Heart failure
Aortic Root Growth in Men and Women With the Marfan’s Syndrome

https://doi.org/10.1016/j.amjcard.2005.06.094Get rights and content

The leading cause of premature death in patients with Marfan’s syndrome (MS) is type A aortic dissection or rupture due to progressive aortic root dilation. The aim of this study was to analyze aortic root growth in 113 men and 108 women with MS. All patients were prospectively followed with serial echocardiograms of the native aortic root. At baseline, women had on average a 5-mm smaller aortic root diameter adjusted for age than men. Average aortic root growth was 0.42 mm/year (SE 0.05) in men and 0.38 mm/year (SE 0.04) in women. On the basis of aortic root growth rates, the men and women could be divided into 2 normally distributed subgroups: fast and slow growers. Approximately 1 in 7 men (1.5 mm/year, SE 0.5) and approximately 1 in 9 women (1.8 mm/year, SE 0.3) had fast-growing aortic root diameters. Significantly more type A dissections (25% vs 4%, p <0.001) were observed in fast growers than in slow growers; this was found in men and women. Type A dissections were observed in 4 men and 9 women. By reducing the cut-off value by 5 mm for elective aortic root replacement in women, type A dissections could have been prevented in 3 women. In conclusion, guidelines should take gender differences into account, and therefore, the investigators propose reducing the threshold for elective aortic root replacement in women with MS by 5 mm.

Section snippets

Methods

From January 1993 to December 2003, 221 adults with definite diagnoses of MS were prospectively followed with serial echocardiograms of the native aortic root.5 Only patients aged ≥18 years for whom ≥2 echocardiograms were available were included. From these patients, information regarding cardiovascular status, family history of MS, and the use of β-blocking agents was obtained. Echocardiographic measurements of the largest aortic root diameter were made by M-mode and cross-sectional

Gender differences

The clinical characteristics of the 113 men and 108 women are listed in Table 1. At baseline, women had on average a 5 -mm (SE 0.86) smaller aortic root diameter adjusted for age than men. During follow-up, significantly more elective aortic root replacements were performed in men than in women (26 [23%] vs 13 [12%], p = 0.03). In contrast, fewer type A dissections occurred in men than in women (4 [4%] vs 9 [8%], p = 0.13).

Aortic root growth

Change in aortic root diameter with age is illustrated separately for

Discussion

Our study provides data on the natural course of aortic root growth in a very large population of men and women with MS. Aortic root diameter corrected for age differed between men and women. Approximately 15% of men and 11% of women had fast-growing aortic roots and were at increased risk for type A dissections. A formula is provided to identify patients at risk for fast-growing aortic roots.

In current guidelines for elective aortic root surgery, aortic root diameter differences between men

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