Central pulse pressure is a major determinant of ascending aorta dilation in Marfan syndrome

Background-In patients with Marfan syndrome (MFS), brachial pulse pressure (PP) has been recognized as a risk factor for aortic dilatation, leading to aortic dissection, the main cause of premature death. However, the relatio nships between aortic PP, aortic stiffness, and aortic root dilation have n ot been investigated. Our main objective was to determine whether central P P, which takes into account wave reflections and aortic stiffness, is a bet ter determinant of ascending aorta diameter than brachial PP in MFS patient s. Methods and Results-Twenty patients with confirmed MFS and 20 age- and sex- matched control subjects were included in this cross-sectional, noninvasive study. Elastic properties of the abdominal aorta and common carotid, commo n femoral, and radial arteries were calculated from the pulsatile changes i n arterial diameter and pressure. The ascending aorta diameter, measured wi th conventional echocardiography, was 37% larger in MFS than in control sub jects (P<0.001). Arterial distensibility was 38% lower in MFS than in contr ol subjects at the site of the abdominal aorta (P<0.01) but not at other si tes (common carotid, common femoral, and radial arteries). Independently of age and body surface area, ascending aorta diameter was positively correla ted with carotid PP in MFS (P<0.01) and negatively in control subjects (P<0 .01) but was not correlated with brachial PP and mean blood pressure, Conclusions-In patients with MFS, local PP, estimated from carotid PP, was a major determinant of ascending aorta diameter, whereas brachial PP was no t. Increased arterial stiffness was confined to the aorta.