Family history of severe cardiovascular disease in Marfan syndrome is associated with increased aortic diameter and decreased survival

Objectives. We attempted to determine whether family history of severe cardiovascular disease in patients with the Marfan syndrome is associated with increased aortic dilation or decreased survival, or both. Background. The prognostic importance of family history of severe cardiovascular disease in patients with the Marfan syndrome has been incompletely examined. We hypothesized that such family history would correlate with increased aortic dilation and would be associated with decreased survival. Methods. One hundred eight affected patients and 48 unaffected family members from 33 multigenerational families with the Marfan syndrome underwent echocardiographic measurement of the aortic root, arch and mid-abdominal aorta. Date of birth and age at death ascertained from family pedigrees were used to perform life table analysis and estimate survival. Results. Aortic root and arch diameters were significantly greater in patients with family history of severe cardiovascular disease than in patients without such family history. Of subjects in the highest quartile for aortic size, >80% had such family history in contrast to <10% of those in the lowest quartile (chisquare 57.37, p < 0.00001). Mean age at death and cumulative probability of survival were significantly lower in patients with such family history. Conclusions. Among patients with the Marfan syndrome, aortic dilation is greater and life expectancy shorter in those with family history of severe cardiovascular manifestations. These dat suggest that such family history is an important risk factor for cardiovascular events in patients with the Marfan syndrome.