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. 2017 Jun;10(3):e001647.
doi: 10.1161/CIRCGENETICS.116.001647.

Associations of Age and Sex With Marfan Phenotype: The National Heart, Lung, and Blood Institute GenTAC (Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions) Registry

Mary J Roman  1 , Richard B Devereux  2 , Liliana R Preiss  2 , Federico M Asch  2 , Kim A Eagle  2 , Kathryn W Holmes  2 , Scott A LeMaire  2 , Cheryl L Maslen  2 , Dianna M Milewicz  2 , Shaine A Morris  2 , Siddharth K Prakash  2 , Reed E Pyeritz  2 , William J Ravekes  2 , Ralph V Shohet  2 , Howard K Song  2 , Jonathan W Weinsaft  2 ; GenTAC Investigators*
Affiliations

Associations of Age and Sex With Marfan Phenotype: The National Heart, Lung, and Blood Institute GenTAC (Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions) Registry

Mary J Roman et al. Circ Cardiovasc Genet. 2017 Jun.

Abstract

Background: The associations of age and sex with phenotypic features of Marfan syndrome have not been systematically examined in a large cohort of both children and adults.

Methods and results: We evaluated 789 Marfan patients enrolled in the National Heart, Lung, and Blood Institute GenTAC (Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions) Registry (53% male; mean age 31 [range: 1-86 years]). Females aged ≥15 and males aged ≥16 years were considered adults based on average age of skeletal maturity. Adults (n=606) were more likely than children (n=183) likely to have spontaneous pneumothorax, scoliosis, and striae but were comparable in revised Ghent systemic score, ectopia lentis, and most phenotypic features, including prevalence of aortic root dilatation. Prophylactic aortic root replacement and mitral valve surgery were rare during childhood versus adulthood (2% versus 35% and 1% versus 9%, respectively, both P<0.0001). Adult males were more likely than females to have aortic root dilatation (92% versus 84%), aortic regurgitation (55% versus 36%), and to have undergone prophylactic aortic root replacement (47% versus 24%), all P<0.001. Prevalence of previous aortic dissection tended to be higher in males than females (25% versus 18%, P=0.06); 44% of dissections were type B. Type B dissection was strongly associated with previous prophylactic aortic root replacement.

Conclusions: Pulmonary, skeletal, and aortic complications, but not other phenotypic features, are more prevalent in adults than children in Marfan syndrome. Aortic aneurysms and prophylactic aortic surgery are more common in men. Aortic dissection, commonly type B, occurs in an appreciable proportion of Marfan patients, especially in men and after previous prophylactic aortic root replacement.

Keywords: Marfan syndrome; adult; aneurysm; dilatation; prevalence.

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Figures

Figure 1
Figure 1
Prevalences of aortic root dilatation, ectopia lentis, and pectus deformities according to tertiles of childhood age.
Figure 2
Figure 2
Prevalences of arachnodactyly, scoliosis, striae atrophicae, and mitral valve prolapse according to tertiles of childhood age.
Figure 3
Figure 3
Age distributions of prophylactic aortic surgery (A), mitral valve surgery (B), Type A dissection (C), Type B dissection (D).
Figure 3
Figure 3
Age distributions of prophylactic aortic surgery (A), mitral valve surgery (B), Type A dissection (C), Type B dissection (D).
Figure 3
Figure 3
Age distributions of prophylactic aortic surgery (A), mitral valve surgery (B), Type A dissection (C), Type B dissection (D).
Figure 3
Figure 3
Age distributions of prophylactic aortic surgery (A), mitral valve surgery (B), Type A dissection (C), Type B dissection (D).
See this image and copyright information in PMC

Comment in

  • Marfan Syndrome: Always Evolving.
    Jondeau G, Boileau C, Milleron O. Jondeau G, et al. Circ Cardiovasc Genet. 2017 Jun;10(3):e001785. doi: 10.1161/CIRCGENETICS.117.001785. Circ Cardiovasc Genet. 2017. PMID: 28600389 No abstract available.

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