P1820New parameters for the evaluation of mechanic and elastic properties of the aortic root in Marfan Syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Torres Sanabria ◽  
E Garcia Izquierdo Jaen ◽  
V Monivas Palomero ◽  
A Forteza Gil ◽  
S Navarro Rico ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Aortic Root ◽  
Speckle Tracking ◽  
Aortic Stiffness ◽  
Aortic Wall ◽  
Aortic Distensibility ◽  
Root Diameter ◽  
Stiffness Index ◽  
Wall Displacement ◽  
Aortic Strain

Abstract Background Elastic properties of the thoracic aorta in patients with Marfan Syndrome (MS) have already been evaluated with classic echocardiographic parameters. In the latest years the use of Speckle-Tracking (STE) ecocardiography has been widely extended. Our aim is to describe and provide new parameters of aortic deformation measured by STE in patients with MS. Methods 95 unoperated adult patients with MS and 32 healthy controls were prospectively enrolled. We measured classic parameters of the aortic root using 2D echocardiography. We calculated the posterior aortic wall systolic excursion at the sinuses of Valsalva and ascending aorta using M Mode in TDI colour; with ST 2D ecocardiography we measured the aortic strain at the sinuses of Valsalva (SV) and the anterior and posterior aortic wall displacement at the SV. Aortic distensibility was calculated using the formula: 1000 * (Ds − Dd)/Dd * 1/(Ps − Pd) in mmHg–1 (Ds: systolic and Dd: diastolic diameters, Ps systolic and Pd diastolic blood pressure). Aortic stiffness index was calculated as Ln((Ps/Pd)/(Ds-Dd)/Dd)). Results As shown in the table bellow, patients with MS had lower aortic strain, aortic anterior and posterior wall displacement and impaired aortic distensibility and stiffness index compared to healthy controls. We found a strong negative linear correlation between aortic root diameter at the SV and aortic root strain (r=−0.56, figure 1). Results of statistical analysis MS (n=95) Controls (n=32) p Age (years) 32.84±12.35 32.41±7.98 0.85 Aortic root diameter at the sinuses of Valsalva (mm) 38.82±5.35 30.92±3.65 <0.001 Aortic root strain (%) 4.66±2.45 9.19±2.49 <0.001 Anterior aortic wall displacement STE (mm) 10.39±3.64 13.10±2.26 <0.001 Posterior aortic wall displacement STE (mm) 9.02±2.87 11.04±1.82 <0.001 Aortic distensibility 0.98±0.46 1.37±0.72 0.01 Aortic stiffness index 3.74±0.43 3.47±0.51 0.01 MS = Marfan Syndrome; STE = Speckle Tracking Ecocardiography. Figure 1. Dispersion plot Conclusions Our results suggest that aortic deformation and displacement obtained by STE echocardiography is impaired in MS, showing a reduced distensibility and an increased stiffness of the aortic wall, with a strong negative correlation between aortic root dilation and aortic strain. All these parameters may be useful as additional tools for the diagnosis and follow-up of Marfan patients, and could be useful to to improve the echocardiographic evaluation of the aortic root.

The Relationship Between Serum Endocan Level and Aortic Elastic Properties in Patients With Newly Diagnosed Essential Hypertension

Angiology ◽  
2019 ◽  
Vol 70 (7) ◽  
pp. 662-668 ◽  
Author(s):  
Mustafa Çelik ◽  
Erdoğan Sökmen ◽  
Serkan Sivri ◽  
Cahit Uçar ◽  
Rukiye Nar ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Elastic Properties ◽  
Aortic Stiffness ◽  
Surrogate Marker ◽  
Aortic Distensibility ◽  
Stiffness Index ◽  
Newly Diagnosed ◽  
The Relationship ◽  
Aortic Elastic Properties ◽  
Aortic Strain

