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The concepts of arterial stiffness are not commonly considered in the “cardiological arena”. The available information in literature mainly come from epidemiological and prevention studies, not from clinical ones. The velocity of the arterial waves, both forward and the reflected one from periphery, are influenced by the arterial stiffness the higher the arterial stiffness, the higher the speed of travel. In youngs (with elastic arteries) the pulse wave reflection arrives in diastole and the coronary perfussion is augmented; in elderly (with stiff arteries) the speed of travel of pulse wave is higher and the reflection wave is premature in late systole, increasing central PP and SBP; SBP increases the load on the LV, leading to ventricular hypertrophy and increased myocardial oxygen demand. Therefore, determining the arterial stiffness has a clinical relevance. The arterial stiffness can be assesed at various sites: regional stiffness, local stiffness, systemic stiffness (the last one can only be estimated) There are a lot of methods and device for this, both invasive and non/invasive (the last based on pressure sensors, doppler probes and echotracking system, but there is a lack of standardization. Pulse wave velocity (PWV) represents intrinsecally arterial stiffness. It is the most simple, non-invasive and reproducible method to determine arterial stiffness. It has an independent predictive value for CV events in different populations (end-stage renal diseaee, hypertension, diabetes, elderly, and also in general population). Carotid-femoral PWV is considered as the “gold standard” measurement of arterial stiffness, being included in 2007 European Guidelines for Management of Arterial Hypertension as a parameter for subclinical organ damage. Echography is a nonivasive tool for assessing arterial stiffness. One way for determining aortic stiffness is by using tissue doppler imaging, the information being of clinical relevance in various pathology, like Marfan Syndrom. A modern technique used for doing this is echotracking. It uses two independent ultrasound beams, both steereable, one for the detection of changes in vessel diameter, the other for the blood velocity measurement. Another field of application of echo is study of ventricular-arterial interaction. Aortic stenosis is one pathology in witch determining the contribution of the arterial stiffness in total impedance that left ventricle is confronted can be of clinical relevance. New techniques, like carotid e-tracking, allow an easy and complete evaluation of arterial function in these patients. An abnormal arterial hemodynamic with significant impact on LV afterload could be unmasked by routinely doing the arterial assessment. However, despite the large amount of evidences of the clinical usefulness of assessment of arterial stiffness, these techniques are still underused in clinical practice.
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