Management of Marfan Syndrome, with a Specific Focus on the Significance of Physical Activity in this Patient Population
DOI:
https://doi.org/10.12775/QS.2024.37.57713Keywords
Marfan's syndorme, Connective Tissue Diseases, physical activity, aortic aneurysm, FBN1Abstract
Introduction: Marfan syndrome is an autosomal dominant disorder of connective tissue. Timely diagnosis and effective therapy are essential for individuals with Marfan syndrome, as they are susceptible to severe cardiovascular consequences, including aortic aneurysms and aortic dissection. The conventional treatment comprises beta-blockers to mitigate the dilatation of the aorta and aortic surgery. The efficacy of contemporary medicinal and surgical interventions in Marfan syndrome has significantly enhanced mean life expectancy. International guidelines generally discourage physical activity for individuals with Marfan syndrome. Recent recommendations have created exclusions for these patients, indicating benefits from engaging in low-intensity physical activity exclusively.
Aim of the study: The primary aim of this research is to elucidate the most recent management ideas pertaining to Marfan syndrome. Significant emphasis is placed on the importance and safety of physical activity in individuals afflicted with this disease. The risks linked to physical activity are addressed, however the advantages of particular activities are highlighted.
Materials and methods: A review of the literature available in the PubMed database was performed, using the key words: „Marfan syndrome", „connective tissue disease”, „physical activity", „aortic aneurysm”, „FBN1”.
Conclusion: The prognosis for patients with Marfan syndrome has markedly improved in the last years. Contrary to conventional guidance to refrain from physical activity, emerging research indicates that low-intensity exercise may be advantageous. Research on the safety and health implications of physical activity in patients with Marfan syndrome is exceedingly few. Current information indicates that moderate physical activity at a particular intensity may be safe in this condition. Additional study is necessary to offer targeted recommendations for patient training and enhance their long-term quality of life.
References
[1] Marelli S, Micaglio E, Taurino J, Salvi P, Rurali E, Perrucci GL, et al. Marfan Syndrome: Enhanced Diagnostic Tools and Follow-up Management Strategies. Diagnostics 2023;13. https://doi.org/10.3390/diagnostics13132284.
[2] Benke K, Ágg B, Pólos M, Sayour AA, Radovits T, Bartha E, et al. The effects of acute and elective cardiac surgery on the anxiety traits of patients with Marfan syndrome. BMC Psychiatry 2017;17. https://doi.org/10.1186/s12888-017-1417-9.
[3] Milewicz DM, Braverman AC, De Backer J, Morris SA, Boileau C, Maumenee IH, et al. Marfan syndrome. Nat Rev Dis Primers 2021;7. https://doi.org/10.1038/s41572-021-00298-7.
[4] Magenis RE, Maslen CL, Smith L, Allen L, Sakai LY. Localization of the fibrillin (FBN) gene to chromosome 15, band q21.1. Genomics 1991;11:346–51. https://doi.org/10.1016/0888-7543(91)90142-2.
[5] Vanem TT, Geiran OR, Krohg-Sørensen K, Røe C, Paus B, Rand-Hendriksen S. Survival, causes of death, and cardiovascular events in patients with Marfan syndrome. Mol Genet Genomic Med 2018;6:1114–23. https://doi.org/10.1002/mgg3.489.
[6] Muiño-Mosquera L, Cervi E, De Groote K, Dewals W, Fejzic Z, Kazamia K, et al. Management of aortic disease in children with FBN1 -related Marfan syndrome . Eur Heart J 2024. https://doi.org/10.1093/eurheartj/ehae526.
[7] Loeys BL, Dietz HC, Braverman AC, Callewaert BL, De Backer J, Devereux RB, et al. The revised Ghent nosology for the Marfan syndrome. J Med Genet 2010;47:476–85. https://doi.org/10.1136/jmg.2009.072785.
[8] Stheneur C, Tubach F, Jouneaux M, Roy C, Benoist G, Chevallier B, et al. Study of phenotype evolution during childhood in Marfan syndrome to improve clinical recognition. Genetics in Medicine 2014;16:246–50. https://doi.org/10.1038/gim.2013.123.
[9] Wozniak-Mielczarek L, Sabiniewicz R, Drezek-Nojowicz M, Nowak R, Gilis-Malinowska N, Mielczarek M, et al. Differences in Cardiovascular Manifestation of Marfan Syndrome Between Children and Adults. Pediatr Cardiol 2019;40:393–403. https://doi.org/10.1007/s00246-018-2025-2.