Endothelial dysfunction plays role in the generation of both essential hypertension (EH) and aortic stiffness. We evaluated the relationship between serum endocan level and aortic elastic properties (AEPs) assessed with the aortic strain, aortic distensibility, and aortic stiffness index by echocardiography. Newly diagnosed EH patients (n = 67) and controls (n = 70) were included in the study. The EH group was subdivided into stage 1 and 2 EH groups. A higher endocan level was found in the EH group, compared to the controls (34.2 ± 13.0 vs 24.1 ± 7.3 ng/mL, respectively, P < .001). All the AEP parameters were worse in the EH group, compared to the controls. Further, endocan levels correlated with aortic distensibility ( r = −0.305, P < .001) and aortic strain ( r = −0.181, P = .038), but not with aortic stiffness index ( r = 0.162, P = .064) in the whole study population. Aortic elastic properties deteriorate and serum endocan level increases in patients with EH. Moreover, serum endocan level shows a correlation with deteriorated AEPs, and hence may a surrogate marker of escalating aortic stiffness in patients with newly diagnosed EH.

Aortic elastic properties are impaired in patients with Graves’ ophtalmopathy

VASA ◽  
2011 ◽  
Vol 40 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Akcay ◽  
Akcay ◽  
Yeter ◽  
Durmaz ◽  
Keles ◽  
...  
Keyword(s):  
Thyroid Hormones ◽  
Elastic Properties ◽  
Aortic Stiffness ◽  
Aortic Distensibility ◽  
Stiffness Index ◽  
Control Group ◽  
Cross Sectional ◽  
Cardiovascular Morbidity And Mortality ◽  
Aortic Elastic Properties ◽  
Aortic Strain

Backround: Aortic elastic properties have been shown to be an important predictor of cardiovascular morbidity and mortality. Hyperthyroidism was shown to be an important cause of impaired aortic elastic properties both due to the direct effect of the thyroid hormones on the aorta and also due to modulating effects of thyroid hormones on the vascular renin angiotensin system. However, there is no study investigating the aortic elastic properties in Graves’s patients who were euthyroid. The goal of the present study was to investigate the aortic elastic properties of patients with Graves’ Ophtalmopathy (GO) who had been euthyroid for at least 3 months. Patients and methods: A cross-sectional study was performed on 47 GO patients and 27 controls. Aortic-diastolic and aortic-systolic diameters, aortic strain, aortic distensibility, and aortic stiffness indices were calculated from the diameter of the thoracic aorta as measured by transthoracic echocardiography. Results: The aortic stiffness index was markedly increased (31 ± 26 vs. 17 ± 8.9; p = 0.015) and aortic strain was markedly reduced (20.3 ± 10 % vs. 25.9 ± 12 %; p = 0.046) in the GO group relative to the control group. Aortic distensibility was statistically significantly decreased in the GO group as compared to the control group (9.5 ± 5.7 10-3/kPa vs. 13.5 ± 7.1 10-3/kPa; p = 0.022). Weak correlations were detected between GO severity and aortic distensibility (r = -0.333, p = 0.011) as well as the aortic stiffness index (r = 0.266, p = 0.044). Conclusions: Aortic elastic properties were impaired in patients with GO. Therefore, patients with GO, especially those with severe manifestations of the condition, should be followed closely with regard to the occurrence of future cardiovascular events.

EVALUATION OF ELASTIC PROPERTIES OF THE ASCENDING AORTA IN MALE TOBACCO ADDICTS BY ECHOCARDIOGRAPHY

2014 ◽  
pp. 71-76
Author(s):  
Minh Hoa Tran ◽  
Thi Thuy Hang Nguyen
Keyword(s):  
Elastic Properties ◽  
Aortic Stiffness ◽  
Cell Injury ◽  
Aortic Distensibility ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Stiffness Index ◽  
Control Group ◽  
Chronic Smoking ◽  
Aortic Strain

Background: Cigarette smoking causes endothelial cell injury, loss of smoothness, elasticity, it would be easy to form plaques in the endothelium. Etude of elasticity of ascending aorta by echocardiography in male smokers contribute to the assessment of vascular changes through indices such as aortic strain, aortic stiffness, aortic distensibility. Aim: was to estimate the effects of chronic smoking on the elastic properties of the ascending aorta. Material and Methods: this study was carried on 180 male subject, 90 smokers, mean age 37.56 ± 7.31 and 90 healthy male non-smokers with similar age. They are all under echocardiography to measure systolic aortic diameter and diastolic aortic diameter, determine the indexes such as: aortic strain, aortic stiffness, aortic distensibility and blood pressure simultaneously. Results: strain index and aortic distensibility is significantly lower in smokers than the control group, whereas stiffness index in smokers is higher than the control group with p <0.001. Conclusions: In tobacco addicts, smoking change the elasticity of the aorta, so it is a predictor of cardiovascular risk factors. Keywords: Tobacco addicts, aortic elastic properties, echocardiography

