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Isolated aortic root dilation in homocystinuria
Massimiliano Lorenzini1,2, Nishan Guha3, James E Davison4
1University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
Insights
Patients with homocystinuria can develop aortic root dilation, similar to Marfan syndrome. This study found no ascending aorta involvement, suggesting isolated aortic root dilation in some homocystinuria patients.
Area of Science:
- Cardiovascular Medicine
- Metabolic Disorders
- Genetics
Background:
- Vascular complications are known in homocystinuria.
- Ascending aorta involvement in homocystinuria has not been previously reported.
Purpose of the Study:
- To investigate aortic root and ascending aorta involvement in patients with homocystinuria.
Main Methods:
- Cross-sectional study of 34 homocystinuria patients.
- Transthoracic echocardiogram used for evaluation.
- Aortic root dilation defined by Z-score ≥ 2.0 SD.
Main Results:
- 21% of patients (7/34) had aortic root dilation (mild, moderate, or severe).
- No ascending aorta dilation was observed.
- Two patients with moderate aortic root dilation had significant aortic regurgitation.
Conclusions:
- A subset of homocystinuria patients exhibit isolated aortic root dilation.
- This finding resembles the aortic root dilation seen in Marfan syndrome.
Background:
Vascular complications in homocystinuria have been known for many years, but there have been no reports to date on involvement of the ascending aorta.
Methods:
We conducted a cross-sectional study of patients with homocystinuria, known to a single metabolic centre, and evaluated in 2016 with a transthoracic echocardiogram. Aortic root dilation was defined as Z-score ≥ 2.0 SD, and graded mild (Z-score 2.0-3.0), moderate (Z-score 3.01-4.0) and severe (Z-score > 4.0).
Results:
The study population included 34 patients, median age of 44.3 years (IQR 33.3-52.2), 50% males, 69% diagnosed aged <18 years and 29% pyridoxine-responsive. Eight (24%) had a history of hypertension. Seven patients (21%) were found to have a dilation of the aortic root, mild in two cases (6%), moderate in four (12%) and severe in one (3%). None had dilation of the ascending aorta. Significant aortic regurgitation, secondary to moderate aortic root dilation, was documented in two patients. A single patient had significant mitral regurgitation due to prolapse of both valve leaflets, as well as mild aortic root dilation. Comparing patients with a dilation of the aortic root to those without, there were no significant clinical, laboratory or echocardiographic differences, with the only exception being that the diameter of the ascending aorta was larger in the group with a dilated aortic root, albeit within normal limits.
Conclusions:
A subset of patients with homocystinuria have isolated dilation of the aortic root similar to that observed in Marfan syndrome.
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