In 515 children and adolescents with Marfan syndrome from the Pediatric Heart Network trial, all proximal aortic absolute diameters increased over 36 months while Z-scores decreased, and the between-patient network of aortic segments was stronger than the within-patient network, so network findings complement but do not replace serial measurement of individual aortic levels.
The analysis included 515 participants from the Pediatric Heart Network Marfan trial, most of whom had complete echocardiographic follow-up.
From baseline to 36 months, absolute diameters of all analyzed proximal aortic segments increased.
Z-scores of the proximal aortic segments decreased over 36 months despite increases in absolute diameter.
Exploratory age-stratified analyses showed larger Z-score decreases among participants aged 6-11 years.
The interindividual network of the proximal aorta was stronger than the intraindividual network.
Sensitivity analyses showed the same overall pattern of declining Z-scores.
The proximal aorta shows a multisegment architecture in which organization across patients is stronger than within-patient coordination of change.
This study re-analyzed data from a large clinical trial of children and adolescents with Marfan syndrome, a genetic condition that can weaken the aorta, the body's main artery. Using heart ultrasound measurements taken over three years in 515 young people, the researcher looked at four parts of the aorta near the heart and how they changed together as the children grew. All parts of the aorta got larger in absolute size, as expected with growth. But when size was adjusted for body size (Z-scores), the values went down slightly, meaning the aorta grew a bit less than expected relative to the children's growth. This drop appeared larger in children aged 6-11 years, though that analysis was exploratory. The study also found that differences between patients in how the aortic segments relate to each other were stronger than the coordination of changes within a single patient over time. This research suggests that looking at the aorta as a connected, multi-segment structure may add information, but it does not replace measuring each part of an individual's aorta repeatedly over time. The author notes that whether these network patterns can predict outcomes has not been tested and needs independent validation.
Tirado A. (2026). Longitudinal Remodeling and Network Architecture of the Proximal Aorta in Children and Adolescents With Marfan Syndrome.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70662