SURVEY OF RELATIONSHIP BETWEEN SMOKING STATUS AND ELASTIC INDEXES OF THE ASCENDING AORTA BY ECHOCARDIOGRAPHY IN MALE TOBACCO ADDICTS

2014 ◽  
pp. 84-89
Author(s):  
Thi Thuy Hang Nguyen
Keyword(s):  
Elastic Properties ◽  
Aortic Stiffness ◽  
Smoking Status ◽  
Aortic Distensibility ◽  
Ascending Aorta ◽  
Stiffness Index ◽  
Control Group ◽  
Strain Index ◽  
Chronic Smoking ◽  
Aortic Strain

Background: Many studies has reported that chronic smoking affects arterial stiffness. Smoking causes changes in both peripheral and central blood vessel function, even in young or middle-aged smokers. Echocardiography is a noninvasive and simple test, simply, to help evaluate the elastic properties of ascending aorta through the indices such as aortic strain, aortic stiffness, aortic distensibility. Aim: To determine the association between smoking status and elastic indexes of the ascending aortia measured by echocardiography. Material and Methods: this study was carried on 180 male subject, 90 smokers, mean age 37.56 ± 7.31 years and 90 healthy male non-smokers with similar age. Echocardiography was done with the following indexes: systolic and diastolic aortic diameter, aortic strain, aortic stiffness, aortic distensibility and blood pressure. Relationship between these indexes and duration of smoking was determined. Results: In group of smoking <17 pack one year, the indices of aortic elasticity is not different from the control group, p> 0,05. In group of smoking ≥ 17 pack year, strain index and aortic distensibility are significantly lower than the control group, whereas stiffness index is higher than the control group with p <0.001. Strain index and aortic distensibility of the ascending aorta were negatively correlated with duration of smoking, with p <0.0001. Stiffness index is positively correlated with duration of smoking, with p <0.0001. Conclusions: Smoking have decreased ascending aortic distensibility compared to non-smokers in a manner is related to duration of smoking. Keywords: Duration of smoking, aortic elastic properties, echocardiography

Abstract 10890: Aortic Stiffness Predicts Clinical Outcome and Rate of Aortic Root Growth in Marfan Syndrome

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Elif Seda Selamet Tierney ◽  
Jami C Levine ◽  
Lynn A Sleeper ◽  
Mary J Roman ◽  
Timothy J Bradley ◽  
...  
Keyword(s):  
Heart Rate ◽  
Elastic Modulus ◽  
Clinical Outcome ◽  
Marfan Syndrome ◽  
Aortic Root ◽  
Aortic Stiffness ◽  
Cox Regression ◽  
Rate Of Change ◽  
Stiffness Index ◽  
Significant Treatment

