41598-024-56438-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/06/2024] [Indexed: 03/11/2024] Open
Abstract
In individuals with Marfan Syndrome (MFS), fibrillin-1 gene (FBN1) mutations can lead to vascular wall weakening and dysfunction. The experimental mouse model of MFS (Fbn1C1041G/+) has been advantageous in investigating MFS-associated life-threatening aortic aneurysms. It is well established that the MFS mouse model exhibits an accelerated-aging phenotype in elastic organs like the aorta, lung, and skin. However, the impact of Fbn1 mutations on the in vivo function and structure of various artery types with the consideration of sex and age, has not been adequately explored in real-time and a clinically relevant context. In this study, we investigate if Fbn1 mutation contributes to sex-dependent alterations in central and cerebral vascular function similar to phenotypic changes associated with normal aging in healthy control mice. In vivo ultrasound imaging of central and cerebral vasculature was performed in 6-month-old male and female MFS and C57BL/6 mice and sex-matched 12-month-old (middle-aged) healthy control mice. Our findings confirm aortic enlargement (aneurysm) and wall stiffness in MFS mice, but with exacerbation in male diameters. Coronary artery blood flow velocity (BFV) in diastole was not different but left pulmonary artery BFV was decreased in MFS and 12-month-old control mice regardless of sex. At 6 months of age, MFS male mice show decreased posterior cerebral artery BFV as compared to age-matched control males, with no difference observed between female cohorts. Reduced mitral valve early-filling velocities were indicated in MFS mice regardless of sex. Male MFS mice also demonstrated left ventricular hypertrophy. Overall, these results underscore the significance of biological sex in vascular function and structure in MFS mice, while highlighting a trend of pre-mature vascular aging phenotype in MFS mice that is comparable to phenotypes observed in older healthy controls. Furthermore, this research is a vital step in understanding MFS's broader implications and sets the stage for more in-depth future analyses, while providing data-driven preclinical justification for re-evaluating diagnostic approaches and therapeutic efficacy.
Collapse
Affiliation(s)
- T Curry
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - M E Barrameda
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, 19555 N 59th Ave., Glendale, AZ, 85308, USA
| | - T Currier Thomas
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA.
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, 19555 N 59th Ave., Glendale, AZ, 85308, USA.
- Arizona State University, Tempe, AZ, USA.
- Phoenix VA Health Care System, Phoenix, AZ, USA.
| | - M Esfandiarei
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA.
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, 19555 N 59th Ave., Glendale, AZ, 85308, USA.
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
4
|
Lin XF, Xie LF, Zhang ZF, He J, Xie YL, Dai XF, Chen LW. Quality of life in young patients with acute type a aortic dissection in China: comparison with Marfan syndrome and non-Marfan syndrome. BMC Cardiovasc Disord 2024; 24:132. [PMID: 38424531 PMCID: PMC10905939 DOI: 10.1186/s12872-024-03740-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND There is a paucity of Chinese studies evaluating the quality of life (QoL) in young acute type A aortic dissection (AAAD) patients with Marfan syndrome. METHODS Young adult AAAD patients (younger than 45 years old) underwent surgical treatment at our institution from January 2017 to December 2020 were consecutive enrolled. The hospital survivors completed 1 year of follow up. Patients were divided into two groups according to the presence or absence of Marfan syndrome (MFS). A 1:1 propensity score matching (PSM) with a caliper 0.2 was conducted to balance potential bias in baseline. The follow-up data were analyzed primarily for change in quality of life and anxiety status. RESULTS After PSM, 32 comparable pairs were matched. The baseline data were comparable and postoperative complications were similar between groups. In terms of SF-36 scale, the role physical, bodily pain, role emotional and mental health subscales were no significantly improved in MFS patients over time. At 1 year after discharged, the subscale of mental health and bodily pain were significantly lower in the MFS group than in the non-MFS group. In terms of HADS assessments, the level of anxiety in MFS patients was significantly higher than in non-MFS patients at 1 year after discharged. CONCLUSIONS The QoL in young AAAD patients with MFS is lower than those without MFS after surgery. This may be associated with the uncontrollable persistent chronic pain and the uncertainty and concerns for the disease's progression.
Collapse
Affiliation(s)
- Xin-Fan Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, P. R. China
| | - Lin-Feng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, P. R. China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Zhao-Feng Zhang
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Jian He
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, P. R. China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Yu-Ling Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, P. R. China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Xiao-Fu Dai
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, P. R. China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, P. R. China.
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China.
| |
Collapse
|
5
|
Curry T, Barrameda ME, Currier Thomas T, Esfandiarei M. In Vivo Phenotypic Vascular Dysfunction Extends Beyond the Aorta in a Mouse Model for Fibrillin-1 ( FBN1 ) Mutation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.18.567641. [PMID: 38014144 PMCID: PMC10680800 DOI: 10.1101/2023.11.18.567641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
In individuals with Marfan Syndrome (MFS), fibrillin-1 gene ( FBN1 ) mutations can lead to vascular wall weakening and dysfunction. The experimental mouse model of MFS ( FBN1 C1041G/+ ) has been advantageous in investigating MFS-associated life-threatening aortic aneurysms. Although the MFS mouse model presents an accelerated-aging phenotype in elastic organs (e.g., lung, skin), the impact of FBN1 mutations on other central and peripheral arteries function and structure with the consideration of the impact of sex remains underexplored. In this study, we investigate if FBN1 mutation contributes to sex-dependent alterations in central and cerebral vascular function similar to phenotypic changes associated with normal aging in healthy control mice. In vivo ultrasound imaging of central and cerebral vasculature was performed in 6-month-old male and female MFS and C57BL/6 mice and sex-matched 12-month-old (middle-aged) healthy control mice. Our findings confirm aortic enlargement (aneurysm) and wall stiffness in MFS mice, but with exacerbation in male diameters. Coronary artery blood flow velocity (BFV) in diastole was not different but left pulmonary artery BFV was decreased in MFS and 12-month-old control mice regardless of sex. At 6 months of age, MFS male mice show decreased posterior cerebral artery BFV as compared to age-matched control males, with no difference observed between female cohorts. Reduced mitral valve early-filling velocities were indicated in MFS mice regardless of sex. Male MFS mice also demonstrated left ventricular hypertrophy. Overall, these results underscore the significance of biological sex in vascular function and structure in MFS mice, while highlighting a trend of pre-mature vascular aging phenotype in MFS mice that is comparable to phenotypes observed in older healthy controls.
Collapse
|
6
|
Panetta M, Bianchetti A, Udugampolage NS, Taurino J, Caruso R, Pini A, Callus E. Discussing psychological and psychotherapeutic support for patients with Marfan syndrome (MFS) and their family: an example of a structured program in Italy. Front Psychol 2023; 14:1176692. [PMID: 37397303 PMCID: PMC10307951 DOI: 10.3389/fpsyg.2023.1176692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- Mariangela Panetta
- Cardiovascular-Genetic Centre, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandra Bianchetti
- Cardiovascular-Genetic Centre, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Jacopo Taurino
- Cardiovascular-Genetic Centre, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Alessandro Pini
- Cardiovascular-Genetic Centre, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Edward Callus
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy
| |
Collapse
|
7
|
Velvin G, Dammann B, Haagensen T, Johansen H, Strømme H, Geirdal AØ, Bathen T. Work participation in adults with rare genetic diseases - a scoping review. BMC Public Health 2023; 23:910. [PMID: 37208707 DOI: 10.1186/s12889-023-15654-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Work participation is a crucial aspect of health outcome and an important part of life for most people with rare genetic diseases. Despite that work participation is a social determinant of health and seems necessary for understanding health behaviours and quality of life, it is an under-researched and under-recognized aspect in many rare diseases. The objectives of this study was to map and describe existing research on work participation, identify research gaps, and point to research agendas in a selection of rare genetic diseases. METHODS A scoping review was performed by searching relevant literature in bibliographic databases and other sources. Studies addressing work participation in people with rare genetic diseases published in peer reviewed journals were assessed using EndNote and Rayyan. Data were mapped and extracted based on the research questions concerning the characteristics of the research. RESULTS Of 19,867 search results, 571 articles were read in full text, and 141 satisfied the eligibility criteria covering 33 different rare genetic diseases; 7 were reviews and 134 primary research articles. In 21% of the articles the primary aim was to investigate work participation. The extent of studies varied between the different diseases. Two diseases had more than 20 articles, but most had only one or two articles. Cross-sectional quantitative studies were predominant, with few utilizing prospective or qualitative design. Nearly all articles (96%) reported information about work participation rate, and 45% also included information about factors associated with work participation and work disability. Due to differences in methodologies, cultures and respondents, comparison between and within diseases are difficult. Nevertheless, studies indicated that many people with different rare genetic diseases experience challenges related to work, closely associated to the symptoms of the disease. CONCLUSION While studies indicate high prevalence of work disability in many patients with rare diseases, the research is scarce and fragmented. More research is warranted. Information about the unique challenges of living with different rare diseases is crucial for health and welfare systems to better facilitate work participation. In addition, the changing nature of work in the digital age, may also open up new possibilities for people with rare genetic diseases and should be explored.
Collapse
Affiliation(s)
- Gry Velvin
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway.
| | - Brede Dammann
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Trond Haagensen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Heidi Johansen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Oslo, Norway
| | - Amy Østertun Geirdal
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Science, Oslo Metropolitan University, Oslo, Norway
| | - Trine Bathen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| |
Collapse
|
8
|
Velvin G, Johansen H, Østertun-Geirdal A, Bathen T. Fatigue in patients with syndromic heritable thoracic aortic disease: a systematic review of the literature and a qualitative study of patients' experiences and perceptions. Orphanet J Rare Dis 2023; 18:119. [PMID: 37208760 DOI: 10.1186/s13023-023-02709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/30/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION The purpose of this study was to explore the literature on fatigue in patients with syndromic heritable thoracic aortic disease (sHTAD), including Marfan syndrome (MFS), Loeys-Dietz syndrome (LDS), vascular Ehlers Danlos syndrome (vEDS) and other sHTADs, critically appraise and synthesize the relevant literature. We also aimed to investigate how adults with sHTAD experience and perceive fatigue, and to discuss clinical implications and direction for further research. METHODS First, a systematic review was performed by searching the published literature in all relevant databases and other sources until 20th October 2022. Second, a qualitative focus group interview study was conducted of 36 adults with sHTADs (LDS n = 11, MFS n = 14, vEDS n = 11). RESULTS In the systematic review, 33 articles satisfied the eligibility criteria (3 reviews and 30 primary studies). Of the primary studies: 25 dealt with adults (MFS n = 17, MFS/EDS n = 1, EDS n = 2, LDS/vEDS n = 3, different sHTADs n = 2), 5 with children (MFS n = 4, different sHTADs n = 1). Twenty-two were cross-sectional quantitative studies, 4 prospective and 4 qualitative studies. The quality of the included studies was mostly good, but many had small sample sizes, low response rates and/or participants without verified diagnosis. Despite these limitations, studies indicated high prevalence of fatigue (ranging from 37 to 89%), and fatigue was associated with both health and psychosocial aspects. Few studies found that fatigue was associated with disease-related symptoms. In the qualitative focus groups most of the participants reported that they had experienced fatigue which influenced several aspects of life. Four themes related to fatigue were elucidated: (1) different diagnoses-different fatigue?, (2) the nature of fatigue, (3) searches for causes of fatigue, (4) dealing with fatigue in daily life. The four themes seemed mutually interrelated in terms of barriers, strategies and facilitators for dealing with fatigue. The participants experienced fatigue as a consistent dilemma between self-assertion and inadequacy. Fatigue seems to influence several aspects of daily life and may be one of the most debilitating symptoms of having a sHTAD. CONCLUSION Fatigue seems to negatively impact the lives of people with sHTADs and should be recognized as an important aspect in the lifelong follow-up of these patients. The life-threatening complications of sHTADs may result in emotional stress, including fatigue and the risk of developing a sedentary lifestyle. Research and clinical initiatives should consider rehabilitation interventions aiming at postponing the onset or reducing symptoms of fatigue.