[10] Laganà G, Venza N, Malara A, Liguori C, Cozza P, Pisano C. Obstructive sleep apnea, palatal morphology, and aortic dilatation in marfan syndrome growing subjects: A retrospective study. Int J Environ Res Public Health 2021;18:1–10. https://doi.org/10.3390/ijerph18063045.
[11] Zarate YA, Morris SA, Blackshare A, Algaze CA, Connor BS, Kim AJ, et al. A clinical scoring system for early onset (neonatal) Marfan syndrome. Genetics in Medicine 2022;24:1503–11. https://doi.org/10.1016/j.gim.2022.03.016.
[12] Stheneur C, Faivre L, Collod-bé Roud L, Gautier E, Binquet C, Bonithon-kopp C, et al. Prognosis Factors in Probands With an FBN1 Mutation Diagnosed Before the Age of 1 Year. 2011.
[13] Rybczynski M, Mir TS, Sheikhzadeh S, Bernhardt AMJ, Schad C, Treede H, et al. Frequency and age-related course of mitral valve dysfunction in the marfan syndrome. American Journal of Cardiology 2010;106:1048–53. https://doi.org/10.1016/j.amjcard.2010.05.038.
[14] Beckman JA. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/ American College of Cardiology Joint Committee on Clinical Practice Guidelines. n.d.
[15] Goldstein SA, Evangelista A, Abbara S, Arai A, Asch FM, Badano LP, et al. Multimodality imaging of diseases of the thoracic aorta in adults: From the American society of echocardiography and the european association of cardiovascular imaging: Endorsed by the society of cardiovascular computed tomography and society for cardiovascular magnetic resonance. Journal of the American Society of Echocardiography 2015;28:119–82. https://doi.org/10.1016/j.echo.2014.11.015.
[16] Van Kimmenade RRJ, Kempers M, De Boer MJ, Loeys BL, Timmermans J. A clinical appraisal of different Z-score equations for aortic root assessment in the diagnostic evaluation of Marfan syndrome. Genetics in Medicine 2013;15:528–32. https://doi.org/10.1038/gim.2012.172.
[17] Weinrich JM, Avanesov M, Lenz A, Tahir E, Henes FO, Schoennagel BP, et al. Reliability of non-contrast magnetic resonance angiography-derived aortic diameters in Marfan patients: comparison of inner vs. outer vessel wall measurements. International Journal of Cardiovascular Imaging 2020;36:1533–42. https://doi.org/10.1007/s10554-020-01850-4.
[18] Lopez-Sainz A, Mila L, Rodriguez-Palomares J, Limeres J, Granato C, La Mura L, et al. Aortic Branch Aneurysms and Vascular Risk in Patients With Marfan Syndrome. J Am Coll Cardiol 2021;77:3005–12. https://doi.org/10.1016/j.jacc.2021.04.054.
[19] Marelli S, Micaglio E, Taurino J, Salvi P, Rurali E, Perrucci GL, et al. Marfan Syndrome: Enhanced Diagnostic Tools and Follow-up Management Strategies. Diagnostics 2023;13. https://doi.org/10.3390/diagnostics13132284.
[20] Van De Laar IMBH, Arbustini E, Loeys B, Björck E, Murphy L, Groenink M, et al. European reference network for rare vascular diseases (VASCERN) consensus statement for the screening and management of patients with pathogenic ACTA2 variants. Orphanet J Rare Dis 2019;14. https://doi.org/10.1186/s13023-019-1186-2.
[21] David TE. Aortic valve repair and aortic valve - Sparing operations. Journal of Thoracic and Cardiovascular Surgery 2015;149:9–11. https://doi.org/10.1016/j.jtcvs.2014.11.019.
[22] Treasure T, King A, Hidalgo Lemp L, Golesworthy T, Pepper J, Takkenberg JJM. Developing a shared decision support framework for aortic root surgery in Marfan syndrome. Heart 2018;104:480–6. https://doi.org/10.1136/heartjnl-2017-311598.
[23] Ott ILG, Reene ESG, Lejo EA, Uke D, Ameron EC, Aftel ACN, et al. REPLACEMENT OF THE AORTIC ROOT IN PATIENTS WITH MARFAN’S SYNDROME A BSTRACT Background Replacement of the aortic root with. vol. 340. 1999.
[24] Everitt MD, Pinto N, Hawkins JA, Mitchell MB, Kouretas PC, Yetman AT. Cardiovascular surgery in children with Marfan syndrome or Loeys-Dietz syndrome. Journal of Thoracic and Cardiovascular Surgery 2009;137:1327–33. https://doi.org/10.1016/j.jtcvs.2009.02.007.
