Aortic stiffness is strikingly increased with age ≥50 years in clinically normal individuals and preclinical patients with cardiovascular risk factors: Assessment by the new technique of 2D strain echocardiography

Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, 1-1 Ohmukai-kita, Ohtera, Itano, Tokushima 779-0193, Japan.
Journal of Cardiology (Impact Factor: 2.78). 02/2011; 57(3):354-9. DOI: 10.1016/j.jjcc.2010.12.003
Source: PubMed


Various measures of aortic stiffness have been proposed as cardiovascular risk markers, but interest has now shifted to more direct and easier evaluation of aortic function. The present study was conducted to determine the feasibility of measuring aortic stiffness (β) with two-dimensional (2D) strain echocardiography and the impact of age and gender on preclinical atherosclerosis.
The peak circumferential strain of the abdominal aorta was measured using 2D strain echocardiography, and β was determined in 54 clinically normal individuals and 104 patients with cardiovascular risk factors and no evidence of cardiovascular disease. The β correlated significantly with age in all 158 patients. However, the relationship was nonlinear, and β was markedly greater in patients ≥ 50 years. In 54 clinically normal individuals, the relationship was comparatively linear. The systolic blood pressure and pulse pressure were significantly greater in patients ≥ 50 years. There were no significant differences in β and blood pressure parameters between genders.
The β increased dramatically with advanced age (≥ 50 years), regardless of gender, in clinically healthy and community-based patients with cardiovascular risk factors. The aortic circumferential strain was measured with 2D strain echocardiography which is a new tool that can be used to directly and easily evaluate aortic stiffness.

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    • "Arterial stiffness is an early marker of systemic atherosclerosis and a risk factor of hypertension [6] [7]. There are several methods to estimate arterial stiffness [8] [9]. Among them, pulse wave velocity (PWV) is generally accepted as the most simple, non-invasive and validated indicator of arterial stiffness [9]. "
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    ABSTRACT: Vitamin D regulates the renin-angiotensin system, suppresses proliferation of vascular smooth muscle and improves endothelial cell dependent vasodilatation. These mechanisms may play a role on pathogenesis of arterial and left ventricular stiffness. We aimed to investigate the association between serum 25-hydroxyvitamin D with arterial and left ventricular stiffness in healthy subjects. We studied 125 healthy subjects without known cardiovascular risk factors or overt heart disease (mean age: 60.2±11.9 years). Serum 25-hydroxyvitamin D was measured using a direct competitive chemiluminescent immunoassay. The subjects were divided into two groups according to the serum vitamin D level; vitamin D sufficient (≥20ng/ml, n=56) and vitamin D deficient (<20ng/ml, n=69). Indexes of LV stiffness such as E/A and E/E' were measured. Pulse wave velocity (PWV), which reflects arterial stiffness, was calculated using the single-point method via the Mobil-O-Graph(®) ARC solver algorithm. Systolic blood pressure, level of serum calcium, PWV and E/E' values were higher and E/A values were lower in vitamin D deficient group compared with vitamin D sufficient group. Multiple linear regression analysis showed that vitamin D level was independently associated with E/E' (β=-0.364, p<0.001), serum calcium (r=-0.136, p=0.014), PWV (β=-0.203, p=0.003), E/A (β=0.209, p=0.001) and systolic blood pressure (β=-0.293, p<0.001). 25-Hydroxyvitamin D levels are associated with increased ventricular and arterial stiffness as well as systolic blood pressure in healthy subjects.
    Journal of Cardiology 07/2013; 62(6). DOI:10.1016/j.jjcc.2013.06.004 · 2.78 Impact Factor
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    • "Central pulse pressure (PP) and arterial stiffness of the large, elastic conduit arteries are considered a risk marker of vascular aging, as well as a new biomarker of cardiovascular (CV) disease [1] [2] [3] [4] [5] [6] [7]. Recently, the most commonly used non-invasive markers to evaluate the arterial stiffness are aortic pulse wave velocity (PWV) and wave reflection using radial applanation tonometry. "
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    ABSTRACT: BACKGROUND: Augmentation index (AIx) and pulse pressure amplification (PPA, here the aortic/brachial pulse pressure ratio) are an age-related emerging risk factor for cardiovascular disease. However, it has not been clearly shown that AIx and PPA predict a high risk of coronary artery disease (CAD). OBJECTIVES: The aim of the study was to investigate the association between non-invasively measured aortic wave reflection (AWR) and PPA and CAD. METHODS: The study group consisted of 80 patients who were admitted to our institute for elective coronary angiography. We non-invasively measured augmentation pressure (AP), AIx, and PPA using radial applanation tonometry. RESULTS: When the extent of CAD was divided by no or minimal CAD, 1- or 2- and 3-vessel disease (VD), there was a significant association between the extent of CAD and AIx and PPA in patients aged <65 years, but not in patients aged ≥65 years. In multivariate regression analysis after controlling the traditional risk factors, the odds ratio of having 3VD was significant in patients aged <65 years: 2.15 (1.04-4.44; p=0.039) per 5% increase of AIx and 2.02 (1.15-3.55; p=0.015) per 0.05 increase of PPA, but not in patients aged ≥65 years. The severity of CAD expressed as a Gensini score showed a significant correlation with AP, AIx, and PPA in patients aged <65 years, but not in patients aged ≥65 years. CONCLUSION: Increasing of non-invasively measured AWR and PPA is related to the severity of CAD, particularly in younger patients up to 65 years of age.
    Journal of Cardiology 05/2013; 37(2). DOI:10.1016/j.jjcc.2013.03.014 · 2.78 Impact Factor
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    • "Wall stress may be the outcome of several factors, such as the wall components, the geometry of the aorta, the shape of the aneurysm, and the dynamic interaction of the wall with fluid flow [11]. In addition, various measures of aortic stiffness have been proposed as cardiovascular risk markers, but interest has now shifted to more direct and easier evaluation of aortic function [12]. "
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    ABSTRACT: Weak aortic media layers can lead to intimal tear (IT) in patients with overt aortic dissection (AD), and aortic plaque rupture is thought to progress to penetrating atherosclerotic ulcer (PAU) with intramural hematoma (IMH). However, the influences of shear stress and atherosclerosis on IT and PAU have not been fully examined. Ninety-eight patients with overt AD and 30 patients with IMH and PAU admitted to our hospital from 2002 to 2007 were enrolled. The greater curvatures of the aorta, including the anterior and right portions of the ascending aorta and anterior portion of the aortic arch, were defined as sites of high shear stress. The other portions of the aorta were defined as sites of low shear stress based on anatomic and hydrodynamic theories. Aortic calcified points (ACPs) were manually counted on computed tomography slices of the whole aorta every 10 mm from the top of the arch to the abdominal bifurcation point. IT was more often observed at sites of high shear stress in overt AD than in PAU (73.5 vs 20.0 %, P < 0.0001). Significantly more ACPs were present in PAU than in overt AD (18.6 ± 8 vs 13.3 ± 10, P = 0.007). The present study suggests that high shear stress and less severe atherosclerosis could induce the occurrence of an IT, thereafter progressing to overt AD, and that low shear stress and more severe atherosclerosis could proceed to PAU with IMH. These findings may help to identify the entrance-tear site.
    Heart and Vessels 03/2013; 29(1). DOI:10.1007/s00380-013-0328-z · 2.07 Impact Factor
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