Collapse
Affiliation(s)
- Gry Velvin
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, 1450, Nesoddtangen, Norway.
| | - Heidi Johansen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, 1450, Nesoddtangen, Norway
| | - Amy Østertun-Geirdal
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Science, Oslo Metropolitan University, Oslo, Norway
| | - Trine Bathen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, 1450, Nesoddtangen, Norway
| |
Collapse
|
9
|
van Andel MM, Graaumans K, Groenink M, Zwinderman AH, van Kimmenade RRJ, Scholte AJHA, van den Berg MP, Dickinson MG, Knoop H, Bosch JA, Mulder BJM, de Waard V, Bennebroek Evertsz' F. A cross-sectional study on fatigue, anxiety, and symptoms of depression and their relation with medical status in adult patients with Marfan syndrome. Psychological consequences in Marfan syndrome. Clin Genet 2022; 102:404-413. [PMID: 36059006 PMCID: PMC9828141 DOI: 10.1111/cge.14211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/07/2022] [Accepted: 08/15/2022] [Indexed: 01/12/2023]
Abstract
Marfan syndrome (MFS) is a connective tissue disorder affecting the cardiovascular, ocular, and skeletal system, which may be accompanied by psychological features. This study aimed to determine the prevalence of fatigue, anxiety, and symptoms of depression in MFS patients, and to assess the degree to which sociodemographic and clinical variables are associated with fatigue and psychological aspects. The prevalence of fatigue, anxiety, and symptoms of depression were assessed in two cohorts of MFS patients and compared with healthy controls. The checklist individual strength (CIS), and hospital anxiety and depression scale (HADS) questionnaires were utilized. Medical status was assessed (family history of MFS, aortic root dilatation >40 mm, previous aortic surgery, aortic dissection, chronic pain, skeletal involvement, and scoliosis). Severe fatigue was experienced by 37% of the total MFS cohort (n = 155). MFS patients scored significantly higher on the CIS questionnaire, concerning severe fatigue, as compared with the general Dutch population (p < 0.0001). There were no differences in HADS anxiety or depression scores. In older MFS patients, with a more severe cardiovascular phenotype, chronic pain, and a higher unemployment rate, significantly more symptoms of depression were observed, when compared with the general population (p = 0.027) or compared with younger MFS patients (p = 0.026). Multivariate analysis, showed that anxiety was associated with chronic pain (p = 0.022) and symptoms of depression with unemployment (p = 0.024). MFS patients report significantly more severe fatigue as compared with the general population. Since the cause of fatigue is unclear, more research may be needed. Psychological intervention, for example, cognitive behavioral therapy, may contribute to a reduction in psychological symptoms.
Collapse
Affiliation(s)
| | - Kim Graaumans
- Department of Medical PsychologyAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Maarten Groenink
- Department of CardiologyAmsterdam UMCAmsterdamThe Netherlands,Department of RadiologyAmsterdam UMCAmsterdamThe Netherlands
| | - Aeilko H. Zwinderman
- Department of Clinical Epidemiology, Biostatistics and BioinformaticsAmsterdam UMCAmsterdamThe Netherlands
| | | | | | | | - Michael G. Dickinson
- Department of CardiologyUniversity Medical Center GroningenGroningenThe Netherlands
| | - Hans Knoop
- Department of Medical PsychologyAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Jos A. Bosch
- Department of Medical PsychologyAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | | | - Vivian de Waard
- Department of Medical Biochemistry, Amsterdam UMC, Amsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
| | | |
Collapse
|
10
|
Wafa SEI, Chahal CAA, Sawatari H, Khanji MY, Khan H, Asatryan B, Ahmed R, Deshpande S, Providencia R, Deshmukh A, Owens AT, Somers VK, Padmanabhan D, Connolly H. Frequency of Arrhythmias and Postural Orthostatic Tachycardia Syndrome in Patients With Marfan Syndrome: A Nationwide Inpatient Study. J Am Heart Assoc 2022; 11:e024939. [PMID: 36000435 PMCID: PMC9496423 DOI: 10.1161/jaha.121.024939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder affecting multiple systems, particularly the cardiovascular system. The leading causes of death in MFS are aortopathies and valvular disease. We wanted to identify the frequency of arrhythmia and postural orthostatic tachycardia syndrome, length of hospital stay, health care-associated costs (HAC), and in-hospital mortality in patients with MFS. Methods and Results The National Inpatient Sample database from 2005 to 2014 was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for MFS and arrhythmias. Patients were classified into subgroups: supraventricular tachycardia, ventricular tachycardia (VT), atrial fibrillation, atrial flutter, and without any type of arrhythmia. Data about length of stay, HAC, and in-hospital mortality were also abstracted from National Inpatient Sample database. Adjusted HAC was calculated as multiplying HAC and cost-to-charge ratio; 12 079 MFS hospitalizations were identified; 1893 patients (15.7%) had an arrhythmia; and 4.9% of the patients had postural orthostatic tachycardia syndrome. Median values of length of stay and adjusted HAC in VT group were the highest among the groups (VT: 6 days, $18 975.8; supraventricular tachycardia: 4 days, $11 906.6; atrial flutter: 4 days, $11 274.5; atrial fibrillation: 5 days, $10431.4; without any type of arrhythmia: 4 days, $8336.6; both P=0.0001). VT group had highest in-patient mortality (VT: 5.3%, atrial fibrillation: 4.1%, without any type of arrhythmia: 2.1%, atrial flutter: 1.7%, supraventricular tachycardia: 0%; P<0.0001) even after adjustment for potential confounders (without any type of arrhythmia versus VT; odds ratio [95% CI]: 3.18 [1.62-6.24], P=0.001). Conclusions Arrhythmias and postural orthostatic tachycardia syndrome in MFS were high and associated with increased length of stay, HAC, and in-hospital mortality especially in patients with VT.
Collapse
Affiliation(s)
- Syed Emir Irfan Wafa
- Department of Cardiology Northampton General Hospital Northampton United Kingdom
| | - C Anwar A Chahal
- Division of Cardiology, Department of Medicine University of Pennsylvania Philadelphia PA.,Department of Cardiovascular Diseases Mayo Clinic Rochester MN.,Department of Cardiology, Barts Heart Centre Barts Health NHS Trust London United Kingdom
| | - Hiroyuki Sawatari
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN.,Department of Perioperative and Critical Care Management Hiroshima University Hiroshima Japan
| | - Mohammed Y Khanji
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry Queen Mary University of London London United Kingdom.,Department of Cardiology St. Bartholomew's Hospital London United Kingdom.,Department of Cardiology Newham University Hospital, Barts Health NHS Trust London United Kingdom
| | - Hassan Khan
- Leon H. Charney Division of Cardiology New York University Langone Health New York NY
| | - Babken Asatryan
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Raheel Ahmed
- Department of Cardiology Royal Brompton Hospital London United Kingdom
| | - Saurabh Deshpande
- Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore Karnataka
| | - Rui Providencia
- Department of Cardiology, Barts Heart Centre Barts Health NHS Trust London United Kingdom
| | | | - Anjali Tiku Owens
- Division of Cardiology, Department of Medicine University of Pennsylvania Philadelphia PA
| | - Virend K Somers
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Deepak Padmanabhan
- Division of Cardiology, Department of Medicine University of Pennsylvania Philadelphia PA.,Department of Cardiovascular Diseases Mayo Clinic Rochester MN.,Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore Karnataka
| | - Heidi Connolly
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| |
Collapse
|
11
|
Baylow HE, Esfandiarei M, Ratiu I. Swallowing and quality of life in individuals with Marfan syndrome: a cross-sectional study. Qual Life Res 2022; 31:3365-3375. [PMID: 35867322 DOI: 10.1007/s11136-022-03192-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Marfan syndrome (MFS) is a connective tissue disorder that affects skeletal, ocular, pulmonary, cardiovascular, and central nervous systems. Symptoms may lead to diminished quality of life (QoL) in individuals with MFS compared with healthy individuals. Currently, there is little evidence regarding the impact of MFS on swallowing and QoL. This study examined perceptions of swallowing difficulties and QoL among persons with MFS. METHOD A total of 356 participants (1% response rate) with a self-reported diagnosis of MFS provided medication regime and completed a Quality-of-Life Index and a modified version of the SWAL-QOL used to assess 8 QOL concepts related to swallowing: burden, duration, desire, food choice, fear, mental health, social concerns, and fatigue. RESULTS Dysphagia symptoms were reported by 62% (N = 356) of the participants. Analyses assessing correlations between responses to SWAL-QOL questions, QoL scores, and reported medications were conducted. Further, responses on the SWAL-QOL predicted QoL satisfaction, even after controlling for medications. Findings revealed that greater swallowing difficulty affects QoL satisfaction and overall QoL, but not QoL importance. Further, specific medications were associated with differences in swallowing difficulty as well as QoL satisfaction. CONCLUSIONS The findings of the current study suggest that individuals with MFS may experience specific swallowing difficulties which impact QoL. Specific classes of drugs may also be associated with reported swallowing QoL and QoL satisfaction in MFS. These findings have implications for clinicians who work with individuals with MFS.
