Myocardial Function, Heart Failure and Arrhythmia in Marfan Syndrome: A Systematic Literature Review
Abstract
:1. Introduction
2. Methods
3. Myocardial Involvement
3.1. Left Ventricular Dimensions and Function: Evidence Obtained from Echocardiographic Studies
3.2. Evidence Obtained from Advanced Imaging Techniques
3.3. Involvement of the Right Ventricle and Atria
4. Pathophysiology of Marfan Cardiomyopathy
4.1. Intrinsic vs. Stressor-Induced Problem
4.2. Valvular Disease, Surgery and Genotype-Phenotype Relation
4.3. Evidence Obtained from Mouse Models
4.4. Proposed Hypothesis
5. Association with Arrhythmia
Arrhythmia in Marfan Syndrome
6. Heart Failure and Arrhythmia as Additional Causes of Death
7. Discussion
7.1. Current View on Marfan Cardiomyopathy
7.2. The Intertwined Mechanism of Marfan Cardiomyopathy and Ventricular Arrhythmia
8. Current Limitations and Evidence Gaps
9. Conclusions
Funding
Conflicts of Interest
Abbreviations
BSA | Body surface area |
CMR | Cardiac magnetic resonance imaging |
DN | Dominant negative |
EF | Ejection fraction |
FBN1 | Fibrillin-1 |
FS | Fractional shortening |
HF | Heart failure |
HI | Haploinsufficiency |
LV | Left ventricular |
LVEDD | Left ventricular end-diastolic diameter |
LVESD | Left ventricular end-systolic diameter |
MFS | Marfan syndrome |
MVP | Mitral valve prolapse |
NSVT | Non-sustained ventricular tachycardia |
NTproBNP | N-terminal pro b-type natriuretic peptide |
PAC | Premature atrial complex |
PVC | Premature ventricular complex |
RV | Right ventricular |
SCD | Sudden cardiac death |
TDI | Tissue Doppler imaging |
TGF-β | Transforming growth factor beta |
VF | Ventricular fibrillation |
VT | Ventricular tachycardia |
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In the Absence of Family History of MFS: |
(1) Ao * (Z-score ≥ 2) AND EL = MFS |
(2) Ao * (Z-score ≥ 2) AND causal FBN1 mutation = MFS |
(3) Ao * (Z-score ≥ 2) AND systemic score ≥ 7 points = MFS |
(4) EL AND causal FBN1 mutation with known Ao = MFS |
In the Presence of Family History of MFS: |
(5) EL AND family history of MFS = MFS |
(6) Systemic score ≥ 7 points AND family history of MFS = MFS |
(7) Ao * (Z-score ≥ 2 above 20 years old, ≥ 3 below 20 years) + family history of MFS = MFS |
Author | Type of Study | Number of Patients with MFS | Controls | Assessment | Findings in MFS |
---|---|---|---|---|---|
Roman et al. 1989 [19] | Case-control | 59 children and adults (51% female) | 59 age- and sex-matched controls 59 age- and sex-matched subjects with MVP | M-mode 2D echo | Similar LV diameter and systolic function Increased LV mass |
Savolainen et al. 1994 [20] | Case-control | 22 children (64% female) | 22 age-matched healthy children | M-mode Doppler CMR | Similar LV diameter and systolic function LV diastolic dysfunction |
Porciani et al. 2002 [21] | Case-control | 20 adult MFS and 8 MASS phenotype (54% female) | 28 healthy, age and gender-matched controls | M-mode 2D echo Doppler | Similar LV diameter and systolic function LV diastolic dysfunction |
Yetman et al. 2003 [14] | Follow-up: 6 years ^ (1.6–24.5) | 70 children and adults (51% female) | / | 2D echo | 68% had LV dilatation (LVEDD Z-score > 2) 11% had LV systolic dysfunction (FS < 30%) |
Chatrath et al. 2003 [22] | Follow-up: 10.8 years * (1–29) | 36 children and adults (36% female) | / | M-mode | 19% had LV dilatation (LVEDD > 95% above normal limits) No change in LV dimensions during follow-up No LV systolic dysfunction |
Meijboom et al. 2005 [23] | Follow-up: 6 years * (0.3–15) | 234 adults (51% female) | / | M-mode 2D echo | 9% had mild LV dysfunction (FS 25–30%) 7% had LV dilatation (LVEDD > 117% (2SD + 5%)) 3% developed LV dilatation during follow-up 1% had LVEDD > 112% and FS < 30% |
De Backer et al. 2006 [24] | Case-control | 26 adults (54% female) | 26 age and sex-matched controls | 2D echo Doppler TDI CMR | LV systolic and diastolic dysfunction LV dilatation |
Das et al. 2006 [25] | Case-control | 40 children and adults (68% female) | 40 age and sex-matched controls | M-mode Doppler | Similar systolic function LV diastolic dysfunction LV dilatation |