Background: The NHLBI Pediatric Heart Network randomized trial of atenolol vs. losartan in Marfan Syndrome demonstrated no significant treatment difference in the rate of change in body surface area adjusted maximum aortic root diameter z score (AoRz). Objectives: To report trial results on aortic stiffness and to determine whether aortic stiffness predicts clinical outcome and change in AoRz. Methods: 608 patients (6 mo - 25 yr) who met original Ghent criteria and had AoRz > 3 were enrolled. Echocardiograms obtained at 0, 6, 12, 24 & 36 months were centrally interpreted. Aortic dimensions were measured by 2D imaging, and stiffness indices were calculated for aortic root (AoR) and ascending aorta (AA). Where appropriate, stiffness measurements were indexed to 1/sqrt(R-R interval) to adjust for heart rate. Data were analyzed by multivariable mixed effects modeling and Cox regression. Results: The rate of change over three years in heart rate-adjusted AoR stiffness index differed by treatment (p = 0.016), with a decrease in the atenolol group and no significant change in the losartan group (-0.29 ± 0.14 vs. 0.14 ± 0.14/year). There was no significant treatment effect on the rate of change for AA stiffness index or for elastic modulus (AoR and AA). In the entire cohort, baseline AoR but not the AA stiffness index predicted the rate of change in ARz, with above-average stiffness index (≥ 10) predicting a slower annual decline of AoRz (-0.08 ± 0.02 vs. -0.15 ± 0.01 for below-average stiffness, p < 0.001), even after adjusting for baseline age. Elastic modulus was not a significant predictor of rate of change in AoRz. AoR elastic modulus >122 kPA (75th %ile) independently predicted the composite outcome of AoR surgery, dissection or death (hazard ratio 2.17, 95% CI 1.02 - 4.63, p = 0.04), controlling for baseline age and AoRz. Crude 3-year event rates were 10.4% vs. 3.2% for higher vs. lower elastic modulus groups, respectively. Conclusions: Atenolol reduced AoR stiffness over 3 years, while losartan did not. In this medically-treated cohort, higher baseline AoR stiffness was associated with a smaller decrease in AoRz, and a greater hazard of AoR dissection/surgery/death. These data suggest that aortic stiffness measures may identify patients at higher risk and guide management.

scholarly journals Assessment of Aortic Elasticity and the Doppler Tissue Echocardiography in Thalassemia Major Children

2020 ◽  
Vol 10 (01) ◽  
pp. e63-e73
Author(s):  
Noor Mohammad Noori ◽  
Alireza Teimouri ◽  
Kambiz Keshavarz ◽  
Malihe Moradi
Keyword(s):  
Blood Pressure ◽  
Elastic Modulus ◽  
Systolic Blood Pressure ◽  
Pulse Pressure ◽  
Aortic Stiffness ◽  
Aortic Distensibility ◽  
Thalassemia Major ◽  
Left Ventricular ◽  
Stiffness Index ◽  
Aortic Strain

AbstractCardiovascular diseases are the most common illness that needs special medical care in thalassemia particularly in children and adolescents. We aimed to compare aortic stiffness in thalassemia major and healthy children. The study included 65 asymptomatic thalassemia major 6 to 19-year–old children without known history of heart disease and 65 age- and sex-matched healthy controls. Arterial stiffness indices determined using two-dimensional (2D) and Doppler echocardiography. Data were analyzed by SPSS 20.0 with 0.05 as significant error. From the study, results showed that systolic (p = 0.009) and diastolic (p < 0.001) blood pressures were higher in controls. Left ventricular mass index (LVMI) was higher in patients (p < 0.001). Aortic stiffness index (p < 0.001), pulse pressure (p < 0.001), and pressure strain elastic modulus (p < 0.001) were higher in patients, while aortic strain (p < 0.002) and aortic distensibility (p < 0.001) were lower significantly. Aortic stiffness index was correlated with diastole aorta (p = 0.005), systole aorta (p < 0.001), and LVMI (p < 0.001). Strain was correlated with diastole aorta (p < 0.001). Pulse pressure was correlated with systolic blood pressure (p < 0.001), diastolic blood pressure (p = 0.002) significantly. Aortic distensibility was correlated with systolic blood pressure (p = 0.039) and diastole aorta (p < 0.001) significantly. The pressure strain elastic modulus was correlated only with diastole aorta (p = 0.029). Concluded, aortic stiffness index, pulse pressure, and pressure strain elastic modulus were higher in thalassemia children, while aortic strain and aortic distensibility were lower. This increase may result in reduction of mechanical efficiency of the heart. Therefore, assessment of aortic elastic properties as nontraditional cardiovascular risk factors may contribute to the identification of cardiovascular risks in children with thalassemia

scholarly journals P1503 Aortic root distensibility and stiffness assessed by echocardiography as predictors of coronary artery lesion severity in patients undergoing coronary angiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H M El-Naggar ◽  
H S Anwar ◽  
H A Helmy ◽  
S R Demitry
Keyword(s):  
Elastic Modulus ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Confidence Interval ◽  
Aortic Stiffness ◽  
Aortic Distensibility ◽  
Stiffness Index ◽  
P Value ◽  
Syntax Score ◽  
Aortic Strain

