Article

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
ABSTRACT
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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Available from: sciencedirect.com
Journal of Cardiology (2011) 57, 354—359
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/jjcc
Original article
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
KEYWORDS
Aortic stiffness;
Two-dimensional
strain
echocardiography;
Aging
Summary
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
preclinical atherosclerosis.
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: yoishi@higasitokusima.hosp.go.jp (Y. Oishi).
0914-5087/$ see front matter © 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.jjcc.2010.12.003
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    • "As the extent and the severity of the atherosclerosis increase, AD and AS decrease. As atherosclerosis progresses, tunica media increases in thickness and tunica media gets stiffer [17,18]. Therefore, it is very valuable to detect atherosclerotic disease before clinical disease comes out via a noninvasive method. "
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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) disease1234567. 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. The aortic pressure wave is composed of a forward traveling wave generated by left ventricular ejection and a later arriving reflected wave from the periphery891011. "
    [Show abstract] [Hide abstract] 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.
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