Transesophageal echocardiographic assessment of thoracic aorta elastic properties by TDI in patients with Marfan syndrome

Background: It has been shown that the presence of aortic dilation is associated with an increased risk of aortic dissection in patients with Marfan disease. The purpose of the study was to establish the value of combined thoracic aorta dilation and decreased aortic elastic properties to assess the severity of aortic disease in patients with Marfan syndrome. Methods: Fifteen patients (pts) with Marfan syndrome (Beighton criteria) aged 13 to 42 years were studied with multiplane transesophageal echocardiography (TEE). 6/15 pts had surgery for aortic dissection. Tissue Doppler imaging (TDI, Toshiba corp.) during TEE was used for the quantification of aortic elastic properties. The descending aorta was visualized in a TEE short axis view at the level of the left atrium and TDI was used for the rates of velocity change (dV/dt) over time. Peak positive dV/dt (dV/dt max, cm2sec-1) was measured. Results: Descending thoracic aorta dilation (>30mm) was present in 11/15 pts. dV/dt max was 7.97±1.82 in pts without surgery and 4.39±1.47 in pts with surgery (p<0.005). Aortic dilation > 40 mm was detected in 5/6 pts with surgery and 3/25 pts without surgery. dV/dt max < 5.0 cm2 sec–1 combined with descending thoracic aortic dilation > 40 mm had a sensitivity of 91%, specificity of 73% and positive predictive value of 83% for predicting aortic dissection. Conclusion: Our results indicate that these described combined methods are highly predictive for the development of aortic dissection in Marfan syndrome and should suggest aggressive treatment.