Collapse
Affiliation(s)
- Hope E Baylow
- Department of Health and Human Performance, The University of Scranton, Edward Leahy Hall Rm. 824, 800 Linden St, Scranton, PA, 18510, USA.
| | - Mitra Esfandiarei
- Department of Biomedical Sciences, Midwestern University, Glendale, AZ, USA
| | - Ileana Ratiu
- Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA
- Speech-Language Pathology Program, Midwestern University, Glendale, AZ, USA
| |
Collapse
|
12
|
Health-Related Quality of Life of Patients with Marfan Syndrome-Polish Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116827. [PMID: 35682408 PMCID: PMC9180829 DOI: 10.3390/ijerph19116827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022]
Abstract
Background: Despite extensive knowledge about the quality of life of people suffering from rare diseases, data on patients with Marfan syndrome (MFS) are scarce and inconsistent. Hence, the problem of assessing the quality of life (QOL) and its relationship with the assessment of which ailments are the most burdensome for these patients is still open. Aim: Comparison of the quality of life of patients with MFS and determination as to which of the reported complaints in patients with MFS are related to the QOL of patients. Methods: The study included 35 patients with MFS and 35 healthy controls, matched for gender and age. In the study, the questionnaire of quality of life assessment SF-36 was used to assess the level of health-related quality of life, as well as an interview of the most severe symptoms reported by patients with MFS. Results: The level of the physical dimension of the QOL (p < 0.001) and limiting of roles due to physical health (p = 0.002), as well as the level of general index of the QOL (p < 0.001), were statistically significantly lower in MFS patients when compared to controls. People from both studied groups do not vary in the scope of pain, vitality, social functioning, limiting the roles due to emotional problems, and state of mind but also in the mental dimension of the health-related quality of life (HRQL). Additionally, there has been a correlation between HRQL and the subjective assessment of the effects of orthopedic, ophthalmic, and cardiological problems in life, as well as lower exercise tolerance in the evaluation of people with MFS and QOL in most areas. Conclusions: Patients with MFS present a reduced QOL in the areas of physical functioning, limiting roles due to physical health, general feeling of general health, the physical dimension of the HRQL, and the general index of the QOL; in these areas, they require careful evaluation, as well as medical and psychosocial assistance.
Collapse
|
13
|
Baylow HE, Esfandiarei M, Ratiu I. Voice Symptoms and Quality of Life in Individuals With Marfan Syndrome: A Cross-Sectional Study. J Voice 2022:S0892-1997(22)00107-2. [PMID: 35525628 DOI: 10.1016/j.jvoice.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Marfan Syndrome (MFS) is a connective tissue disorder that affects skeletal, ocular, pulmonary, cardiovascular, and central nervous systems. Symptoms may lead to diminished quality of life (QoL) in individuals with MFS compared with healthy individuals. Currently, there is little evidence regarding the impact of MFS on voicing and QoL. This study examined perceptions of voicing difficulties and QoL among persons with MFS. METHOD A total of 356 participants with a self-reported diagnosis of MFS completed the Quality-of-Life Index (QLI) and voice handicap index-10 (VHI-10) and provided medication regime. RESULTS Some degree of voice handicap was reported by a majority of participants. Analyses assessing correlations between responses to the VHI-10, QLI scores, and reported medications were conducted. Specific medications and responses on the VHI-10 were significantly associated with QLI scores. Multiple regression analyses revealed that a summed VHI-10 score was the strongest predictor of QLI satisfaction, QLI importance, and overall QLI. CONCLUSIONS The findings of the current study suggest that individuals with MFS may experience self-perceived phonatory dysfunction which impact QoL. Specific classes of drugs may also be associated with reported voice handicap and QoL satisfaction in MFS. These findings have implications for physicians and clinicians who work with individuals with MFS.
Collapse
Affiliation(s)
- Hope E Baylow
- University of Scranton, Health and Human Performance, Scranton, Pennsylvania.
| | | | - Ileana Ratiu
- Midwestern University, Speech-Language Pathology, Glendale, Arizona
| |
Collapse
|
14
|
Is SF-12 a valid and reliable measurement of health-related quality of life among adults with Marfan syndrome? A confirmatory study. PLoS One 2021; 16:e0252864. [PMID: 34106976 PMCID: PMC8189474 DOI: 10.1371/journal.pone.0252864] [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: 09/15/2020] [Accepted: 05/24/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The structural validity and reliability of the Short-Form Health Survey 12 (SF-12) has not yet been tested in adults with the Marfan syndrome (MFS). This gap could undermine an evidence-grounded practice and research, especially considering that the need to assess health-related quality of life in patients with MFS has increased due to the improved life expectancy of these patients and the need to identify their determinants of quality of life. For this reason, this study aimed to confirm the dimensionality (structural validity) of the SF-12, its concurrent validity, and its reliability (internal consistency). Methods We performed a cross-sectional study in a convenience sample of 111 Italian adults with MFS, collecting anamnestic and socio-demographic information, the SF-12, and short-form Health Survey 36 (SF-36). A confirmatory factor analysis was performed to verify whether the items of SF-12 related to physical restrictions, physical functioning, and bodily pain were retained by the physical summary component of the SF-12. The items referred to the role limitations due to emotional issues, social functioning, and mental health were retained by the mental summary component (MCS12). SF-36 was used to assess the concurrent validity of SF-12, hypothesizing positive correlations among the equivalent summary scores. Results The two-factor structural solution resulted in fitting the sample statistics adequately. The internal consistency was adequate for the two factors. Furthermore, the physical and mental summary scores of the SF-36 were positively correlated with their equivalent summary scores derived from the SF-12. Conclusions This study confirmed the factor structure of the SF-12. Therefore, the use of SF-12 in clinical practice and research for assessing the health-related quality of life among adults with MFS is evidence-grounded. Future research is recommended to determine whether the SF-12 shows measurement invariance in different national contexts and determine eventual demographic variation in the SF-12 scores among patients with MFS.
Collapse
|
15
|
Shimizu T, Shimizu Y. Association between subjective well-being and perception of medical care system among patients with Marfan syndrome: A cross-sectional study. Mol Genet Genomic Med 2021; 9:e1661. [PMID: 33949154 PMCID: PMC8172200 DOI: 10.1002/mgg3.1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/21/2020] [Accepted: 03/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background This study investigated the association between subjective well‐being and perception for collaboration among clinical departments of adult Marfan syndrome (MFS) patients. Methods We performed a self‐administered questionnaire survey to ask about current medical treatment and support systems and subjective well‐being for 114 patients with MFS aged 18–64 years. It was hypothesized that patients’ perception of collaboration between clinical departments would raise their subjective well‐being. Mean value differences were predicted by a multiple regression analysis model, with supportive medical staff, age, sex, aorta dissection, family history, marriage status, and educational background adjusted. Results Patients’ perception of collaboration between clinical departments and being married raised SWLS scores (mean difference for patients’ perception of collaboration versus not = 3.41, 95% CI = 0.28, 6.53, p = .03; for married versus single = 5.22, 95% CI = 1.75, 8.69, p = .003). Conclusion Our results have suggested that it is necessary to maintain and enhance the medical treatment system with the patients for improving the subjective well‐being of MFS patients. In addition, the result indicated the need for intervention to the patients themselves and also their family so that it allows patients to receive physical and emotional support from people close to them.
Collapse
Affiliation(s)
- Tomoko Shimizu
- Division of Health SciencesOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Yasuko Shimizu
- Division of Health SciencesOsaka University Graduate School of MedicineSuitaOsakaJapan
| |
Collapse
|
16
|
Andonian C, Freilinger S, Achenbach S, Ewert P, Gundlach U, Kaemmerer H, Nagdyman N, Neidenbach RC, Pieper L, Schelling J, Weyand M, Beckmann J. Quality of life in patients with Marfan syndrome: a cross-sectional study of 102 adult patients. Cardiovasc Diagn Ther 2021; 11:602-610. [PMID: 33968637 DOI: 10.21037/cdt-20-692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Marfan syndrome (MFS) is a genetically determined multiorgan disease that leads to severe physiological and psychological impairments in adult life. Little consensus exists regarding quality of life (QOL) in individuals with MFS. The present study sought to investigate QOL in a representative cohort of adults with MFS. Methods Patient-reported outcome measures from a representative sample of 102 adults with MFS (39.3±13.1 years of age; 40.2% female) were retrospectively analyzed and compared with those from adults with different congenital heart defects (CHD), at the German Heart Center Munich. QOL was assessed using the updated five-level version of the EQ-5D. Results Differences between both populations were analyzed. Subjects affected by MFS reported an overall reduced QOL. Compared to CHD patients, individuals with MFS scored significantly lower in the dimensions of pain/discomfort, anxiety/depression, mobility and usual activities (P<0.05). Conclusions Patients with MFS are at high risk for impaired QOL, especially in mental and physical domains. Psychosocial consequences of MFS cost resources for both, patients and professionals. Current findings highlight the great importance of additional psychological support to cope with disease-related challenges. Increased attention should be directed towards enhancing their subjective wellbeing to potentially improve their QOL and long-term health outcomes.
Collapse
Affiliation(s)
- Caroline Andonian
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany.,Department of Sport and Health Sciences, Chair of Sport Psychology, Technical University Munich, Munich, Germany.,Sigmund Freud University, Vienna, Austria
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Stefan Achenbach
- Department of Cardiology, University of Erlangen, Erlangen, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Ulrike Gundlach
- Department of Cardiology, University of Erlangen, Erlangen, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Rhoia Clara Neidenbach
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Lars Pieper
- Department of Behavioral Epidemiology, Technical University of Dresden, Dresden, Germany
| | - Jörg Schelling
- Faculty of Medicine, Ludwig Maximilians University (LMU) of Munich, Munich, Germany
| | - Michael Weyand
- Department of Cardiology, University of Erlangen, Erlangen, Germany
| | - Jürgen Beckmann
- Department of Sport and Health Sciences, Chair of Sport Psychology, Technical University Munich, Munich, Germany.,School of Human Movement and Nutrition Sciences, University of Queensland, Australia.,Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
17
|
Vanem TT, Rand-Hendriksen S, Brunborg C, Geiran OR, Røe C. Health-related quality of life in Marfan syndrome: a 10-year follow-up. Health Qual Life Outcomes 2020; 18:376. [PMID: 33256748 PMCID: PMC7706277 DOI: 10.1186/s12955-020-01633-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 11/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background Marfan syndrome, a rare hereditary connective tissue disorder caused by mutations in fibrillin-1, can affect many organ systems, especially the cardiovascular system. Previous research has paid less attention to health-related quality of life and prospective studies on this topic are needed. The aim of this study was to assess changes in health-related quality of life after 10 years in a Norwegian Marfan syndrome cohort. Methods Forty-seven Marfan syndrome patients ≥ 18 years were investigated for all organ manifestations in the 1996 Ghent nosology and completed the self-reported questionnaire, Short-Form-36 Health Survey, at baseline in 2003–2004 and at follow-up in 2014–2015. Paired sample t tests were performed to compare means and multiple regression analyses were performed with age, sex, new cardiovascular and new non-cardiovascular pathology as predictors. Results At 10-year follow-up: a significant decline was found in the physical domain. The mental domain was unchanged. Older age predicted a larger decline in physical health-related quality of life. None of the chosen Marfan-related variables predicted changes in any of the subscales of the Short-Form 36 Health Survey or in the physical or the mental domain. Conclusion Knowledge of decline in the physical domain, not related to organ affections, may be important in the follow-up of Marfan syndrome patients.
