Download PDF
CC BY-NC-ND 4.0 · Aorta (Stamford) 2023; 11(02): 063-070
DOI: 10.1055/a-2072-0469
Original Research Article

Beta-Blocker Use during Pregnancy Correlates with Less Aortic Root Dilatation in Patients with Marfan's Syndrome

Emma A. Roberts    #
1   Department of Obstetrics and Gynecology, University of California San Diego, San Diego, California
,
Andrew Pistner   #
2   Division of Cardiology, University of Washington, Seattle, Washington
,
Oyinkansola Osobamiro
3   Department of Medicine, University of Washington, Seattle, Washington
,
Stephanie Banning
4   Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
,
Sherene Shalhub
5   Division of Vascular Surgery, University of Washington, Seattle, Washington
,
Catherine Albright
6   Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
,
Ofir Horovitz
7   School of Public Health, University of Washington, Seattle, Washington
,
Jonathan Buber
2   Division of Cardiology, University of Washington, Seattle, Washington
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Pregnant patients with Marfan's syndrome (MFS) are at an increased risk for adverse aortic outcomes. While beta-blockers are used to slow aortic root dilatation in nonpregnant MFS patients, the benefit of such therapy in pregnant MFS patients remains controversial. The purpose of this study was to investigate the effect of beta-blockers on aortic root dilatation during pregnancy in MFS patients.

Methods This was a longitudinal single-center retrospective cohort study of females with MFS who completed a pregnancy between 2004 and 2020. Clinical, fetal, and echocardiographic data were compared in patients on- versus off-beta-blockers during pregnancy.

Results A total of 20 pregnancies completed by 19 patients were evaluated. Beta-blocker therapy was initiated or continued in 13 (65%) of the 20 pregnancies. Pregnancies on-beta-blocker therapy experienced less aortic growth compared with those off-beta-blockers (0.10 [interquartile range, IQR: 0.10–0.20] vs. 0.30 cm [IQR: 0.25–0.35]; p = 0.03). Using univariate linear regression, maximum systolic blood pressures (SBP), increase in SBP, and absence of beta-blocker use in pregnancy were found to be significantly associated with greater increase in aortic diameter during pregnancy. There were no differences in rates of fetal growth restriction between pregnancies on- versus off-beta-blockers.

Conclusion This is the first study that we are aware of to evaluate changes in aortic dimensions in MFS pregnancies stratified by beta-blocker use. Beta-blocker therapy was found to be associated with less aortic root growth during pregnancy in MFS patients.