Rybczynski et al. 2007 [26] | Case-control | 55 adults (49% female) | 86 healthy controls | 2D echo Doppler TDI | LV diastolic dysfunction LV systolic dysfunction |
Kiotsekoglou et al. 2008 [27] | Case-control | 66 adults (44% female) | 61 healthy controls | M-mode 2D echo Doppler TDI | 17% had LV dilatation (predicted LVEDD ≥ 112% and FS ≥ 25%) LV diastolic dysfunction LV systolic dysfunction |
Kiotsekoglou et al. 2009 [34] | Case-control | 66 adults (44% female) | 61 age, sex, height, weight, and BSA-matched normal volunteers | M-mode 2D echo Doppler TDI | RV systolic dysfunction RV dilatation Increased right atrium area |
Kiotsekoglou et al. 2009 [35] | Case-control | 72 adults (42% female) | 73 age, sex, and BSA-matched controls | 2D echo Doppler TDI | LV diastolic dysfunction RV diastolic dysfunction Atrial systolic and diastolic dysfunction |
Alpendurada et al. 2010 [28] | Cross-sectional | 68 adults (40% female) | / | CMR | 25% had reduced LV EF (below 95% CI for sex and age decile) 10% had reduced RV EF (below 95% CI for sex and age decile) LV dilatation RV dilatation |
Kiotsekoglou et al. 2011 [31] | Case-control | 44 adults (41% female) | 49 controls without significant differences in age, sex, height, weight, and BSA | M-mode 2D echo Doppler Strain rate imaging | 20% had LV dilatation (predicted LVEDD ≥ 112% and FS ≥ 25%) LV diastolic dysfunction LV systolic dysfunction |
de Witte et al. 2011 [29] | Case-control | 144 adults (51% female) | 19 healthy controls | CMR | 9% had reduced LV EF (<45%) LV systolic dysfunction RV systolic dysfunction |
Scherptong et al. 2011 [36] | Case-control Follow-up: 4 years ^ | 50 adults (50% female) | 50 controls matched for age, sex, and BSA | M-mode 2D echo Doppler Strain rate imaging | Similar LV and RV EF LV systolic dysfunction RV systolic dysfunction No changes in systolic or diastolic function during follow-up |
Angtuaco et al. 2012 [32] | Case-control | 16 children and adults (56% female) | 26 controls without significant differences in sex, race, age, weight, height, and BSA | M-mode 2D echo Doppler Strain rate imaging | LV systolic dysfunction No significant differences in strain |
Abd El Rahman et al. 2015 [33] | Case-control | 45 children and adults (42% female) | 40 age-matched healthy controls | M-mode 2D and 3D echo Doppler 3D speckle tracking | LV diastolic dysfunction LV systolic dysfunction Left atrial diastolic dysfunction No differences in left atrial systolic function No differences in M-mode LVEDD, LVESD and FS |
Campens et al. 2015 [37] | Case-control Follow-up: 6 years * (3.4–10.3) | 19 adults (47% female) | 19 age and sex-matched controls | 2D echo Doppler TDI | No changes in LV dimensions during follow-up No changes in LV systolic or diastolic function during follow-up |
Gehle et al. 2016 [38] | Case-control | 217 children and adults (51% female) | 339 patients referred for suspected MFS (diagnosis ruled out according to the Gh. nosology) | M-mode 2D echo Doppler TDI NT-proBNP | Increased NT-proBNP levels LV diastolic dysfunction LV dilatation No signs of LV systolic dysfunction |
Loeper et al. 2016 [39] | Case-control | 104 adults with MFS (45% female) and 111 adults with ns-TAAD (35% female) | 148 healthy controls | 2D echo Doppler TDI | Increased aortic stiffness index in MFS and ns-TAAD Reduced LV end-systolic elastance in MFS ventricular-vascular coupling index was abnormal in MFS No difference in LV stroke work in MFS |
Winther et al. 2019 [30] | Case-control | 69 adults (44% female) | 20 age-matched controls | 2D echo CMR | 22% had reduced LV EF (≤55%) LV systolic dysfunction |
Author | Type of Study | Number of Patients with MFS | Prior Aortic Surgery |
---|---|---|---|
Kesler et al. 1994 [42] | Survey | 11 | Not stated |
Mullen et al. 1996 [43] | Case report | 1 | Yes |
Varghese et al. 2006 [44] | Case report | 1 | Yes |
Botta et al. 2006 [45] | Case report | 1 | Yes |
Knosalla et al. 2007 [46] | Case series | 10 | Yes (100%) |
