Echocardiographic Assessment of Large Artery Stiffness

Abstract

Arterial wall stiffness is a highly relevant phenotype for cardiovascular medicine. Large artery stiffening is a key element in the pathogenesis of isolated systolic hypertension, 1 Kaess B.M. Rong J. Larson M.G. Hamburg N.M. Vita J.A. Levy D. et al. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA. 2012; 308: 875-881 Crossref PubMed Scopus (681) Google Scholar a condition mainly affecting older adults, which is responsible for a high burden of cardiovascular disease worldwide. 2 Olsen M.H. Asma S. Boutouyrie P. Burger D. Chirinos J.A. Damasceno A. et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on Hypertension. Lancet. 2016; ([published online September 23, 2016])https://doi.org/10.1016/S0140-6736(16)31134-5 Abstract Full Text Full Text PDF Scopus (487) Google Scholar Arterial stiffening impairs the ability of conduit arteries to accommodate the stroke volume intermittently delivered by the left ventricle during systole, thus increasing the pulsatile hydraulic load impeding left ventricular ejection. 3 Chirinos J.A. Segers P. Noninvasive evaluation of left ventricular afterload: part 1: pressure and flow measurements and basic principles of wave conduction and reflection. Hypertension. 2010; 56: 555-562 Crossref PubMed Scopus (91) Google Scholar , 4 Chirinos J.A. Segers P. Noninvasive evaluation of left ventricular afterload: Part 2: Arterial pressure-flow and pressure-volume relations in humans. Hypertension. 2010; 56: 563-570 Crossref PubMed Scopus (123) Google Scholar There is increasing recognition of the adverse influence of increased pulsatile arterial load in conditions such as heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, hypertensive heart disease, and valvular heart disease (particularly aortic stenosis). In addition, given the effect of arterial stiffness on pulsatile hemodynamics, increased large artery stiffness can also promote excessive penetration of pressure and flow pulsatility into the kidney and the brain, leading to target organ damage. 5 O'Rourke M.F. Safar M.E. Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension. 2005; 46: 200-204 Crossref PubMed Scopus (965) Google Scholar Echocardiographic Assessment of Aortic Pulse-Wave Velocity: Validation against Invasive Pressure MeasurementsJournal of the American Society of EchocardiographyVol. 29Issue 11PreviewAortic pulse-wave velocity (PWV) is a measure of aortic stiffness that has a prognostic role in various diseases and in the general population. A number of methods are used to measure PWV, including Doppler ultrasound. Although echocardiography has been used for PWV measurement, to the authors' knowledge, it has never been tested against an invasive reference method at the same time point. Therefore, the aim of this study was to compare prospectively an echocardiographic PWV measurement, called echo-PWV, with an invasive study. Full-Text PDF