Abstract
The prevalence of each single feature in the Ghent criteria in patients with Marfan syndrome (MFS) is not known. To elucidate this, a cross-sectional study of 105 adults with presumed MFS was carried out. All patients were examined by the same group of investigators with standardized and complete assessment of all features in the Ghent criteria. Eighty-seven (83%) fulfilled the criteria in 56 different variants. The most prevalent major criterion in Ghent-positive persons was dural ectasia (91%), followed by major genetic criterion (89%) and ectopic lenses (62 %). In 14 persons (16%), the diagnosis was dependent on the dural findings. In all, 79% fulfilled both major dural and major genetic (positive family history and/or FBN1 mutation) criteria, suggesting that most patients with MFS might be identified by investigating these criteria. A history or finding of ascending aortic disease was present in 46 patients (53%). This low prevalence might partly reflect a high number of diagnosed patients encompassing the whole spectrum of the syndrome. The study confirms the need to examine for the complete set of features in the Ghent criteria to identify all patients with MFS. The majority of persons with MFS might be identified by the combined assessment of dura mater and family history, supplemented with DNA analysis in family-negative cases. The low prevalence of ascending aortic disease might indicate better future prospects in an adult population than those traditionally considered.
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References
De Paepe A, Devereux RB, Dietz HC, Hennekam RC, Pyeritz RE : Revised diagnostic criteria for the Marfan syndrome. Am J Med Genet 1996; 62: 417–42.
Ammash NM, Sundt TM, Connolly HM : Marfan syndrome-diagnosis and management. Curr Probl Cardiol 2008; 33: 7–39.
Gray JR, Bridges AB, Faed MJ et al: Ascertainment and severity of Marfan syndrome in a Scottish population. J Med Genet 1994; 31: 51–54.
Fuchs J : Marfan syndrome and other systemic disorders with congenital ectopia lentis. A Danish national survey. Acta Paediatr 1997; 86: 947–952.
Pyeritz RE : The Marfan syndrome. Annu Rev Med 2000; 51: 481–510.
Collod-Beroud G, Boileau C : Marfan syndrome in the third Millennium. Eur J Hum Genet 2002; 10: 673–681.
Collod-Beroud G, Le Bourdelles S, Ades L et al: Update of the UMD-FBN1 mutation database and creation of an FBN1 polymorphism database. Hum Mutat 2003; 22: 199–208.
Disabella E, Grasso M, Marziliano N et al: Two novel and one known mutation of the TGFBR2 gene in Marfan syndrome not associated with FBN1 gene defects. Eur J Hum Genet 2006; 14: 34–38.
Singh KK, Rommel K, Mishra A et al: TGFBR1 and TGFBR2 mutations in patients with features of Marfan syndrome and Loeys-Dietz syndrome. Hum Mutat 2006; 27: 770–777.
Faivre L, Collod-Beroud G, Loeys BL et al: Effect of mutation type and location on clinical outcome in 1,013 probands with Marfan syndrome or related phenotypes and FBN1 mutations: an International Study. Am J Hum Genet 2007; 81: 454–466.
Faivre L, Collod-Beroud G, Child A et al: Contribution of molecular analyses in diagnosing Marfan syndrome and type I fibrillinopathies: an International Study of 1009 Probands. J Med Genet 2008; 45: 384–390.
Dean JC : Marfan syndrome: clinical diagnosis and management. Eur J Hum Genet 2007; 15: 724–733.
Grahame R, Pyeritz RE : The Marfan syndrome: joint and skin manifestations are prevalent and correlated. Br J Rheumatol 1995; 34: 126–131.
Hasan A, Poloniecki J, Child A : Ageing in Marfan syndrome. Int J Clin Pract 2007; 61: 1308–1320.
Fattori R, Nienaber CA, Descovich B et al: Importance of dural ectasia in phenotypic assessment of Marfan's syndrome. Lancet 1999; 354: 910–913.
Hall JG, Froster-Iskenius UG, Allanson JE : Handbook of normal physical measurements, Oxford; New York; Toronto, Oxford University Press. ISBN 0 19 261696, 1995; vol, pp 270–275.
Roman MJ, Devereux RB, Kramer-Fox R, O'Loughlin J : Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol 1989; 64: 507–512.
Roman MJ, Devereux RB, Kramer-Fox R, Spitzer MC : Comparison of cardiovascular and skeletal features of primary mitral valve prolapse and Marfan syndrome. Am J Cardiol 1989; 63: 317–321.
Rand-Hendriksen S, Tjeldhorn L, Lundby R et al: Search for correlations between FBN1 genotype and complete Ghent phenotype in 44 unrelated Norwegian patients with Marfan syndrome. Am J Med Genet A 2007; 143: 1968–1977.
Tjeldhorn L, Rand-Hendriksen S, Gervin K et al: Rapid and efficient FBN1 mutation detection using automated sample preparation and direct sequencing as the primary strategy. Genet Test 2006; 10: 258–264.
Arbustini E, Grasso M, Ansaldi S et al: Identification of sixty-two novel and twelve known FBN1 mutations in eighty-one unrelated probands with Marfan syndrome and other fibrillinopathies. Hum Mutat 2005; 26: 494.