Collapse
Affiliation(s)
- Thy Thy Vanem
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. .,Department of Cardiothoracic Surgery, Oslo University Hospital (OUH), Oslo, Norway.
| | - Svend Rand-Hendriksen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | | | - Odd Ragnar Geiran
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital (OUH), Oslo, Norway
| | - Cecilie Røe
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, OUH, Oslo, Norway
| |
Collapse
|
18
|
Thijssen CGE, Dekker S, Bons LR, Gökalp AL, Kauling RM, van den Bosch AE, Cuypers JAAE, Utens EMWJ, van Kimmenade RRL, Takkenberg JJM, Roos LMH, Goossens E, Roos-Hesselink JW. Health-related quality of life and lived experiences in males and females with thoracic aortic disease and their partners. Open Heart 2020; 7:openhrt-2020-001419. [PMID: 33033116 PMCID: PMC7545641 DOI: 10.1136/openhrt-2020-001419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 01/16/2023] Open
Abstract
Objective Thoracic aortic disease (TAD) may have substantial impact on health-related quality of life (HRQOL). We described HRQOL in patients with TAD, cardiovascular screening participants and their partners; identified factors associated with HRQOL; and explored lived experiences and feelings of anxiety or depression using a mixed methods design. Methods For this cross-sectional study, all consecutive patients visiting the TAD outpatient clinic (2017–2019) at our centre were asked to complete three questionnaires: the Short Form 36 (SF-36), the Hospital Anxiety and Depression Scale (HADS) and the Rotterdam Disease Specific Questionnaire (RDSQ). A subsample was invited for in-depth interviews. Results In total, 261 participants were included: 147 patients with TAD (thoracic aortic diameter ≥40 mm; 54 females, 36.7%), 114 screening participants (cardiovascular family screening; 71 females, 62.3%) and 66 partners. Compared with the general population, patients with TAD showed markedly lower HRQOL, whereas screening participants’ HRQOL was less impaired. Female and younger participants scored significantly lower on the SF-36 and HADS compared with male and older participants. Smaller aortic diameter was associated with better RDSQ score, and previous aortic surgery was associated with higher HADS depression scores. Furthermore, partners scored significantly lower on 2/8 SF-36 subdomains when compared with the general population. From 11 interviewees, determinants of psychological distress included coping strategies, impact on social and professional life, disease-related knowledge, state of aortic diameters and physical symptoms. Conclusions Healthcare professionals must be aware of HRQOL impairments in patients with TAD, particularly in younger females. Moreover, attention for partners is needed. Coping strategies and communication within the family were found to be important factors influencing psychological distress, and might be valuable leads for counselling and HRQOL improvement in this population.
Collapse
Affiliation(s)
- Carlijn G E Thijssen
- Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Silvy Dekker
- Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Arjen L Gökalp
- Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands.,Research Institue of Child Development and Education, De Bascule-AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roland R L van Kimmenade
- Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | - Eva Goossens
- Departement of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Fonds Wetenschappelijk Onderzoek-Vlaanderen, Brussels, Belgium.,Department of Nursing, UAntwerpen, Antwerp, Belgium
| | | |
Collapse
|
19
|
Wang Z, Lu Y, Xiao K, Gao Y, He J, Zhang S, Wang G, Zhang M. Bimanual irrigation-aspiration for ectopia lentis and use of a small incision for 4-point scleral-sutured foldable intraocular lens and anterior vitrectomy in patients with Marfan syndrome. Indian J Ophthalmol 2020; 67:1629-1633. [PMID: 31546497 PMCID: PMC6786229 DOI: 10.4103/ijo.ijo_250_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: This study evaluated bimanual intracapsular irrigation-aspiration for ectopia lentis with use of a small incision for 4-point scleral fixation of a foldable posterior-chamber intraocular lens (IOL) and anterior vitrectomy in patients with Marfan syndrome. Methods: We performed a retrospective study of 18 eyes from 10 patients with Marfan syndrome who underwent surgical intervention for ectopia lentis at our clinic between July 2012 and September 2018. In this study, intraoperative and postoperative complications, uncorrected visual acuity, best-corrected visual acuity, spherical equivalent, intraocular pressure, and endothelial cell density were evaluated. Results: No intraoperative complications were reported. In all cases, early postoperative evaluation revealed a clear cornea, round pupil, and well-centered IOL. Mean logMAR uncorrected visual acuity improved from 1.09 preoperatively to 0.56 postoperatively (P < 0.05). Mean logMAR best-corrected visual acuity improved from 0.45 preoperatively to 0.17 postoperatively (P < 0.05). Aside from transient ocular hypertension, no postoperative complications were reported. Conclusion: The combined surgical technique presented above yields excellent visual outcomes with an extremely low incidence of complications. This approach is simple, safe, and effective in the treatment of ectopia lentis in patients with Marfan syndrome.
Collapse
Affiliation(s)
- Zhenmao Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Guangdong Province, China
| | - Yan Lu
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Kailin Xiao
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Guangdong Province, China
| | - Ying Gao
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Jing He
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Shaobin Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Guangdong Province, China
| | - Geng Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Guangdong Province, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Guangdong Province, China
| |
Collapse
|
20
|
Hansen LB, von Kodolitsch Y, Schroeder F, Benninghoven D. Body Image in Patients with Marfan Syndrome. J Clin Med 2020; 9:jcm9041015. [PMID: 32260184 PMCID: PMC7230675 DOI: 10.3390/jcm9041015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/22/2020] [Accepted: 03/31/2020] [Indexed: 12/15/2022] Open
Abstract
This study aimed to assess body image impairments of individuals with Marfan syndrome and to determine to what extent psychological, physical, and sociodemographic factors influence body image. We assessed the physical fitness and psychosocial health of 42 patients with Marfan syndrome at the beginning of an inpatient rehabilitation program. All participants filled out a body image questionnaire consisting of two scales: (1) Negative Body Evaluation and (2) Vital Body Dynamics. We compared body image data of the study sample with the German representative norming sample and carried out two separate regression analyses in order to determine which variables were associated with the two dimensions of patients' body image. Body image of individuals with Marfan syndrome appeared to be significantly impaired, with high percentile ranks for Negative Body Evaluation (women = 88, men = 91) and low percentile ranks for Vital Body Dynamics (women = 11, men = 4). Vital Body Dynamics was predicted by age (p = 0.016) and by depression (p < 0.001), and Negative Body Evaluation was predicted by anxiety (p = 0.001). Body image in individuals with Marfan syndrome is not primarily determined by objective measures of fitness or by objective cardiac impairment but by psychological variables like depression and anxiety and by age. This finding can inform treatment and rehabilitation concepts. Accepting Marfan syndrome, including the acceptance of being visually different, may not only demand medical treatment and physical rehabilitation but also psychological treatment for depression and anxiety.
Collapse
Affiliation(s)
- Laura Birke Hansen
- Muehlenberg-Clinic for Rehabilitation, 23714 Bad Malente-Gremsmühlen, Germany; (L.B.H.); (F.S.)
| | - Yskert von Kodolitsch
- Clinic of Cardiology at the University Heart Centre, University of Hamburg, 20246 Hamburg, Germany;
| | - Friedrich Schroeder
- Muehlenberg-Clinic for Rehabilitation, 23714 Bad Malente-Gremsmühlen, Germany; (L.B.H.); (F.S.)
| | - Dieter Benninghoven
- Muehlenberg-Clinic for Rehabilitation, 23714 Bad Malente-Gremsmühlen, Germany; (L.B.H.); (F.S.)
- Clinic of Psychosomatic Medicine and Psychotherapy, University of Luebeck, 23538 Luebeck, Germany
- Correspondence: ; Tel.: +494523-993-7014; Fax: +494523-993-2222
| |
Collapse
|
21
|
Internalizing and externalizing behaviors in chronically ill adolescents in the context of family system functioning. HEALTH PSYCHOLOGY REPORT 2019. [DOI: 10.5114/hpr.2019.87934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BackgroundDiagnosis of chronic illness, which constitutes a life-threatening situation such as in Marfan syndrome or dis-ease with periods of remission and severity such as in juvenile idiopathic arthritis (JIA), leads to problems with the functioning of the adolescent and the whole family system. Therefore the aim of the study was to determine the differences in severity of internalizing and externalizing problems and in the perception of the family sys-tem between adolescents with Marfan syndrome, with JIA, and without chronic disease, as well as to determine whether characteristics of the family system are associated with externalizing and internalizing behaviors in those groups.Participants and procedureThe study involved three groups of adolescents: 1) with Marfan syndrome (n = 25), 2) with JIA (n = 29), and 3) without chronic illness (n = 20). We used the adolescent version of the Child Behavior Checklist (CBCL) Youth Self-Report (YSR) and the Family Assessment Scale.ResultsOur results indicated that adolescents with Marfan syndrome have similar scores compared to adolescents without illness on all subscales concerning both internalizing and externalizing behaviors, as well as the family system’s characteristics. Compared to adolescents with JIA, adolescents with Marfan syndrome had lower scores on externalization symptoms and Attention Problems and they also perceive their families as less bal-anced. Additionally, in the perception of adolescents with Marfan syndrome and with JIA the weaker the family bond, the stronger the intensity of externalizing behaviors.ConclusionsAlthough in the light of our novel research, adolescents with Marfan syndrome do not present behavioral prob-lems different from healthy peers, it is worth continuing such research in order to verify the results. Adolescents with JIA present more externalizing behaviors than peers without chronic illness, which is consistent with some previous research. Research on families of an adolescent child with Marfan and JIA are quite novel and they should be continued.
Collapse
|
22
|
Marfan syndrome in childhood: parents' perspectives of the impact on daily functioning of children, parents and family; a qualitative study. BMC Pediatr 2019; 19:262. [PMID: 31357961 PMCID: PMC6661807 DOI: 10.1186/s12887-019-1612-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 07/02/2019] [Indexed: 02/07/2023] Open
Abstract
Background Marfan syndrome (MFS) is a heritable connective tissue disease caused by a defect in FBN1. The diagnosis is based on the revised Ghent criteria. The main features involve the cardiovascular, musculoskeletal, ophthalmic, pulmonary systems and facial features. Although the clinical manifestations of MFS in children are thoroughly addressed in several studies, literature on the impact of MFS on daily functioning is restricted to pediatric advice on sports and leisure participation. Therefore, the full impact of MFS on daily functioning remains unclear. The aim of this qualitative study was to explore parents’ perspectives on the impact of MFS on daily functioning of children with MFS aged 4–12 years, themselves and family regarding functional performance, activities, participation, personal and environmental factors, and disease burden. Methods In this qualitative study parents participated in individual semi-structured interviews (n = 10) and 3 focus groups (n = 5, n = 5 and n = 6). Meetings were transcribed, and data were analyzed using thematic analysis. Meaningful concepts were coded, and concepts concerning children with MFS were linked to the International Classification of Functioning, Disability and Health for Children and Youth. Thereafter themes were identified and interpreted. Results Parents reported their children could not keep up with peers because of fatigue, pain and physical impairments. Children experienced participation restrictions in school, sports, play and other leisure activities. Parents reported their child as being different due to physical appearance, which provoked unsupportive attitudes. Parental burden was caused by high care needs, lack of support, a limited social life, and concerns about the child’s development. Family burden was caused by adjusted and complex family schedules, other family members with MFS, and reproductive planning decision-making, whereas family cohesiveness and caring were positively perceived factors. Conclusions Parents perceived a large impact of MFS on daily functioning of their children with MFS, themselves and their family. More awareness among all professionals involved in the care of children with MFS and their families is needed so that professionals can address their support needs and provide tailored interventions, rehabilitation and/or educational programs to empower and improve daily functioning of the children, parents and family. Electronic supplementary material The online version of this article (10.1186/s12887-019-1612-6) contains supplementary material, which is available to authorized users.