Abstract Background Aortic stiffness (AS) and distensibility (AD) have been shown as predictors for cardiovascular morbidity and mortality. Aim: To assess the relation of aortic stiffness and distensibility using simple two-dimensional (2D) and tissue Doppler imaging (TDI) derived measures with the severity of coronary artery disease (CAD) assessed using the syntax score (SS), evaluating which of these measures has better predictivity for CAD severity. Methods We prospectively enrolled 150 individuals who underwent elective coronary angiography for suspected CAD, out of them 29 subjects (19.3%) had normal angiographic findings, while 121 (80.7%) subjects had CAD for whom the SS was calculated. All patients underwent simple 2D and TDI echocardiographic assessment of AS and AD. Results Patients with CAD had significantly higher aortic stiffness and elastic modulus and significantly lower aortic distensibility, aortic strain, aortic peak systolic and peak early diastolic velocities compared to those without CAD. Univariate and multivariate logistic regression analysis showed that decreased aortic distensibility, aortic strain, aortic peak early diastolic velocity and increased elastic modulus were predictors for the severity and complexity of CAD. However, along with diabetes, increased aortic stiffness index (&gt; 17.7) was the only independent predictor of CAD severity, carrying twice the odds of having moderate-high syntax score (OR= 2.19, 95% CI= 0.97 – 4.95, p&lt; 0.05). Conclusion Aortic stiffness index can be a screening tool for detecting patients with more severe CAD. Univariate analysis Multivariate analysis Variables Odd’s ratio 95% confidence interval P value Odd’s ratio 95% confidence interval P value Age (years) 0.98 0.94-1.01 0.3 – –- – Sex (male) 1.52 0.58- 3.94 0.3 – –- – Smoking 1.21 0.59- 2.50 0.5 – –- – Diabetes mellitus 5.00 2.29-10.90 0.000 4.99 2.21- 11.31 0.000 Body mass index 0.93 0.83- 1.04 0.2 – –- – ↓↓ Distensibility (≤3.8)* 2.62 1.08- 4.70 0.02 2.01 0.91- 4.46 0.08 ↑↑ Stiffness index (&gt;17.7)* 2.06 0.99- 4.27 0.05 2.19 0.97- 4.95 &lt;0.05 ↑↑ Elastic modulus (&gt;68.7)* 2.22 1.06- 4.64 0.03 2.01 0.91- 4.45 0.08 ↓↓ Aortic strain (≤9.3%)* 2.04 0.97- 4.27 0.05 1.64 0.73- 3.67 0.2 ↓↓ SAo (≤7cm/sec) 1.49 0.71- 3.12 0.2 – –- – ↓↓ EAo (≤9cm/sec) 2.30 1.08- 4.90 0.03 1.80 0.79- 4.10 0.1 Predictors of severity and complexity of CAD

scholarly journals Aortic root longitudinal strain by speckle-tracking echocardiography predicts progressive aortic root dilation in Marfan syndrome patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Guala ◽  
MI Pons ◽  
A Ruiz-Munoz ◽  
L Dux-Santoy ◽  
L Madrenas ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Aortic Root ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Aortic Surgery ◽  
Root Diameter ◽  
Aortic Diseases ◽  
Severe Aortic Regurgitation

