Journal of Cardiology (2011) 57, 354—359
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/jjcc
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
Yoshifumi Oishi (MD, FJCC)∗, Hirokazu Miyoshi (MD), Yukio Mizuguchi (MD),
Arata Iuchi (MD, FJCC), Norio Nagase (MD), Takashi Oki (MD, FJCC)
Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, 1-1 Ohmukai-kita, Ohtera, Itano,
Tokushima 779-0193, Japan
Received 30 September 2010; received in revised form 7 December 2010; accepted 15 December 2010
Available online 17 February 2011
Background: 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
(ˇ) with two-dimensional (2D) strain echocardiography and the impact of age and gender on
Methods and results: The peak circumferential strain of the abdominal aorta was measured
using 2D strain echocardiography, and ˇ was determined in 54 clinically normal individuals and
104 patients with cardiovascular risk factors and no evidence of cardiovascular disease. The ˇ
correlated significantly with age in all 158 patients. However, the relationship was nonlinear,
and ˇ 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 ˇ and blood
pressure parameters between genders.
Conclusions: The ˇ 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.
© 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
∗Corresponding author. Tel.: +81 88 672 1171; fax: +81 88 672 3809.
E-mail address: email@example.com (Y. Oishi).
0914-5087/$ — see front matter © 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Effects of aging on aortic stiffness 359
assessment of myocardial function. J Am Soc Echocardiogr
 Oishi Y, Mizuguchi Y, Miyoshi H, Iuchi A, Nagase N, Oki T. A
novel approach to assess aortic stiffness related to changes in
aging using a two-dimensional strain imaging. Echocardiogra-
 Lartaud-Idjouadiene I, Lompré AM, Kieffer P, Colas T, Atkinson
J. Cardiac consequences of prolonged exposure to an isolated
increase in aortic stiffness. Hypertension 1999;34:63—9.
 Chae CU, Pfeffer MA, Glynn RJ, Mitchell GF, Taylor JO, Hen-
nekens CH. Increased pulse pressure and risk of heart failure
in the elderly. JAMA 1999;281:634—9.
 Vaccarino V, Holford TR, Krumholz HM. Pulse pressure and risk
for myocardial infarction and heart failure in the elderly. J Am
Coll Cardiol 2000;36:130—8.
 Kawaguchi M, Hay I, Fetics B, Kass DA. Combined ventricular
systolic and arterial stiffening in patients with heart failure
and preserved ejection fraction: implications for systolic and
diastolic reserve limitations. Circulation 2003;107:714—20.
 Mizuguchi Y, Tanaka H, Oishi Y, Miyoshi H, Emi S, Ishimoto
T, Nagase N, Oki T. Predictive value of associations between
carotid arterial sclerosis and left ventricular diastolic dysfunc-
tion in patients with cardiovascular risk factors. J Am Soc
 Mizuguchi Y, Oishi Y, Tanaka H, Miyoshi H, Ishimoto T, Nagase
N, Oki T. Arterial stiffness is associated with left ventric-
ular diastolic function in patients with cardiovascular risk
factors: early detection with the use of cardio-ankle vascu-
lar index and ultrasonic strain imaging. J Card Fail 2007;13:
 Kubozono T, Miyata M, Ueyama K, Nagaki A, Otsuji Y, Kusano K,
Kubozono O, Tei C. Clinical significance and reproducibility of
new arterial distensibility index. Circ J 2007;71:89—94.
 O’Rourke MF, Hashimoto J. Mechanical factors in arterial aging.
A clinical perspective. J Am Coll Cardiol 2007;50:1—13.
 McEniery CM, Yasmin, Hall IR, Qasem A, Wilkinson IB, Cockcroft
JR, ACCT Investigators. Normal vascular aging: differential
effects on wave reflection and aortic pulse wave velocity, The
Anglo-Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol
 Mitchell GF, Guo CY, Benjamin EJ, Larson MG, Keyes MJ, Vita
JA, Vasan RS, Levy D. Cross-sectional correlates of increased
aortic stiffness in the community. The Framingham heart study.
 Safar ME, Levy BI, Struijker-Boudier H. Current perspectives
on arterial stiffness and pulse pressure in hypertension and
cardiovascular diseases. Circulation 2003;107:2864—9.
 Franklin SS, Gustin W, Wong ND, Larson MG, Weber MA, Kan-
nel WB, Levy D. Hemodynamic patterns of age-related changes
in blood pressure. The Framingham heart study. Circulation
 Mizuguchi Y, Oishi Y, Miyoshi H, Iuchi A, Nagase N, Oki T.
arterial stiffness in patients with hypercholesterolemia. Circ J
 Mizuguchi Y, Oishi Y, Miyoshi H, Iuchi A, Nagase N, Oki T. Telmis-
artan improves morphologic and functional changes in both left
ventricular myocardium and carotid arterial wall in patients
with hypertension: assessment by tissue Doppler imaging and
carotid ultrasonography. Echocardiography 2010;27:864—72.
 Smulyan H, Asmar RG, Rudnicki A, London GM, Safar ME. Com-
parative effects of aging in men and women on the properties
of the arterial tree. J Am Coll Cardiol 2001;37:1374—80.
 Waddell TK, Dart AM, Gatzka CD, Cameron JD, Kingwell BA.
Women exhibit a greater age-related increase in proximal aor-
tic stiffness than men. J Hypertens 2001;19:2205—12.