Collapse
|
23
|
Nielsen C, Ratiu I, Esfandiarei M, Chen A, Selamet Tierney ES. A Review of Psychosocial Factors of Marfan Syndrome: Adolescents, Adults, Families, and Providers. J Pediatr Genet 2019; 8:109-122. [PMID: 31406616 DOI: 10.1055/s-0039-1693663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/12/2019] [Indexed: 02/07/2023]
Abstract
The purpose of this article was to review the current literature on psychosocial implications of Marfan syndrome (MFS) and its impact on adolescents, adults, their families and to provide important considerations for providers. Since the previous reviews in 2015, numerous studies have been published that are included in the current review. This literature review was conducted using PubMed, Medline, PsychINFO, ERIC, Web of Science, and Academic Search Premier databases and only articles that studied psychosocial factors that influence MFS patients as adolescents, adults, family members, or their interactions with providers were included in this review. Of the 522 articles reviewed, 41 were selected based on the inclusion and exclusion criteria. All articles were peer-reviewed. MFS has various implications that can impact one's life; studies have shown that MFS causes a negative impact on an individual's formative years, quality of life, reproductive decision-making, work participation, and satisfaction with life. Clinicians and multidisciplinary teams should be aware of these factors to provide support focusing on coping strategies for the patient and their family.
Collapse
Affiliation(s)
- Cory Nielsen
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, Glendale, Arizona, United States
| | - Ileana Ratiu
- Speech-Language Pathology Program, College of Health Sciences, Midwestern University, Glendale, Arizona, United States
| | - Mitra Esfandiarei
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, Glendale, Arizona, United States
| | - Angela Chen
- Department of Pediatric Cardiology, Stanford University, Palo Alto, California, United States
| | | |
Collapse
|
24
|
Velvin G, Wilhelmsen JE, Johansen H, Bathen T, Geirdal AØ. Systematic review of quality of life in persons with hereditary thoracic aortic aneurysm and dissection diagnoses. Clin Genet 2019; 95:661-676. [DOI: 10.1111/cge.13522] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Gry Velvin
- TRS National Resource Centre for Rare DisordersSunnaas Rehabilitation Hospital Nesodden Norway
| | - Jan E. Wilhelmsen
- TRS National Resource Centre for Rare DisordersSunnaas Rehabilitation Hospital Nesodden Norway
| | - Heidi Johansen
- TRS National Resource Centre for Rare DisordersSunnaas Rehabilitation Hospital Nesodden Norway
| | - Trine Bathen
- TRS National Resource Centre for Rare DisordersSunnaas Rehabilitation Hospital Nesodden Norway
| | - Amy Ø. Geirdal
- Departments of Social Work, Child Welfare and Social Policy, Faculty of Social SciencesMetropolitan University of Oslo Norway
| |
Collapse
|
25
|
Warnink-Kavelaars J, Beelen A, Goedhart TMHJ, de Koning LE, Nollet F, Alsem MW, Menke LA, Engelbert RHH. Marfan syndrome in adolescence: adolescents' perspectives on (physical) functioning, disability, contextual factors and support needs. Eur J Pediatr 2019; 178:1883-1892. [PMID: 31620888 PMCID: PMC6881250 DOI: 10.1007/s00431-019-03469-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 12/11/2022]
Abstract
Although essential for providing optimal adolescent patient support, knowledge of the impact of Marfan syndrome in adolescence is limited. To explore adolescents' perceived impact of Marfan syndrome on (physical) functioning (activities, participation), disability (limitations, restrictions), contextual factors and support needs, we interviewed 19 adolescents with Marfan syndrome. Audio-recordings were transcribed, coded and analysed using thematic analysis. Identified themes were "difficulties in keeping up with peers" and "being and feeling different from peers". Furthermore, an adolescent Marfan syndrome-specific International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) model derived from the data describing the adolescent perceived impact of Marfan syndrome on functioning, disability and its contextual factors. Adolescents perceived problems in keeping up with peers in school, sports, leisure and friendships/relationships, and they could not meet work requirements. Moreover, participants perceived to differ from peers due to their appearance and disability. Contextual factors: coping with Marfan syndrome, self-esteem/image, knowledge about Marfan syndrome, support from family/friends/teachers, ability to express needs and peer-group acceptation acted individually as barrier or facilitator for identified themes.Conclusion: Adolescents with Marfan syndrome perceived limitations and restrictions in (physical) functioning. They perceived problems in keeping up with peers and perceived to differ from peers due to their appearance and disability. This warrants awareness and tailored physical, psychosocial, educational and environmental support programmes to improve (physical) functioning and empowerment of adolescents with Marfan syndrome.What is known:• Marfan syndrome is a hereditary connective tissue disorder.• Marfan syndrome affects multiple systems.What is new:• Adolescents with Marfan syndrome perceive (1) problems in keeping up with peers in school, sports, leisure, friendships/relationships and work (2) to differ from peers due to their appearance and disability.• An adolescent Marfan syndrome-specific International Classification of Functioning, Disability and Health for Children and Youth model derived from the data describing the adolescent perceived impact of Marfan syndrome on functioning, disability and contextual factors.
Collapse
Affiliation(s)
- Jessica Warnink-Kavelaars
- Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, PO 22660, 1100 DD, Amsterdam, Netherlands.
| | - Anita Beelen
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, PO 22660, 1100 DD Amsterdam, Netherlands ,grid.7692.a0000000090126352Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands ,grid.7692.a0000000090126352Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Tine M. H. J. Goedhart
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, PO 22660, 1100 DD Amsterdam, Netherlands
| | - Lisanne E. de Koning
- grid.431204.0ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, the Netherlands
| | - Frans Nollet
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, PO 22660, 1100 DD Amsterdam, Netherlands
| | - Mattijs W. Alsem
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, PO 22660, 1100 DD Amsterdam, Netherlands
| | - Leonie A. Menke
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Pediatrics, Meibergdreef 9, Amsterdam, Netherlands
| | - Raoul H. H. Engelbert
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, PO 22660, 1100 DD Amsterdam, Netherlands ,grid.431204.0ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, the Netherlands ,grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Pediatrics, Meibergdreef 9, Amsterdam, Netherlands
| |
Collapse
|
26
|
Handisides JC, Hollenbeck-Pringle D, Uzark K, Trachtenberg FL, Pemberton VL, Atz TW, Bradley TJ, Cappella E, De Nobele S, Groh GKT, Hamstra MS, Korsin R, Levine JC, Lindauer B, Liou A, Mac Neal MK, Markham LW, Morrison T, Mussatto KA, Olson AK, Pierpont MEM, Pyeritz RE, Radojewski EA, Roman MJ, Xu M, Lacro RV. Health-Related Quality of Life in Children and Young Adults with Marfan Syndrome. J Pediatr 2019; 204:250-255.e1. [PMID: 30270167 PMCID: PMC6800200 DOI: 10.1016/j.jpeds.2018.08.061] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/25/2018] [Accepted: 08/21/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess health-related quality of life (HRQOL) in a large multicenter cohort of children and young adults with Marfan syndrome participating in the Pediatric Heart Network Marfan Trial. STUDY DESIGN The Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales were administered to 321 subjects with Marfan syndrome (5-25 years). PedsQL scores were compared with healthy population norms. The impact of treatment arm (atenolol vs losartan), severity of clinical features, and number of patient-reported symptoms on HRQOL was assessed by general linear models. RESULTS Mean PedsQL scores in children (5-18 years) with Marfan syndrome were lower than healthy population norms for physical (P ≤ .003) and psychosocial (P < .001) domains; mean psychosocial scores for adults (19-25 years) were greater than healthy norms (P < .001). HRQOL across multiple domains correlated inversely with frequency of patient-reported symptoms (r = 0.30-0.38, P < .0001). Those <18 years of age with neurodevelopmental disorders (mainly learning disability, attention-deficit/hyperactivity disorder) had lower mean PedsQL scores (5.5-7.4 lower, P < .04). A multivariable model found age, sex, patient-reported symptoms, and neurodevelopmental disorder to be independent predictors of HRQOL. There were no differences in HRQOL scores by treatment arm, aortic root z score, number of skeletal features, or presence of ectopia lentis. CONCLUSIONS Children and adolescents with Marfan syndrome were at high risk for impaired HRQOL. Patient-reported symptoms and neurodevelopmental disorder, but not treatment arm or severity of Marfan syndrome-related physical findings, were associated with lower HRQOL.
Collapse
Affiliation(s)
| | | | - Karen Uzark
- C. S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
| | | | | | - Teresa W. Atz
- Medical University of South Carolina, Charleston, SC
| | - Timothy J. Bradley
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | - Jami C. Levine
- Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Bergen Lindauer
- Primary Children’s Hospital, University of Utah, Salt Lake City, UT
| | | | | | - Larry W. Markham
- The Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | | | | | | | | | - Reed E. Pyeritz
- The Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Mingfen Xu
- Duke University School of Medicine, Durham, NC
| | - Ronald V. Lacro
- Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | | |
Collapse
|
27
|
Pyeritz RE. Marfan syndrome: improved clinical history results in expanded natural history. Genet Med 2018; 21:1683-1690. [DOI: 10.1038/s41436-018-0399-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/29/2018] [Indexed: 11/09/2022] Open
|
28
|
Ratiu I, Virden TB, Baylow H, Flint M, Esfandiarei M. Executive function and quality of life in individuals with Marfan syndrome. Qual Life Res 2018; 27:2057-2065. [PMID: 29671248 DOI: 10.1007/s11136-018-1859-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Marfan syndrome (MFS) is a connective tissue disorder that affects skeletal, ocular, pulmonary, cardiovascular, and central nervous systems. Psychological and physiologic symptoms may lead to diminished quality of life (QoL) in individuals with MFS compared with healthy individuals. Currently, there is little evidence regarding the impact of MFS on executive function and QoL. This study examined perceptions of executive function and QoL among persons with MFS. METHOD A total of 318 participants with MFS completed surveys assessing perceptions of executive function abilities and QoL. Responses to executive function questions were grouped using principle component analysis. Responses to QoL questions were separated into overall QoL, questions dealing with satisfaction of QoL, and importance placed on aspect of QoL. RESULTS Principle component analysis revealed that executive function difficulties, particularly mental fatigue, associated with MFS symptoms affect QoL satisfaction and total QoL. Interestingly, medication status did not significantly impact QoL, over and above executive function difficulties. CONCLUSIONS The findings of the current study suggest that individuals with MFS may experience specific executive function difficulties which impact QoL. These findings also have implications for clinicians who work with individuals with MFS.