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Ministry of Science, Innovation and Universities; Instituto de Salud Carlos III Introduction In Marfan syndrome (MFS) patients reduced longitudinal strain of the ascending aorta (AAo) as measured by applying feature-tracking on cine cardiac magnetic resonance (CMR) images predicts aortic root dilation and aortic events during the follow-up. Speckle-tracking is well established for cardiac deformation assessment but proximal aorta applications are challenging due to limited wall thickness and substantial cardiac motion. Moreover, echocardiography is widely used in the clinical assessment aortic diseases. Purpose We aimed to test a speckle-tracking tool for root longitudinal strain analysis in terms of comparison with CMR-derived AAo longitudinal strain and reproducibility and as predictor of dilation in MFS patients. Methods Thirty-five MFS patients diagnosed by original GHENT criteria, with maximum aortic root diameter of 45 mm and free from previous aortic dissection or cardiac/aortic surgery and non-severe aortic regurgitation were consecutive enrolled and followed-up. CMR and echocardiography were performed less than 2 months apart. Baseline and final aortic root diameter were measured on CMR images. To quantify aortic root cyclic elongation by echocardiography, two regions of interests were manually created covering both walls in a parasternal long-axis view and tracked along the cardiac cycle (Figure 1). Longitudinal strain was computed as the average of maximum increase in relative distance of several sub-regions covering both walls. CMR-derived AAo longitudinal strain was available in 29 patients. Intra-observer reproducibility was tested in 15 patients via intraclass correlation coefficient (ICC) for single-rater absolute agreement. Results Aortic root longitudinal strain by echocardiography was mildly related to CMR-derived AAo longitudinal strain (R = 0.27) and was larger compared to CMR-derived values (16.2 ± 6.0 vs 11.3 ± 4.3). Reproducibility was high, with ICC of 0.811, R = 0.802, p &lt; 0.001. After a mean follow up of 76 ± 13 months, aortic root diameter grew in 20 patients with a rate of 0.29± 0.24 mm/year. Overall mean growth-rate was 0.87 ± 0.33 mm/year. In multivariable analysis corrected for age and baseline aortic root diameter, baseline longitudinal strain by echocardiography was independently and inversely related to progressive dilation (p = 0.033). Conclusions The measurement of aortic root longitudinal strain by speckle-tracking echocardiography is feasible. Aortic root longitudinal strain is an independent predictor of progressive dilation in MFS patients. This may permit the improvement of risk-stratification in aortic diseases in large scale studies. Abstract Figure 1

scholarly journals Comparison of aortic pressures and aortic elastic properties between patients with end-stage renal disease and healthy controls

2019 ◽  
Vol 11 (2) ◽  
pp. 77-83 ◽  
Author(s):  
Macit Kalçık ◽  
Mucahit Yetim ◽  
Tolga Doğan ◽  
İbrahim Doğan ◽  
Barış Eser ◽  
...  
Keyword(s):  
Elastic Properties ◽  
End Stage Renal Disease ◽  
Aortic Stiffness ◽  
Aortic Distensibility ◽  
Ascending Aorta ◽  
Stiffness Index ◽  
Healthy Controls ◽  
Aortic Compliance ◽  
Stage Renal Disease ◽  
End Stage

Background Current evidence indicates that vascular calcification plays an essential role in the development of cardiovascular diseases in end-stage renal disease (ESRD) patients. Arterial stiffness is a marker of increased cardiovascular risk in various populations. The aim of this study is to evaluate the elastic properties of ascending aorta in patients with ESRD. Methods This single-center study enrolled 96 patients (45 females, age: 57.2 ± 12.8 years) with ESRD and 96 healthy controls (52 females, age: 55.3 ± 10.1 years). Aortic pressures and aortic elastic parameters including aortic strain, aortic distensibility, aortic stiffness index, and aortic compliance were calculated using accepted formulae. Results The hemodynamic parameters including aortic pulse pressure, aortic mean pressure, aortic fractional pulse pressure, and aortic pulsatility index were significantly higher in patients with ESRD. Systolic and diastolic aortic diameters were similar between the groups. However, pulsatile aortic diameter change, aortic strain, aortic distensibility, and aortic compliance were significantly lower, whereas aortic stiffness index was significantly higher in ESRD group. Conclusions The results demonstrated that a significant difference was present in terms of aortic blood pressures between patients with ESRD and controls. In addition, the elastic properties of ascending aorta were decreased in patients with ESRD.

Perindopril Reduces Large Artery Stiffness and Aortic Root Diameter in Patients with Marfan Syndrome

2007 ◽  
Vol 16 ◽  
pp. S85
Author(s):  
A. Ahimastos ◽  
A. Aggarwal ◽  
K. D’Orsa ◽  
M. Formosa ◽  
R. Savarirayan ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Aortic Root ◽  
Root Diameter ◽  
Large Artery ◽  
Artery Stiffness
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