Marfan's syndrome: propranolol slowed the rate of aortic dilatation.
Unblinded concealed randomised
Setting: teaching hospital, USA
mean 15 years,
- <12 or >50 years old
- ongoing treatment with propranolol
- aortic dissection
- aortic regurgitation on auscultation
- moderate or severe mitral regurgitation
- previous cardiothoracic surgery
- dyspnoea on moderate exercise
- peripheral oedema
- LV function <50%
- atrioventricular conduction delay of any degree
- diabetes mellitus
- recurrent bronchospasm requiring medication
Control Group: (n = 38, 38 analysed):
Experimental Group: (n = 32, 32 analysed):
initially 10 mg qds, and after 2-4 weeks titred so that heart rate was <100 bpm during exercise, or systolic interval increased by <30%
100% followed for
: death, heart failure, aortic regurgitation, aortic dissection or cardiovascular surgery
: heart block, lethargy, insomnia
||Time to outcome
| clinical endpoint
NNH = 4 to infinity)
| side effects
| rate of aortic dilatation per year
( to )
- Two patients with clinical endpoints in the experimental group did not take their propranolol.
- mean propranolol dose 212 mg +/- 68 mg, in four divided doses per day
- aortic ratio: aortic diameter on echocardiogram/ aortic diameter predicted by patient's height/ weight/ age. Slope of regression line equivalent to the rate of dilatation.
- The study was not large enough to demonstrate benefit in terms of clinical outcome, despite showing delay in dilatation of aorta.
Contributor: Chris Ball and Clare Wotton,
EA, et al:
Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan's syndrome.
New England Journal of Medicine
|Intervention or Exposure
||clinical endpoint, side effects