Collapse
Affiliation(s)
| | | | - Hope Baylow
- Richmond University Medical Center, Staten Island, NY, USA
- Hofstra University, Hempstead, NY, USA
| | | | | |
Collapse
|
29
|
Personal resources and satisfaction with life in Marfan syndrome patients with aortic pathology and in abdominal aortic aneurysm patients. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 15:27-30. [PMID: 29681958 PMCID: PMC5907467 DOI: 10.5114/kitp.2018.74672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/02/2018] [Indexed: 11/17/2022]
Abstract
Introduction Whether or not the source of aortic pathology is Marfan syndrome (MFS) or other processes leading to development of abdominal aorta aneurysms (AAA), the awareness of pathology may lead to an emotional upset and low assessment of satisfaction with life. Aim To assess, in regard to MFS patients with aortic pathology and to abdominal aortic aneurysm patients: 1) whether or not self-efficacy (SE) and health locus of control (HLoC) affect the patients' satisfaction with life; 2) whether the two groups of patients differ in terms of mental dispositions. Material and methods The study population consisted of 16 MFS patients with aortic pathology and 16 AAA patients, 9 men and 7 women in each group. The mean age of the MFS patients was 28.5 ±8.214, and of the AAA patients 64.25 ±7.019. The following scales were applied: Generalized Self-Efficacy Scale, Satisfaction With Life Scale, Multidimensional Health Locus of Control Scale. Results Abdominal aorta aneurysms patients compared to MFS patients gave a higher rating for SE (MD = 33.94 and MD = 29.56), internal health locus of control (MD = 25.00 and MD = 21.13), external personal HLoC (MD = 24.50 and MD = 19.25), external impersonal HLoC (MD = 23.06 and MD = 18.25), and satisfaction with life (M = 22.06 and M = 20.13). Internal and external HLoC were significantly lower in MFS patients compared to AAA patients. Conclusions In patients with aortic diseases, special attention must be paid to the state of personal resources (PR). Interactions made by medical professionals should focus on enhancing PR supporting the patients' self-knowledge on their SE. This will help to improve their satisfaction with life and form a positive attitude to the illness.
Collapse
|
30
|
Benke K, Ágg B, Pólos M, Sayour AA, Radovits T, Bartha E, Nagy P, Rákóczi B, Koller Á, Szokolai V, Hedberg J, Merkely B, Nagy ZB, Szabolcs Z. The effects of acute and elective cardiac surgery on the anxiety traits of patients with Marfan syndrome. BMC Psychiatry 2017; 17:253. [PMID: 28716062 PMCID: PMC5512884 DOI: 10.1186/s12888-017-1417-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/04/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Marfan syndrome is a genetic disease, presenting with dysfunction of connective tissues leading to lesions in the cardiovascular and skeletal muscle system. Within these symptoms, the most typical is weakness of the connective tissue in the aorta, manifesting as aortic dilatation (aneurysm). This could, in turn, become annuloaortic ectasia, or life-threatening dissection. As a result, life-saving and preventative cardiac surgical interventions are frequent among Marfan syndrome patients. Aortic aneurysm could turn into annuloaortic ectasia or life-threatening dissection, thus life-saving and preventive cardiac surgical interventions are frequent among patients with Marfan syndrome. We hypothesized that patients with Marfan syndrome have different level of anxiety, depression and satisfaction with life compared to that of the non-clinical patient population. METHODS Patients diagnosed with Marfan syndrome were divided into 3 groups: those scheduled for prophylactic surgery, those needing acute surgery, and those without need for surgery (n = 9, 19, 17, respectively). To examine the psychological features of the patients, Spielberger's anxiety (STAI) test, Beck's Depression questionnaire (BDI), the Berne Questionnaire of Subjective Well-being, and the Satisfaction with Life scale were applied. RESULTS A significant difference was found in trait anxiety between healthy individuals and patients with Marfan syndrome after acute life-saving surgery (p < 0.01). The mean score of Marfan syndrome patients was 48.56 (standard deviation (SD): 5.8) as compared to the STAI population mean score of 43.72 (SD: 8.53). No difference was found between groups on the BDI (p > 0.1). Finally, a significant, medium size effect was found between patient groups on the Joy in Living scale (F (2.39) = 3.51, p = 0.040, η2 = 0.15). CONCLUSIONS Involving psychiatric and mental-health care, in addition to existing surgical treatment interventions, is essential for more successful recovery of patients with Marfan syndrome.
Collapse
Affiliation(s)
- Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122, Hungary. .,Hungarian Marfan Foundation, Városmajor Street 68, Budapest, 1122, Hungary.
| | - Bence Ágg
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary ,Hungarian Marfan Foundation, Városmajor Street 68, Budapest, 1122 Hungary ,0000 0001 0942 9821grid.11804.3cDepartment of Pharmacology and Pharmacotherapy, Semmelweis University, 1089 Nagyvárad tér 4, Budapest, Hungary
| | - Miklós Pólos
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary
| | - Alex Ali Sayour
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary
| | - Tamás Radovits
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary
| | - Elektra Bartha
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary ,Hungarian Marfan Foundation, Városmajor Street 68, Budapest, 1122 Hungary
| | - Péter Nagy
- GenePointPlus Hungary Ltd., János Zsigmond Street 7B, Budapest, 1121 Hungary
| | - Balázs Rákóczi
- 0000 0001 2149 6445grid.5146.6Central European University, Nádor Street 9, Budapest, 1051 Hungary
| | - Ákos Koller
- 0000 0000 9243 1481grid.472475.7Institute of Natural Sciences, University of Physical Education, Alkotás Street 44, Budapest, 1123 Hungary
| | - Viola Szokolai
- GenePointPlus Hungary Ltd., János Zsigmond Street 7B, Budapest, 1121 Hungary
| | - Julianna Hedberg
- Hungarian Marfan Foundation, Városmajor Street 68, Budapest, 1122 Hungary
| | - Béla Merkely
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary
| | - Zsolt B. Nagy
- GenePointPlus Hungary Ltd., János Zsigmond Street 7B, Budapest, 1121 Hungary
| | - Zoltán Szabolcs
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary ,Hungarian Marfan Foundation, Városmajor Street 68, Budapest, 1122 Hungary
| |
Collapse
|
31
|
Goldfinger JZ, Preiss LR, Devereux RB, Roman MJ, Hendershot TP, Kroner BL, Eagle KA. Marfan Syndrome and Quality of Life in the GenTAC Registry. J Am Coll Cardiol 2017; 69:2821-2830. [PMID: 28595698 PMCID: PMC5519341 DOI: 10.1016/j.jacc.2017.04.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/30/2017] [Accepted: 04/04/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous small studies suggested reduced quality of life (QOL) for people with Marfan syndrome (MFS) compared with those without MFS. The national registry of GenTAC (Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions) is a longitudinal observational cohort study of patients with conditions that predispose to thoracic aortic aneurysms and dissections, including MFS. At the time of registry enrollment, GenTAC study participants are asked to complete questionnaires about demographics, medical history, health habits, and QOL. OBJECTIVES This study assessed QOL in GenTAC participants with MFS and identify associated factors using self-reported data. METHODS QOL was assessed using the 4 subscales of the Physical Component Summary (PCS) of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36): physical functioning; role limitations due to physical health; bodily pain; and general health. We studied the association of QOL with self-reported demographics, health behaviors, physical impairments, surgeries, comorbid medical conditions, medications, and MFS severity. RESULTS In the GenTAC registry, 389 adults with MFS completed the SF-36. Mean age was 41 years, 51% were men, 92% were white, and 65% were college graduates. The mean PCS composite score was 42.3. In bivariate analysis, predictors of better QOL included college education, marital status, higher household income, private health insurance, full-time employment, moderate alcohol use, fewer prior surgeries, fewer comorbid conditions, absence of depression, and less severe MFS manifestations. In a multivariable analysis, insurance status and employment remained significant predictors of QOL. CONCLUSIONS In a large cohort of patients with MFS in the GenTAC registry, health-related QOL was below the population norm. Better QOL was independently associated with socioeconomic factors, not factors related to general health or MFS severity.
Collapse
Affiliation(s)
- Judith Z Goldfinger
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Liliana R Preiss
- Biostatistics and Epidemiology Division, Research Triangle Institute International, Rockville, Maryland
| | - Richard B Devereux
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Tabitha P Hendershot
- Biostatistics and Epidemiology Division, Research Triangle Institute International, Rockville, Maryland
| | - Barbara L Kroner
- Biostatistics and Epidemiology Division, Research Triangle Institute International, Rockville, Maryland
| | - Kim A Eagle
- Department of Cardiology, University of Michigan Health System, Ann Arbor, Michigan
| |
Collapse
|
32
|
von Kodolitsch Y, Rybczynski M, Vogler M, Mir TS, Schüler H, Kutsche K, Rosenberger G, Detter C, Bernhardt AM, Larena-Avellaneda A, Kölbel T, Debus ES, Schroeder M, Linke SJ, Fuisting B, Napp B, Kammal AL, Püschel K, Bannas P, Hoffmann BA, Gessler N, Vahle-Hinz E, Kahl-Nieke B, Thomalla G, Weiler-Normann C, Ohm G, Neumann S, Benninghoven D, Blankenberg S, Pyeritz RE. The role of the multidisciplinary health care team in the management of patients with Marfan syndrome. J Multidiscip Healthc 2016; 9:587-614. [PMID: 27843325 PMCID: PMC5098778 DOI: 10.2147/jmdh.s93680] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Marfan syndrome (MFS) is a rare, severe, chronic, life-threatening disease with multiorgan involvement that requires optimal multidisciplinary care to normalize both prognosis and quality of life. In this article, each key team member of all the medical disciplines of a multidisciplinary health care team at the Hamburg Marfan center gives a personal account of his or her contribution in the management of patients with MFS. The authors show how, with the support of health care managers, key team members organize themselves in an organizational structure to create a common meaning, to maximize therapeutic success for patients with MFS. First, we show how the initiative and collaboration of patient representatives, scientists, and physicians resulted in the foundation of Marfan centers, initially in the US and later in Germany, and how and why such centers evolved over time. Then, we elucidate the three main structural elements; a team of coordinators, core disciplines, and auxiliary disciplines of health care. Moreover, we explain how a multidisciplinary health care team integrates into many other health care structures of a university medical center, including external quality assurance; quality management system; clinical risk management; center for rare diseases; aorta center; health care teams for pregnancy, for neonates, and for rehabilitation; and in structures for patient centeredness. We provide accounts of medical goals and standards for each core discipline, including pediatricians, pediatric cardiologists, cardiologists, human geneticists, heart surgeons, vascular surgeons, vascular interventionists, orthopedic surgeons, ophthalmologists, and nurses; and of auxiliary disciplines including forensic pathologists, radiologists, rhythmologists, pulmonologists, sleep specialists, orthodontists, dentists, neurologists, obstetric surgeons, psychiatrist/psychologist, and rehabilitation specialists. We conclude that a multidisciplinary health care team is a means to maximize therapeutic success.
