Critical appraisal of the revised Ghent criteria for diagnosis of Marfan syndrome

T. Radonic, P. De Witte, M. Groenink, R. A.C.M. De Bruin-Bon, J. Timmermans, A. J.H. Scholte, M. P. Van den Berg, M. J.H. Baars, J. P. Van Tintelen, M. Kempers, A. H. Zwinderman, B. J.M. Mulder

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Abstract

Marfan syndrome (MFS) is a connective tissue disorder with major features in cardiovascular, ocular and skeletal systems. Recently, diagnostic criteria were revised where more weight was given to the aortic root dilatation. We applied the revised Marfan nosology in an established adult Marfan population to define practical repercussions of novel criteria for clinical practice and individual patients. Out of 180 MFS patients, in 91% (n = 164) the diagnosis of MFS remained. Out of 16 patients with rejected diagnosis, four patients were diagnosed as MASS (myopia, mitral valve prolapse, borderline non-progressive aortic root dilatation, skeletal findings and striae) phenotype, three as ectopia lentis syndrome and in nine patients no alternative diagnosis was established. In 13 patients, the diagnosis was rejected because the Z-score of the aortic root was <2, although the aortic diameter was larger than 40 mm in six of them. In three other patients, the diagnosis of MFS was rejected because dural ectasia was given less weight in the revised nosology. Following the revised Marfan nosology, the diagnosis of MFS was rejected in 9% of patients, mostly because of the absence of aortic root dilatation defined as Z-score ≥2. Currently used Z-scores seem to underestimate aortic root dilatation, especially in patients with large body surface area (BSA). We recommend re-evaluation of criteria for aortic root involvement in adult patients with a suspected diagnosis of MFS.

Original languageEnglish
Pages (from-to)346-353
Number of pages8
JournalClinical genetics
Volume80
Issue number4
DOIs
Publication statusPublished - Oct 2011

Keywords

  • Aortic root dilatation
  • Connective tissue disorders
  • Diagnosis
  • Marfan syndrome

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