Abstract
Background
Successful prevention of aortic complications has lead to improved survival of Marfan syndrome (MFS). With increasing age, however, ventricular arrhythmia and heart failure are emerging as life‐threatening manifestations of myocardial dysfunction.
Hypothesis
We sought to investigate whether echocardiography with tissue Doppler imaging (TDI) identifies myocardial dysfunction in adults with MFS.
Methods
We performed two‐dimensional (2‐D) and Doppler echocardiography with TDI in 141 individuals with suspected MFS and competent heart valves, including 28 persons with MFS who had not undergone surgery and 86 healthy controls without inherited connective tissue disorders.
Results
Demographic profile, 2‐D, mitral and pulmonary venous flow indices, and left ventricular ejection fractions were similar in both groups. Conversely, isovolumic relaxation time (p < 0.001) and deceleration time of E velocity (p = 0.005) were longer, and atrial reversal velocities (p = 0.02), and systolic and early diastolic TD velocities were slower in MFS than in controls (p = 0.01). Multiple linear regression analysis excluded association of reduced systolic and early diastolic TD velocities with mitral valve prolapse or other clinical or echocardiographic features of MFS.
Conclusions
Our study identifies reduced systolic and early diastolic TD velocities in adults with MFS. Further studies are mandatory to elucidate whether TD velocities predict arrhythmia and heart failure in MFS. Copyright © 2007 Wiley Periodicals, Inc.
Keywords: Marfan syndrome, cardiomyopathy, genetics, systole, diastole
Full Text
The Full Text of this article is available as a PDF (281.1 KB).
REFERENCES
- 1. Silverman DI, Burton KJ, Gray J, Bosner MS, Kouchoukos NT, et al: Life expectancy in the Marfan syndrome. Am J Cardiol 1995; 75: 157–160. [DOI] [PubMed] [Google Scholar]
- 2. Yetman AT, Bornemeier RA, McCrindle BW: Long‐term outcome in patients with Marfan syndrome: Is aortic dissection the only cause of sudden death? J Am Coll Cardiol 2003; 41: 329–332. [DOI] [PubMed] [Google Scholar]
- 3. Siracusa LD, McGrath R, Ma Q, Moskow JJ, Manne J, et al: A tandem duplication within the fibrillin 1 gene is associated with the mouse tight skin mutation. Genome Res 1997; 6: 300–313. [DOI] [PubMed] [Google Scholar]
- 4. Roberts WC, Honig HS: The spectrum of cardiovascular disease in the Marfan syndrome: A clinico‐morphologic study of 18 necropsy patients and comparison to 151 previously reported necropsy patients. Am Heart J 1982; 104: 115–134. [DOI] [PubMed] [Google Scholar]
- 5. Gross DM, Robinson LK, Smith LT, Glass N, Rosenberg H, et al: Severe perinatal Marfan syndrome. Pediatrics 1989; 84: 83–89. [PubMed] [Google Scholar]
- 6. James TN, Frame B, Schatz IJ: Pathology of cardiac conduction system in Marfan's syndrome. Arch Intern Med 1964; 114: 339–343. [DOI] [PubMed] [Google Scholar]
- 7. Chen S, Fagan LF, Nouri S, Donahoe JL: Ventricular dysrhythmias in children with the Marfan's syndrome. Am J Dis Child 1985; 139: 273–276. [DOI] [PubMed] [Google Scholar]
- 8. Johnson CD: The Wolff‐Parkinson‐White syndrome associated with Marfan's syndrome. Bol Assoc Med P Rico 1989; 81: 361–364. [PubMed] [Google Scholar]
- 9. von Kodolitsch Y, Rybczynski M. Cardiovascular aspects of the Marfan syndrome—a systematic review In Marfan Syndrome: A Primer for Clinicians and Scientists (Eds. Robinson PN, Godfrey M.), pp. 45–69. Eurekah.com, Austin and Kluwer Academic/Plenum Publishers, London: (ISBN 0‐306‐48238‐X). [Google Scholar]
- 10. De Paepe A, Devereux RB, Dietz HC, Hennekam RCM, Pyeritz RE: Revised diagnostic criteria for the Marfan syndrome. Am J Med Genet 1996; 62: 417–426. [DOI] [PubMed] [Google Scholar]
