Background: Aortic dilation, stiffening, and dissection are common and potentially lethal complications of Marfan syndrome (MFS) and Loeys-Dietz syndrome (LDS), which involve abnormal transforming growth factor beta (TGF-b) signalling. The relation of aortic dimensions, stiffness, and biomarker levels is unknown. The objective of this study was to measure aortic dimensions, stiffness, TGF-b and matrix metalloproteinase (MMP) levels, and endothelial function in patients with MFS, and to compare TGF-b levels in patients with MFS receiving different therapeutic regimens.