Collapse
Affiliation(s)
| | | | | | - Thomas S Mir
- Clinic for Pediatric Cardiology, University Heart Centre
| | | | | | | | | | | | | | - Tilo Kölbel
- Clinic of Vascular Medicine, University Heart Centre
| | | | - Malte Schroeder
- Department of Trauma, Hand, and Reconstructive Surgery
- Department of Orthopedics
| | - Stephan J Linke
- Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bettina Fuisting
- Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Peter Bannas
- Diagnostic and Interventional Radiology Department and Clinic
| | | | - Nele Gessler
- Clinic of Electrophysiology, University Heart Centre
| | - Eva Vahle-Hinz
- Department of Orthodontics, Center for Dental and Oral Medicine
| | | | | | | | | | - Stefan Neumann
- Business Unit Quality Management, University Medical Center Hamburg-Eppendorf
| | | | | | | |
Collapse
|
33
|
Moon JR, Cho YA, Huh J, Kang IS, Kim DK. Structural equation modeling of the quality of life for patients with marfan syndrome. Health Qual Life Outcomes 2016; 14:83. [PMID: 27249938 PMCID: PMC4890270 DOI: 10.1186/s12955-016-0488-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/26/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We used structural equation modeling to evaluate the quality of life (QOL) for patients with Marfan syndrome (MFS). The goal was to provide guidelines to facilitate the development of interventions and strategies to improve the QOL for patients with MFS. METHODS The participants fulfilled the Ghent 2 criteria for MFS and they comprised patients who visited the cardiology outpatient department of a tertiary hospital in Seoul, Korea, between August 17, 2013 and April 17, 2014. Demographic, social support, disease-related factors, biobehavioral factors, and QOL data were collected in one-on-one interviews. RESULTS The final analyses included 218 patients. Anxious and depressed patients comprised 63.8 and 71.5 % of the sample, respectively. For the hypothetical model, the goodness-of-fit index = 0.91, normal fit index = 0.93, and comparative fit index = 0.90. The outcome was suitable for the recommended level, so the hypothetical model appeared to fit the data. In patients with MFS, the QOL was affected significantly by social support, disease-related factors, and biobehavioral factors. These variables explained 72.4 % of the QOL in patients with MFS. Biobehavioral factors had the strongest and most direct effects on QOL. CONCLUSION To improve QOL in patients with MFS, comprehensive interventions are necessary to assess and manage biobehavioral factors, social support, and disease-related factors.
Collapse
Affiliation(s)
- Ju Ryoung Moon
- Department of nursing, Grown-Up Congenital Heart Clinic, Heart Vascular and Stroke Institute, Samsung Medical Center, Seoul, Korea
| | - Yong Ae Cho
- Redcloss College of Nursing, Chung-Ang University, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Grown-Up Congenital Heart Clinic, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea.
| | - I-Seok Kang
- Department of Pediatrics, Grown-Up Congenital Heart Clinic, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Duk-Kyung Kim
- Department of Medicine, Division of Cardiology, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
34
|
Mueller GC, Steiner K, Wild JM, Stark V, Kozlik‐Feldmann R, Mir TS. Health-related quality of life is unimpaired in children and adolescents with Marfan syndrome despite its distinctive phenotype. Acta Paediatr 2016; 105:311-6. [PMID: 26566600 DOI: 10.1111/apa.13264] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/05/2015] [Indexed: 11/29/2022]
Abstract
AIM Marfan syndrome (MFS) is a progressive, life-threatening genetic disorder of the connective tissue, which causes impaired quality of life (QoL) in adults. This study investigated the quality of life in children and adolescents, taking into account their gender, age and how MFS affected their organs. METHODS This prospective nonrandomised single-centre study included 46 patients with verified MFS with a mean age of 10.98 years (±3.72). QoL was measured using the self-reported, multidimensional KINDL-R questionnaire and compared with an age-matched control group of 174 children and adolescents. RESULTS No significant overall reduction of QoL was found. Total QoL scores for patients diagnosed at four to seven years were the same as the control group (77.65 ± 9.37 versus 77.06 ± 11.72), but they were higher for patients aged eight to 16 years (75.15 ± 9.19 versus 70.46 ± 11.35, p = 0.025). No gender-specific differences or impairments in QoL during adolescence were observed (p > 0.05). Analysis of the effect of organ manifestation on QoL showed better or equal QoL scores (p > 0.05), despite distinctive phenotypes such as ectopia lentis. CONCLUSION QoL was fairly good in paediatric patients with MFS, and there was no impairment during adolescence. Despite the distinctive phenotype, quality of life was unimpaired in younger patients.
Collapse
Affiliation(s)
- Goetz C. Mueller
- Clinic for Paediatric Cardiology University Heart Centre Hamburg Hamburg Germany
| | - Kristoffer Steiner
- Clinic for Paediatric Cardiology University Heart Centre Hamburg Hamburg Germany
| | - Jeske M. Wild
- Clinic for Paediatric Cardiology University Heart Centre Hamburg Hamburg Germany
| | - Veronika Stark
- Clinic for Paediatric Cardiology University Heart Centre Hamburg Hamburg Germany
| | | | - Thomas S. Mir
- Clinic for Paediatric Cardiology University Heart Centre Hamburg Hamburg Germany
| |
Collapse
|
35
|
Velvin G, Bathen T, Rand-Hendriksen S, Geirdal A. Systematic review of chronic pain in persons with Marfan syndrome. Clin Genet 2016; 89:647-58. [DOI: 10.1111/cge.12699] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/20/2015] [Accepted: 11/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
- G. Velvin
- TRS National Resource Centre for Rare Disorders; Sunnaas Rehabilitation Hospital; Nesodden Norway
- Faculty of Social Sciences, Department of Social Work, Child Welfare and Social Policy; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - T. Bathen
- TRS National Resource Centre for Rare Disorders; Sunnaas Rehabilitation Hospital; Nesodden Norway
| | - S. Rand-Hendriksen
- TRS National Resource Centre for Rare Disorders; Sunnaas Rehabilitation Hospital; Nesodden Norway
- Institute of clinical medicine, Faculty of Medicine; University of Oslo; Oslo Norway
| | - A.Ø. Geirdal
- Faculty of Social Sciences, Department of Social Work, Child Welfare and Social Policy; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| |
Collapse
|
36
|
Velvin G, Bathen T, Rand-Hendriksen S, Geirdal AØ. Satisfaction with life in adults with Marfan syndrome (MFS): associations with health-related consequences of MFS, pain, fatigue, and demographic factors. Qual Life Res 2016; 25:1779-90. [DOI: 10.1007/s11136-015-1214-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
|
37
|
Connors E, Jeremy RW, Fisher A, Sharpe L, Juraskova I. Adjustment and Coping Mechanisms for Individuals with Genetic Aortic Disorders. Heart Lung Circ 2015; 24:1193-202. [DOI: 10.1016/j.hlc.2015.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/02/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
|
38
|
Velvin G, Bathen T, Rand-Hendriksen S, Geirdal AØ. Work participation in adults with Marfan syndrome: Demographic characteristics, MFS related health symptoms, chronic pain, and fatigue. Am J Med Genet A 2015; 167A:3082-90. [DOI: 10.1002/ajmg.a.37370] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 08/28/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Gry Velvin
- Sunnaas Rehabilitation Hospital; TRS National Resource Centre for Rare Disorders; Norway
- Department of Social Work; Child Welfare and Social Policy; Faculty of Social Sciences; Oslo and Akershus University College of Applied Sciences; Norway
| | - Trine Bathen
- Sunnaas Rehabilitation Hospital; TRS National Resource Centre for Rare Disorders; Norway
| | - Svend Rand-Hendriksen
- Sunnaas Rehabilitation Hospital; TRS National Resource Centre for Rare Disorders; Norway
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Norway
| | - Amy Østertun Geirdal
- Department of Social Work; Child Welfare and Social Policy; Faculty of Social Sciences; Oslo and Akershus University College of Applied Sciences; Norway
| |
Collapse
|
39
|
Kelleher E, Giampietro PF, Moreno MA. Marfan syndrome patient experiences as ascertained through postings on social media sites. Am J Med Genet A 2015; 167A:2629-34. [PMID: 26272787 DOI: 10.1002/ajmg.a.37255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/06/2015] [Indexed: 11/08/2022]
Abstract
Marfan syndrome (MS) is a connective tissue disorder that affects thousands of adolescents [Population Reference Bureau, 2013]. Some adolescent patients with MS may use social media to express their experiences and emotions, but little is known about what patients choose to share online. To investigate social media content related to Marfan syndrome we used search terms "Marfan syndrome" and "Marfans" on six different social media sites. The top five recent and popular posts for each site were collected and coded weekly for five weeks. Posts were excluded if they were reshared content or not in English. A codebook was developed using an iterative process to categorize posts and comments. Out of 300 posts collected 147 posts (49.0%) were included for evaluation. Categories of displayed content included personal pictures, memes and pictures featuring symptoms of MS (41.5%) and personal MS experiences (27.1% of posts). One quarter of the posts specifically mentioned a positive experience or how thankful the profile owner was for their life. A unique category of posts (13.7%) referenced Austin Carlile, a celebrity singer with MS, as a role model. Physicians and healthcare providers may consider using social media to understand common MS concerns and to place future health education materials.
Collapse
Affiliation(s)
- Erin Kelleher
- University of Wisconsin- Madison, Madison, Wisconsin
| | | | - Megan A Moreno
- Seattle Children's Research Institute, Seattle, Washington.,University of Washington, Seattle, Washington
| |
Collapse
|
40
|
von Kodolitsch Y, De Backer J, Schüler H, Bannas P, Behzadi C, Bernhardt AM, Hillebrand M, Fuisting B, Sheikhzadeh S, Rybczynski M, Kölbel T, Püschel K, Blankenberg S, Robinson PN. Perspectives on the revised Ghent criteria for the diagnosis of Marfan syndrome. APPLICATION OF CLINICAL GENETICS 2015; 8:137-55. [PMID: 26124674 PMCID: PMC4476478 DOI: 10.2147/tacg.s60472] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Three international nosologies have been proposed for the diagnosis of Marfan syndrome (MFS): the Berlin nosology in 1988; the Ghent nosology in 1996 (Ghent-1); and the revised Ghent nosology in 2010 (Ghent-2). We reviewed the literature and discussed the challenges and concepts of diagnosing MFS in adults. Ghent-1 proposed more stringent clinical criteria, which led to the confirmation of MFS in only 32%–53% of patients formerly diagnosed with MFS according to the Berlin nosology. Conversely, both the Ghent-1 and Ghent-2 nosologies diagnosed MFS, and both yielded similar frequencies of MFS in persons with a causative FBN1 mutation (90% for Ghent-1 versus 92% for Ghent-2) and in persons not having a causative FBN1 mutation (15% versus 13%). Quality criteria for diagnostic methods include objectivity, reliability, and validity. However, the nosology-based diagnosis of MFS lacks a diagnostic reference standard and, hence, quality criteria such as sensitivity, specificity, or accuracy cannot be assessed. Medical utility of diagnosis implies congruency with the historical criteria of MFS, as well as with information about the etiology, pathogenesis, diagnostic triggers, prognostic triggers, and potential complications of MFS. In addition, social and psychological utilities of diagnostic criteria include acceptance by patients, patient organizations, clinicians and scientists, practicability, costs, and the reduction of anxiety. Since the utility of a diagnosis or exclusion of MFS is context-dependent, prioritization of utilities is a strategic decision in the process of nosology development. Screening tests for MFS should be used to identify persons with MFS. To confirm the diagnosis of MFS, Ghent-1 and Ghent-2 perform similarly, but Ghent-2 is easier to use. To maximize the utility of the diagnostic criteria of MFS, a fair and transparent process of nosology development is essential.