Rajagopal et al. 2009 [47] | Case report | 1 | Yes |
Audenaert et al. 2015 [49] | Case report | 1 | Yes |
Rao et al. 2018 [40] | Case report | 1 | Yes |
Ogawa et al. 2019 [41] | Case report | 1 | No |
Author | Type of Study | Number of Patients with MFS | Controls | Assessment | Findings in MFS | |
---|---|---|---|---|---|---|
Chen et al. 1985 [81] | Follow-up: 5.7 years * (1–22) | 24 children (63% female) | / | M-mode Resting ECG | 33% presents at least 1 PVC on resting ECG 13% had VT QTc / QTUc prolongation was associated with ventricular arrhythmias Combination of abnormal repolarization and MVP associated with ventricular arrhythmias | |
Savolainen et al. 1997 [80] | Case-control | 45 adults (44% female) | 45 healthy age and sex-matched controls | M-mode and 2D echo Ambulatory ECG | Higher median number of PACs than controls (12/24 h vs. 6/24 h; p < 0.05) Higher median number of PVCs than controls (17/24 h vs. 1/24 h; p < 0.001) More frequently repolarization abnormalities than controls Longer PQ- and QTc-intervals compared to controls 11% had NSVT° | |
Yetman et al. 2003 [14] | Follow-up: 6 years ^ (1.6–24.5) | 70 children and adults (51% female) | / | 2D echo Resting ECG Ambulatory ECG | 21% had ventricular ectopy (defined as >10 PVC/h) 6% had NSVT° 4% died from arrhythmias 16% had QTc prolongation and 60% had QTU prolongation Ventricular ectopy associated with LV size, MVP, and abnormalities of repolarization | |
Hoffmann et al. 2012 [82] | Follow-up: 2.4 years ^ (2.1–2.7) | 77 adults (52% female) | / | 2D echo, Doppler and TDI Resting ECG and SAECG Ambulatory ECG | 9% reached the composite endpoint (SCD, VT, VF or AS) 7% had VT 3% had SCD | |
Aydin et al. 2013 [82] | Follow-up: 2.6 years * | 80 children and adults (63% female) | / | M-mode and 2D echo Doppler Resting ECG Ambulatory ECG | 91% had PVCs with 35% having >10 PVC/h 11% had NSVT° 8% had ventricular tachycardia events (SCD, VT, VF or AS) 4% had SCD Ventricular tachycardia events associated with NTproBNP and mutations in exons 24–32 | |
Schaeffer et al. 2015 [83] | Follow-up: 3.1 years * | 102 adults (56% female) | / | 2D echo Ambulatory ECG Heart rate turbulence | 12% reached the primary endpoint (SCD, survived cardiac arrest, VT/VF and AS) 9% had VT 3% had SCD | |
Arunamata et al. 2018 [85] | Case-control | 45 children (44% female) | 37 age, BSA, sex-matched controls | M-mode and 2D echo Resting ECG | Longer QTc intervals than controls | |
Mah et al. 2018 [79] | Cross-sectional | 274 children and adults (38% female) | / | M-mode and 2D echo Ambulatory ECG | 7% had ventricular ectopy (defined as >10 PVC/h) 5% had supraventricular ectopy (defined as >10 PAC/h) 1% had both supraventricular and ventricular ectopy None had VT or supraventricular tachycardia | |
Muiño Mosquera et al. 2020 [78] | Follow-up Case-control | 86 children and adults (56% female) | 40 age- and sex-matched controls | 2D echo Resting ECG Ambulatory ECG NT-proBNP | Higher median number of PACs than controls (11/24 h vs. 2/24 h; p < 0.001) Higher median number of PVCs than controls (8/24 h vs. 0/24 h; p < 0.001) 23% had NSVT° Larger LVEDD and higher amount of VES were independently associated with NSVT° |
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Demolder, A.; von Kodolitsch, Y.; Muiño-Mosquera, L.; De Backer, J. Myocardial Function, Heart Failure and Arrhythmia in Marfan Syndrome: A Systematic Literature Review. Diagnostics 2020, 10, 751. https://doi.org/10.3390/diagnostics10100751
Demolder A, von Kodolitsch Y, Muiño-Mosquera L, De Backer J. Myocardial Function, Heart Failure and Arrhythmia in Marfan Syndrome: A Systematic Literature Review. Diagnostics. 2020; 10(10):751. https://doi.org/10.3390/diagnostics10100751
Chicago/Turabian StyleDemolder, Anthony, Yskert von Kodolitsch, Laura Muiño-Mosquera, and Julie De Backer. 2020. "Myocardial Function, Heart Failure and Arrhythmia in Marfan Syndrome: A Systematic Literature Review" Diagnostics 10, no. 10: 751. https://doi.org/10.3390/diagnostics10100751