What question did this study set out to answer?

This study aims to investigate the abnormal aortic displacement and wall shear stress in patients with Marfan syndrome, particularly after aortic root surgery.

April 22, 2026Open Access

Aortic displacement and hemodynamics are abnormal in patients with Marfan syndrome: a combined 4D bSSFP and 4D flow CMR study

Key Result

Marfan syndrome patients with prior aortic root surgery show significantly increased wall shear stress (100%) and decreased displacement (97%) in the proximal ascending aorta.

Key Points

This study aims to investigate the abnormal aortic displacement and wall shear stress in patients with Marfan syndrome, particularly after aortic root surgery.
Examined 82 Marfan syndrome patients and 45 matched controls using 4D high-resolution CMR techniques.
Calculated peak displacement and wall shear stress using automated segmentations and heatmaps.
Utilized statistical tests to compare and correlate parameters.
Patients with aortic root surgery showed significantly higher wall shear stress in the proximal aorta (p<0.001).
97% of ARS patients had increased surface areas of decreased displacement in the proximal ascending aorta (p<0.001).
A positive correlation was found between proximal descending aorta displacement and wall shear stress (r=0.46, p=0.008).

Structured PICO

Population

82 patients with Marfan syndrome (32 with history of aortic root surgery, mean age 34 ± 8 years, 36 women) and 45 age- and sex-matched controls

Intervention

4D high resolution CINE and flow CMR

Comparator

Age- and sex-matched controls, and native Marfan syndrome patients (without prior aortic root surgery)

Outcome

Magnitude and location of abnormal aortic displacement and wall shear stress (WSS)surrogate

4D flow CMR reveals abnormal aortic displacement and hemodynamics in Marfan syndrome patients, with distinct features in those with prior aortic root surgery that may predispose to type B aortic dissection.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Marfan syndrome (MFS) patients with a history of aortic root surgery (ARS) are at increased risk of type B aortic dissection, possibly because the noncompliant graft fails to absorb systolic forces, leading to undampened flow in the proximal descending aorta (pDAo). In this study we investigated the magnitude and location of abnormal aortic displacement and wall shear stress (WSS) using cardiac magnetic resonance imaging (CMR). We examined 82 MFS patients (32 with ARS, 34 ± 8 years, 36 women) and 45 age- and sex-matched controls, all undergoing 4D high resolution CINE and flow CMR. Peak displacement and WSS were calculated using automated aortic segmentations. Heatmaps were created to identify and quantify regions with abnormal displacement and WSS. The surface areas of abnormal displacement and WSS were quantified in four aortic regions. The Wilcoxon signed-rank test was used for comparison of abnormal CMR parameter quantification, and Pearson correlation was used to assess correlations between displacement and WSS. WSS was higher in the proximal (p<0.001) and distal ascending aorta (p=0.031) of ARS MFS patients compared to native MFS patients. ARS MFS patients had significantly larger surface areas of decreased displacement (p<0.001; present in 97% of ARS MFS patients) and increased WSS (p<0.001; present in 100% of patients) in the proximal ascending aorta. There was a trend toward a larger surface area of increased displacement in the pDAo of ARS MFS patients (p=0.062; present in 72% of patients), mainly located in the outer pDAo. pDAo displacement was positively correlated with pDAo WSS (Pearson r=0.46 95%CI: 0.13, 0.70, p=0.008). Aortic displacement and flow characteristics are abnormal in MFS patients, both with and without a history of aortic root surgery. ARS MFS patients exhibit distinct features in both the AAo and DAo, particularly in the proximal DAo, which is the region susceptible to type B aortic dissections.