Keywords

Marfan's syndrome - pregnancy - beta-blockers - aorta - aortic dilation

# These authors contributed equally to this work.




Publication History

Received: 02 June 2022

Accepted: 07 April 2023

Accepted Manuscript online:
13 April 2023

Article published online:
31 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Dietz HC, Cutting GR, Pyeritz RE. et al. Marfan syndrome caused by a recurrent de novo missense mutation in the fibrillin gene. Nature 1991; 352 (6333): 337-339
    CrossrefPubMedSearch in Google Scholar
  • 2 Adams JN, Trent RJ. Aortic complications of Marfan's syndrome. Lancet 1998; 352 (9142): 1722-1723
    CrossrefPubMedSearch in Google Scholar
  • 3 Narula N, Devereux RB, Malonga GP, Hriljac I, Roman MJ. Pregnancy-related aortic complications in women with Marfan syndrome. J Am Coll Cardiol 2021; 78 (09) 870-879
    CrossrefPubMedSearch in Google Scholar
  • 4 Roman MJ, Pugh NL, Hendershot TP. et al; GenTAC InvestigatorsDietzHarry C.HabashiJenniferPrakashSiddharth K.MaslenCheryl L.SongHoward K.BavariaJoseph E.MilewskiKariannaWeinsaftJonathan W.McDonnellNazliAschFederico M.TolunayH. EserDesvigne-NickensPatriceTsengHungKronerBarbara L. Aortic complications associated with pregnancy in Marfan syndrome: the NHLBI National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). J Am Heart Assoc 2016; 5 (08) e004052
    CrossrefPubMedSearch in Google Scholar
  • 5 Kamel H, Roman MJ, Pitcher A, Devereux RB. Pregnancy and the risk of aortic dissection or rupture: a cohort-crossover analysis. Circulation 2016; 134 (07) 527-533
    CrossrefPubMedSearch in Google Scholar
  • 6 Donnelly RT, Pinto NM, Kocolas I, Yetman AT. The immediate and long-term impact of pregnancy on aortic growth rate and mortality in women with Marfan syndrome. J Am Coll Cardiol 2012; 60 (03) 224-229
    CrossrefPubMedSearch in Google Scholar
  • 7 Ducas RA, Elliott JE, Melnyk SF. et al. Cardiovascular magnetic resonance in pregnancy: insights from the cardiac hemodynamic imaging and remodeling in pregnancy (CHIRP) study. J Cardiovasc Magn Reson 2014; 16 (01) 1-1
    CrossrefPubMedSearch in Google Scholar
  • 8 Kuperstein R, Cahan T, Yoeli-Ullman R, Ben Zekry S, Shinfeld A, Simchen MJ. Risk of aortic dissection in pregnant patients with the Marfan syndrome. Am J Cardiol 2017; 119 (01) 132-137
    CrossrefPubMedSearch in Google Scholar
  • 9 Shores J, Berger KR, Murphy EA, Pyeritz RE. Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan's syndrome. N Engl J Med 1994; 330 (19) 1335-1341
    CrossrefPubMedSearch in Google Scholar
  • 10 Prokop EK, Palmer RF, Wheat Jr MWJ. Hydrodynamic forces in dissecting aneurysms. In-vitro studies in a Tygon model and in dog aortas. Circ Res 1970; 27 (01) 121-127
    CrossrefPubMedSearch in Google Scholar
  • 11 Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J. et al; ESC Scientific Document Group. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39 (34) 3165-3241
    Search in Google Scholar
  • 12 Loeys BL, Dietz HC, Braverman AC. et al. The revised Ghent nosology for the Marfan syndrome. J Med Genet 2010; 47 (07) 476-485
    CrossrefPubMedSearch in Google Scholar
  • 13 Lang RM, Badano LP, Mor-Avi V. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28 (01) 1-39.e14
    CrossrefPubMedSearch in Google Scholar
  • 14 McGill JB. Optimal use of beta-blockers in high-risk hypertension: a guide to dosing equivalence. Vasc Health Risk Manag 2010; 6: 363-372
    CrossrefPubMedSearch in Google Scholar
  • 15 Lazarevic AM, Nakatani S, Okita Y. et al. Determinants of rapid progression of aortic root dilatation and complications in Marfan syndrome. Int J Cardiol 2006; 106 (02) 177-182
    CrossrefPubMedSearch in Google Scholar
  • 16 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 (03) 406-409
    CrossrefPubMedSearch in Google Scholar
  • 17 Lacro RV, Dietz HC, Sleeper LA. et al; Pediatric Heart Network Investigators. Atenolol versus losartan in children and young adults with Marfan's syndrome. N Engl J Med 2014; 371 (22) 2061-2071
    CrossrefPubMedSearch in Google Scholar
  • 18 Martín CE, Evangelista A, Teixidó G. et al. Aortic events in pregnant patients with Marfan syndrome. Lessons from a multicenter study. Rev Esp Cardiol (Engl Ed) 2022; 75 (07) 552-558
    PubMedSearch in Google Scholar
  • 19 Lind J, Wallenburg HC. The Marfan syndrome and pregnancy: a retrospective study in a Dutch population. Eur J Obstet Gynecol Reprod Biol 2001; 98 (01) 28-35
    CrossrefPubMedSearch in Google Scholar
  • 20 Omnes S, Jondeau G, Detaint D. et al. Pregnancy outcomes among women with Marfan syndrome. Int J Gynaecol Obstet 2013; 122 (03) 219-223
    CrossrefPubMedSearch in Google Scholar
  • 21 Meijboom LJ, Vos FE, Timmermans J, Boers GH, Zwinderman AH, Mulder BJM. Pregnancy and aortic root growth in the Marfan syndrome: a prospective study. Eur Heart J 2005; 26 (09) 914-920
    CrossrefPubMedSearch in Google Scholar
  • 22 Xie RH, Guo Y, Krewski D. et al. Beta-blockers increase the risk of being born small for gestational age or of being institutionalised during infancy. BJOG 2014; 121 (09) 1090-1096
    CrossrefPubMedSearch in Google Scholar
  • 23 Lee JR, Lawrence SO, Soto M. et al; Aortic Dissection Collaborative. The Aortic Dissection Collaborative: methods for building capacity for patient-centered outcomes research in the aortic dissection community. Semin Vasc Surg 2022; 35 (01) 9-15
    CrossrefPubMedSearch in Google Scholar
  • 24 Saeyeldin A, Zafar MA, Velasquez CA. et al. Natural history of aortic root aneurysms in Marfan syndrome. Ann Cardiothorac Surg 2017; 6 (06) 625-632
    CrossrefPubMedSearch in Google Scholar
  • 25 Peres P, Carvalho AC, Perez ABA, Medeiros WM. Abnormal heart rate recovery and deficient chronotropic response after submaximal exercise in young Marfan syndrome patients. Cardiol Young 2016; 26 (07) 1274-1281
    CrossrefPubMedSearch in Google Scholar