Finkbohner R, Johnston D, Crawford ES, Coselli J, Milewicz DM : Marfan syndrome. Long-term survival and complications after aortic aneurysm repair. Circulation 1995; 91: 728–733.
Garreau de Loubresse C, Mullins MM, Moura B et al: Spinal and pelvic parameters in Marfan's syndrome and their relevance to surgical planning. J Bone Joint Surg Br 2006; 88: 515–519.
Knirsch W, Kurtz C, Haffner N et al: Dural ectasia in children with Marfan syndrome: a prospective, multicenter, patient–control study. Am J Med Genet A 2006; 140: 775–781.
Ladouceur M, Fermanian C, Lupoglazoff JM et al: Effect of beta-blockade on ascending aortic dilatation in children with the Marfan syndrome. Am J Cardiol 2007; 99: 406–409.
Loeys B, De Backer J, Van Acker P et al: Comprehensive molecular screening of the FBN1 gene favors locus homogeneity of classical Marfan syndrome. Hum Mutat 2004; 24: 140–146.
Rose PS, Levy HP, Ahn NU et al: A comparison of the Berlin and Ghent nosologies and the influence of dural ectasia in the diagnosis of Marfan syndrome. Genet Med 2000; 2: 278–282.
Rossi-Foulkes R, Roman MJ, Rosen SE et al: Phenotypic features and impact of beta blocker or calcium antagonist therapy on aortic lumen size in the Marfan syndrome. Am J Cardiol 1999; 83: 1364–1368.
van Karnebeek CD, Naeff MS, Mulder BJ, Hennekam RC, Offringa M : Natural history of cardiovascular manifestations in Marfan syndrome. Arch Dis Child 2001; 84: 129–137.
Gray JR, Davies SJ : A clinical severity grading scale for Marfan syndrome. J Med Genet 1996; 33: 758–759.
Pepe G, Lapini I, Evangelisti L et al: Is ectopia lentis in some cases a mild phenotypic expression of Marfan syndrome? Need for a long-term follow-up. Mol Vis 2007; 13: 2242–2247.
Putnam EA, Cho M, Zinn AB et al: Delineation of the Marfan phenotype associated with mutations in exons 23–32 of the FBN1 gene. Am J Med Genet 1996; 62: 233–242.
Ades LC, Holman KJ, Brett MS, Edwards MJ, Bennetts B : Ectopia lentis phenotypes and the FBN1 gene. Am J Med Genet 2004; 126A: 284–289.
Oosterhof T, Groenink M, Hulsmans FJ et al: Quantitative assessment of dural ectasia as a marker for Marfan syndrome. Radiology 2001; 220: 514–518.
Mizuguchi T, Matsumoto N : Recent progress in genetics of Marfan syndrome and Marfan-associated disorders. J Hum Genet 2007; 52: 1–12.
Byers PH : Marfan families have been observed in which men are more likely to have earlier onset aortic enlargement, more rapid enlargement and earlier dissection than the women in the family. Personal communication 2008.
Chan KL, Callahan JA, Seward JB, Tajik AJ, Gordon H : Marfan syndrome diagnosed in patients 32 years of age or older. Mayo Clin Proc 1987; 62: 589–594.
Das BB, Taylor AL, Yetman AT : Left ventricular diastolic dysfunction in children and young adults with Marfan syndrome. Pediatr Cardiol 2006; 27: 256–258.
De Backer J, Loeys B, Devos D et al: A critical analysis of minor cardiovascular criteria in the diagnostic evaluation of patients with Marfan syndrome. Genet Med 2006; 8: 401–408.
Nollen GJ, van Schijndel KE, Timmermans J et al: Pulmonary artery root dilatation in Marfan syndrome: quantitative assessment of an unknown criterion. Heart 2002; 87: 470–471.
Glesby MJ, Pyeritz RE : Association of mitral valve prolapse and systemic abnormalities of connective tissue. A phenotypic continuum. JAMA 1989; 262: 523–528.
Gray JR, Bridges AB, West RR et al: Life expectancy in British Marfan syndrome populations. Clin Genet 1998; 54: 124–128.
Maumenee IH : The eye in the Marfan syndrome. Trans Am Ophthalmol Soc 1981; 79: 684–733.
Cohen PR, Schneiderman P : Clinical manifestations of the Marfan syndrome. Int J Dermatol 1989; 28: 291–299.
Wood JR, Bellamy D, Child AH, Citron KM : Pulmonary disease in patients with Marfan syndrome. Thorax 1984; 39: 780–784.
Acknowledgements
We thank Finn Lilleås, MD and Ina Ghisolfi, technologist, Diakonhjemmet Hospital, Oslo, Norway for performing the radiological investigations. This study has been funded by (South-) Eastern Norway Regional Health Authority (Helse (Sør-)Øst RHF); TRS, a National Resource Centre for Rare Disorders; the Stokbaks Heart Foundation and the Kirkevoll Memory Foundation.
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Rand-Hendriksen, S., Lundby, R., Tjeldhorn, L. et al. Prevalence data on all Ghent features in a cross-sectional study of 87 adults with proven Marfan syndrome. Eur J Hum Genet 17, 1222–1230 (2009). https://doi.org/10.1038/ejhg.2009.30
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DOI: https://doi.org/10.1038/ejhg.2009.30
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