Determinants of rapid progression of aortic root dilatation and complications in Marfan syndrome

Background Progressive aortic dilatation has prognostic significance in the Marfan syndrome. Methods To identify which patients were at high risk of rapid progression, we echocardiographically studied 43 patients (age 22 ± 14 years) with the mean follow-up period of 5.2 ± 3.2 years. Aortic diameters, left ventricular (LV) size, fractional shortening, and the severity of aortic and mitral regurgitation were assessed. Transmitral peak early and atrial flow velocities, their ratio and the deceleration time of peak early velocity were also obtained. Results Mean annual increases of aortic diameters were 0.4 ± 0.3 mm at the annulus, 1.5 ± 1.3 mm at the sinuses of Valsalva, 0.7 ± 0.6 mm at the supraaortic ridge and 0.4 ± 0.4 mm at the proximal ascending aorta. Patients were divided into 2 groups according to the aortic growth rate at the sinuses of Valsalva level: rapid (R, > 3% per year, 15 patients) or slow (S, ≤ 3% per year, 28 patients) progression groups. Measured variables did not show significant differences between the 2 groups except older age, higher blood pressure and more severe aortic regurgitation in group R. Multiple regression analysis identified prolonged deceleration time as the most important variable predicting aortic complications. Aortic dissection occurred more frequently in group R (7 patients, 47%) than in group S (0%, P<0.001). Conclusions Marfan patients at older age, with higher blood pressure, and with significant aortic regurgitation were at high risk of progression of aortic dilatation, with the most remarkable increase at the sinuses of Valsalva. Prolonged deceleration time may relate to an increased risk for aortic complications.