[25] Koo HK, Lawrence KA, Musini VM. Beta-blockers for preventing aortic dissection in Marfan syndrome. Cochrane Database of Systematic Reviews 2017;2017. https://doi.org/10.1002/14651858.CD011103.pub2.
[26] Selamet Tierney ES, Feingold B, Printz BF, Park SC, Graham D, Kleinman CS, et al. Beta-Blocker Therapy Does Not Alter the Rate of Aortic Root Dilation in Pediatric Patients with Marfan Syndrome. Journal of Pediatrics 2007;150:77–82. https://doi.org/10.1016/j.jpeds.2006.09.003.
[27] Lacro R V., Dietz HC, Sleeper LA, Yetman AT, Bradley TJ, Colan SD, et al. Atenolol versus Losartan in Children and Young Adults with Marfan’s Syndrome. New England Journal of Medicine 2014;371:2061–71. https://doi.org/10.1056/nejmoa1404731.
[28] De Backer J. Marfan and Sartans: Time to wake up! Eur Heart J 2015;36:2131–3. https://doi.org/10.1093/eurheartj/ehv228.
[29] Pees C, Heno J, Michel-Behnke I. Initial Angiotensin Receptor Blocker Response in Young Marfan Patients Decreases After 3 Years of Treatment. Pediatr Cardiol 2022;43:586–95. https://doi.org/10.1007/s00246-021-02761-4.
[30] Isselbacher EM. Losartan for the Treatment of Marfan Syndrome: Hope Fades ∗. J Am Coll Cardiol 2018;72:1619–21. https://doi.org/10.1016/j.jacc.2018.07.051.
[31] Pitcher A, Spata E, Emberson J, Davies K, Halls H, Holland L, et al. Angiotensin receptor blockers and β blockers in Marfan syndrome: an individual patient data meta-analysis of randomised trials. The Lancet 2022;400:822–31. https://doi.org/10.1016/S0140-6736(22)01534-3.
[32] Phomakay V, Huett WG, Gossett JM, Tang X, Bornemeier RA, Collins RT. β-blockers and angiotensin converting enzyme inhibitors: Comparison of effects on aortic growth in pediatric patients with Marfan syndrome. Journal of Pediatrics 2014;165:951–5. https://doi.org/10.1016/j.jpeds.2014.07.008.
[33] Drazen JM, Morrissey S, Campion EW. Retraction: Ahimastos AA, Dart AM, Kingwell BA. Angiotensin II blockade in Marfan’s syndrome. N Engl J Med 2008;359:1732. New England Journal of Medicine 2015;373:2280–2280. https://doi.org/10.1056/nejme1514259.
[34] Braverman AC, Harris KM, Kovacs RJ, Maron BJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 7: Aortic Diseases, Including Marfan Syndrome. n.d.
[35] Milleron O, Ropers J, Arnoult F, Bouleti C, Delorme G, Langeois M, et al. Clinical Significance of Aortic Root Modification Associated With Bicuspid Aortic Valve in Marfan Syndrome: An Observational Cohort Study. Circ Cardiovasc Imaging 2019;12. https://doi.org/10.1161/CIRCIMAGING.118.008129.
[36] Benninghoven D, Hamann D, Von Kodolitsch Y, Rybczynski M, Lechinger J, Schroeder F, et al. Inpatient rehabilitation for adult patients with Marfan syndrome: An observational pilot study. Orphanet J Rare Dis 2017;12. https://doi.org/10.1186/s13023-017-0679-0.
[37] von Kodolitsch Y, Rybczynski M, Vogler M, Mir TS, Schüler H, Kutsche K, et al. The role of the multidisciplinary health care team in the management of patients with Marfan syndrome. J Multidiscip Healthc 2016;9:587–614. https://doi.org/10.2147/JMDH.S93680.
[38] Gibson C, Nielsen C, Alex R, Cooper K, Farney M, Gaufin D, et al. Mild aerobic exercise blocks elastin fiber fragmentation and aortic dilatation in a mouse model of Marfan syndrome associated aortic aneurysm. J Appl Physiol 2017;123:147–60. https://doi.org/10.1152/japplphysiol.00132.2017.-Regular.
[39] Mas-Stachurska A, Siegert AM, Batlle M, del Blanco DG, Meirelles T, Rubies C, et al. Cardiovascular benefits of moderate exercise training in Marfan syndrome: Insights from an animal model. J Am Heart Assoc 2017;6. https://doi.org/10.1161/JAHA.117.006438.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Patrycja Jędrzejewska-Rzezak

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 60
Number of citations: 0