- 11. Nagueh SF, Bachinski LL, Meyer D, Hill R, Zoghbi WA, et al: Tissue Doppler imaging consistently detects myocardial abnormalities in patients with hypertrophic cardiomyopathy and provides a novel means for an early diagnosis before and independently of hypertrophy. Circulation 2001; 104: 128–130. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Miller DC: Valve‐sparing aortic root replacement in patients with the Marfan syndrome. J Thorac Cardiovasc Surg 2003; 125: 773–778. [DOI] [PubMed] [Google Scholar]
- 13. Schiller NB, Shah PM, Crawford M, De Maria A, Devereux DB, et al: Recommendations for quantification of the left ventricle by two‐dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantification of Two‐Dimensional Echocardiograms. J Am Soc Echocardiogr 1989; 2: 358–367. [DOI] [PubMed] [Google Scholar]
- 14. Freed LA, Levy D, Levine RA, Larson MG, Evans JC, et al: Prevalence and clinical outcome of mitral valve prolapse. N Engl J Med 1999; 341: 1–7. [DOI] [PubMed] [Google Scholar]
- 15. Savolainen S, Nisula L, Keto P, Hekali P, Viitasalo M, et al: Left ventricular function in children with the Marfan syndrome. Eur Heart J 1994; 15: 625–630. [DOI] [PubMed] [Google Scholar]
- 16. Roman MJ, Devereux RB, Kramer‐Fox R, O'Loughlin J: Two dimensional aortic root dimensions in normal children and adults. Am J Cardiol 1989; 64: 507–512. [DOI] [PubMed] [Google Scholar]
- 17. Porciani M, Giurlani L, Chelucci A, Pepe G, Giusti BH, et al: Diastolic subclinical primary alterations in Marfan syndrome and Marfan‐related disorders. Clin Cardiol 2002; 25: 416–420. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Thomas JD, Wyman AE. Echocardiographic Doppler evaluation of the left ventricular diastolic function. Physics and physiology. Circulation 1991; 84: 977–990. [DOI] [PubMed] [Google Scholar]
- 19. Nagueh SF, McFalls J, Meyer D, Hill R, Zoghbi WA, et al: Tissue Doppler imaging predicts the development of hypertrophic cardiomyopathy in subjects with subclinical disease. Circulation 2003; 108: 395–397. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Burlew BS, Weber KT: Connective tissue and the heart. Functional significance and regulatory mechanisms. Cardiol Clin 2000; 18: 435–442. [DOI] [PubMed] [Google Scholar]
- 21. Raghunath M, Superti‐Furga A, Godfrey M, Steinmann B: Decreased extracellular deposition of fibrillin and decorin in neonatal Marfan syndrome fibroblasts. Hum Genet 1993; 90: 511–515. [DOI] [PubMed] [Google Scholar]
- 22. Ng CM, Cheng A, Myers L, Martinez‐Murillo F, Jie C, et al: TGF‐beta‐dependent pathogenesis of mitral valve prolapse in a mouse model of Marfan syndrome. J Clin Invest 2004; 114: 1586–1592. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. Beighton P, De Paepe A, Steinmann B, Tsipouras P, Wenstrup RJ: Ehlers‐Danlos syndromes: Revised nosology, Villefranche, 1997. Ehlers‐Danlos National Foundation (USA) and Ehlers‐Danlos Support Group (UK). Am J Med Genet 1998; 77: 31–37. [DOI] [PubMed] [Google Scholar]
- 24. Pieroni M, Chimenti C, Ricci R, Sale P, Russo MA, et al: Early detection of Fabry cardiomyopathy by tissue Doppler imaging. Circulation 2003; 107: 1978–1984. [DOI] [PubMed] [Google Scholar]
- 25. Pyeritz RE: The Marfan syndrome. Ann Rev Med 2000; 51: 481–510. [DOI] [PubMed] [Google Scholar]
- 26. Hetzer R, Pregla R, Barthel F: Surgery for cardiovascular disorders in Marfan syndrome In Marfan Syndrome: A Primer for Clinicians and Scientists (Eds. Robinson PN, Godfrey M.), pp 81–92. Eurekah.com, Austin and Kluwer Academic/Plenum Publishers, London: (ISBN 0‐306‐48238‐X). [Google Scholar]