Collapse
Affiliation(s)
| | - Julie De Backer
- Centre for Medical Genetics, University Hospital Ghent, Ghent, Belgium
| | - Helke Schüler
- Centre of Cardiology, University Hospital Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Diagnostic and Interventional Radiology Department and Clinic, Berlin, Germany
| | - Cyrus Behzadi
- Diagnostic and Interventional Radiology Department and Clinic, Berlin, Germany
| | | | | | - Bettina Fuisting
- Department of Ophthalmology, University Hospital Eppendorf, Hamburg, Germany
| | - Sara Sheikhzadeh
- Centre of Cardiology, University Hospital Eppendorf, Hamburg, Germany
| | - Meike Rybczynski
- Centre of Cardiology, University Hospital Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- Centre of Cardiology, University Hospital Eppendorf, Hamburg, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Hospital Eppendorf, Hamburg, Germany
| | | | - Peter N Robinson
- Institute of Medical Genetics and Human Genetics, Charité Universitätsmedizin, Berlin, Germany
| |
Collapse
|
41
|
Velvin G, Bathen T, Rand-Hendriksen S, Geirdal AØ. Systematic review of the psychosocial aspects of living with Marfan syndrome. Clin Genet 2014; 87:109-16. [PMID: 24813698 DOI: 10.1111/cge.12422] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/06/2014] [Accepted: 05/06/2014] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to explore the literature on the psychosocial aspects of Marfan syndrome (MFS), to critically appraise and to synthesize relevant literature. A mixed-method systematic review was performed by searching the published literature databases using available medical, psychological, pedagogical and social databases and other sources. All studies that addressed psychosocial aspects of MFS, published in peer-reviewed journals were assessed. Of 81 search results, 15 articles (four articles based on same study population) satisfied the eligibility criteria. All studies were cross-sectional; no intervention or randomized controlled trial (RCT) studies were found. Most studies were of small sample sizes, had low response rate or participants without a verified diagnosis. Despite these limitations, all studies described, that MFS has a significant impact on the psychosocial aspects of people's lives: Decreased quality of life; challenges in education, work and family life, depression and anxiety. Some studies indicated that the subjective perception of discomfort did not necessarily match the medical severity of a disease. The research of the psychosocial aspects of MFS is limited in size and quality. More research is needed on the psychosocial aspects of MFS in samples with a verified diagnosis to develop evidence-based knowledge and appropriate guidelines.
Collapse
Affiliation(s)
- G Velvin
- Sunnaas Rehabilitation Hospital, TRS National Resource Centre for Rare Disorders, Nesoddtangen, Akershus, Norway; Norway Faculty of Social Sciences, Department of Social Work, Child Welfare and Social Policy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | | | | | | |
Collapse
|
42
|
Hugar BS, Praveen S, Kainoor SK, Shetty ARS. Sudden Death in Marfan Syndrome. J Forensic Sci 2014; 59:1126-8. [DOI: 10.1111/1556-4029.12415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 04/29/2013] [Accepted: 05/04/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Basappa S. Hugar
- Department of Forensic Medicine; MS Ramaiah Medical College; Bangalore 560054 India
| | | | - Sunil K. Kainoor
- Department of Forensic Medicine; MS Ramaiah Medical College; Bangalore 560054 India
| | | |
Collapse
|
43
|
Abstract
Marfan syndrome is a systemic, heritable connective tissue disorder that affects many different organ systems and is best managed by using a multidisciplinary approach. The guidance in this report is designed to assist the pediatrician in recognizing the features of Marfan syndrome as well as caring for the individual with this disorder.
Collapse
|
44
|
Atypical presentation of ectopia lentis in Marfan's syndrome. Int Ophthalmol 2013; 34:129-32. [PMID: 23479050 DOI: 10.1007/s10792-013-9750-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 02/22/2013] [Indexed: 10/27/2022]
Abstract
The purpose of this article is to report an unusual bilateral inferior subluxation of the lens in a patient with Marfan's syndrome. A 14-year-old boy presented with gradual painless diminution of vision in both eyes. His family history showed that his maternal uncle also had similar complaints. Systemic examination of the patient revealed no neurological deficits. Cardiovascular system examination was unremarkable. Hands and fingers were long and slender with hyperflexible joints. The ratio of arm spam to height was 1.06. He was myopic with a best-corrected visual acuity of 6/24 with -11 D spherical/- 2 D cylindrical in both eyes. Anterior chambers were deep with the presence of mild iridodonesis in both eyes. Pupillary reactions were sluggish. On pupillary dilatation, the lens was found to be subluxated inferiorly which is unlike the typical superotemporal subluxation of the lens in Marfan's syndrome. The diagnosis of Marfan's syndrome is usually made on clinical examination only, as there is no specific investigation for this condition; however, it may have atypical presentations. Therefore, it is important to recognize and report such atypical cases.
Collapse
|
45
|
Schoormans D, Radonic T, de Witte P, Groenink M, Azim D, Lutter R, Mulder BJM, Sprangers MAG, Zwinderman AH. Mental quality of life is related to a cytokine genetic pathway. PLoS One 2012; 7:e45126. [PMID: 23049769 PMCID: PMC3458023 DOI: 10.1371/journal.pone.0045126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 08/14/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Quality of life (QoL) in patients with chronic disease is impaired and cannot be solely explained by disease severity. We explored whether genetic variability and activity contributes to QoL in patients with Marfan syndrome (MFS), a genetic connective tissue disorder. METHODOLOGY/PRINCIPAL FINDINGS In 121 MFS patients, patient characteristics (i.e. demographics and MFS-related symptoms) were assessed. Patients completed the SF-36 to measure QoL. In addition, transcriptome wide gene expression and 484 Single Nucleotide Polymorphysms (SNPs) in cytokine genes were available. QoL was first analyzed and associated with patient characteristics. Patients' physical QoL was impaired and weakly related with age and scoliosis, whereas mental quality of life (MCS) was normal. To explain a largely lacking correlation between disease severity and QoL, we related genome wide gene expression to QoL. Patients with lower MCS scores had high expression levels of CXCL9 and CXCL11 cytokine-related genes (p=0.001; p=0.002); similarly, patients with low vitality scores had high expression levels of CXCL9, CXCL11 and IFNA6 cytokine-related genes (p=0.02; p=0.02; p=0.04), independent of patient characteristics. Subsequently, we associated cytokine related SNPs to mental QoL (MCS and vitality). SNP-cluster in the IL4R gene showed a weak association with MCS and vitality (strongest association p=0.0017). Although overall mental QoL was normal, >10% of patients had low scores for MCS and vitality. Post-hoc analysis of systemic inflammatory mediators showed that patients with lowest MCS and vitality scores had high levels of CCL11 cytokine (p=0.03; p=0.04). CONCLUSIONS/SIGNIFICANCE Variation in the cytokine genetic pathway and its activation is related to mental QoL. These findings might allow us to identify and, ultimately, treat patients susceptible to poor QoL.
Collapse
Affiliation(s)
- Dounya Schoormans
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Teodora Radonic
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Piet de Witte
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Maarten Groenink
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Donija Azim
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Rene Lutter
- Departments of Pulmonology and Experimental Immunology Academic Medical Center, Amsterdam, The Netherlands
| | - Barbara J. M. Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | | | - Aeilko H. Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
46
|
Health-related quality of life in Marfan syndrome: a cross-sectional study of Short Form 36 in 84 adults with a verified diagnosis. Genet Med 2010; 12:517-24. [PMID: 20613543 DOI: 10.1097/gim.0b013e3181ea4c1c] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To explore health-related quality of life as measured with Short Form 36 in adults with verified Marfan syndrome and to compare with the general population, other groups with chronic problems and studies on Marfan syndrome. Furthermore, to study potential correlations between the scores on the subscales of Short Form 36 and the presence of biomedical criteria and symptoms of Marfan syndrome. METHOD Cross-sectional study. Short Form 36 was investigated in 84 adults with verified Marfan syndrome. RESULTS The study group had reduced scores on all eight subscales of Short Form 36 compared with the general population, comparable with other groups with chronic diseases. Compared with earlier Short Form 36 results in Marfan syndrome, we found lower scores for social function, vitality, general health, bodily pain, and role physical. No correlations of substantial explanatory values were found between the Short Form 36 subscales and gender, body mass index, ascending aortic surgery, use of beta-blockers, visual acuity, joint hypermobility, fulfillment of the five major Ghent criteria, and number of major criteria fulfilled. Potential explanations are discussed. CONCLUSION Persons with Marfan syndrome have reduced scores for health-related quality of life as measured with Short Form 36, comparable with those in other chronic disorders and disabilities. The reduction does not seem to be related to biomedical criteria or symptoms of Marfan syndrome.
Collapse
|
47
|
Gao LG, Luo F, Hui RT, Zhou XL. Recent molecular biological progress in Marfan syndrome and Marfan-associated disorders. Ageing Res Rev 2010; 9:363-8. [PMID: 19772952 DOI: 10.1016/j.arr.2009.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 09/07/2009] [Accepted: 09/10/2009] [Indexed: 01/28/2023]
Abstract
Marfan syndrome (MFS) is a connective tissue disorder with autosomal dominant inheritance. Advances in medicine and surgery have increased the average lifespan of classically affected patients. Serious visual and/or musculoskeletal impairment often has detrimental effects on day-to-day activities and quality of life. MFS patients suffer from many problems at younger ages and with higher frequencies than the general population because of the degenerative nature of the genetic condition. In classical MFS, changes are caused by mutations in the fibrillin-1 gene (FBN1). Mutations in the fibrillin-2 gene were discovered in individuals with a phenotypically related disorder, congenital contractural arachnodactyly. Some of the clinical manifestations of MFS cannot be explained by mechanical properties alone. Recently, mutations in the genes required for transforming growth factor-beta signaling (TGFBR1 and TGFBR2) have been found in several disorders with varying degrees of overlap with classical MFS, including Loeys-Dietz syndrome and familial thoracic aortic aneurysms and dissections. MFS is a disorder that is variable in its phenotypic expression. Specific information about mutations in the large FBN1 gene will give rise to more information about the phenotype-genotype correlations. Possible molecular mechanisms for the pathogenesis of MFS will be discussed which may assist healthcare professionals to control environmental factors that provoke individual complications in MFS.
Collapse
|