Clinical features and complications of Loeys-Dietz syndrome: A systematic review

Pishoy Gouda a, Robert Kay a, Marina Habib b, Amir Aziz a, Eitan Aziza a, Robert Welsh a c

a) University of Alberta, Division of Cariology, Edmonton, Alberta, Canada; b) Flinders University, School of Medicine, Adelaide, Australia; c) Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada

Received 28 February 2022, Revised 23 May 2022, Accepted 29 May 2022, Available online 1 June 2022, Version of Record 18 June 2022.

Highlights

  • Loeys-Dietz Syndrome is an autosomal dominant connective tissue disease with multi-system involvement.

  • In a systematic review of 3896 reported cases of Loeys-Dietz syndrome the most commonly reported features and complications included: aortic aneurysms and dissections, arterial tortuosity, high arched palate, abnormal uvula and hypertelorism.

  • In the peripartum period, the rate of aortic dissections was found to be 4% with a maternal mortality of 1%.

Abstract

Introduction

Loeys-Dietz syndrome (LDS) is a connective tissue disorder that arises from mutations altering the transforming growth factor β signalling pathway. Due to the recent discovery of the underlying genetic mutations leading to LDS, the spectrum of characteristics and complications is not fully understood.

Methods

Our search included five databases (Pubmed, SCOPUS, Web of Science, EMBASE and google scholar) and included variations of “Loeys-Dietz Syndrome” as search terms, using all available data until February 2021. All study types were included. Three reviewers screened 1394 abstracts, of which 418 underwent full-text review and 392 were included in the final analysis.

Results

We identified 3896 reported cases of LDS with the most commonly reported features and complications being: aortic aneurysms and dissections, arterial tortuosity, high arched palate, abnormal uvula and hypertelorism. LDS Types 1 and 2 share many clinical features, LDS Type 2 appears to have a more aggressive aortic disease. LDS Type 3 demonstrated an increased prevalence of mitral valve prolapse and arthritis. LDS Type 4 and 5 demonstrated a lower prevalence of musculoskeletal and cardiovascular involvement. Amongst 222 women who underwent 522 pregnancies, 4% experienced an aortic dissection and the peripartum mortality rate was 1%.

Conclusion

We observed that LDS is a multisystem connective tissue disorder that is associated with a high burden of complications, requiring a multidisciplinary approach. Ongoing attempts to better characterise these features will allow clinicians to appropriately screen and manage these complications.

Gouda, Pishoy, et al. “Clinical Features and Complications of Loeys-Dietz Syndrome: A Systematic Review.” International Journal of Cardiology, vol. 362, Sept. 2022, pp. 158–167, https://doi.org/10.1016/j.ijcard.2022.05.065.

Accessed February 16, 2024.

ResearchStacey WatsonClinical features, physical features, Aortic Aneurysm, Aortic Dissection, arterial tortuosity, High Arched Palate, Abnormal Uvula, Hypertelorism