Chonnam Med J.  2016 May;52(2):101-106. 10.4068/cmj.2016.52.2.101.

Evaluation of Arterial Stiffness by Echocardiography: Methodological Aspects

  • 1Department of Cardiovascular Medicine, Research Institute of Medical Science, Chonnam National University Medical School, Gwangju, Korea.


As humans age, degenerative changes in the arterial structure gradually progress and result in the stiffening of the arteries, which is called arteriosclerosis. Arterial stiffness is now an established risk factor of cardiovascular disease (CVD). This stiffening has adverse effects for both the general population as well as for patients with CVD. Measurements of pulse wave velocity and pulse wave analysis are the two most commonly used methods in the evaluation of arterial stiffness, but these methods just allow indirect measures of arterial stiffness. Echocardiography is the most widely used imaging modality in the evaluation of cardiac structure and function and with recent technical advances, it has become possible to evaluate the structure, function and blood flow hemodynamics of the arteries using echocardiography. In the present review, we will discuss the current status of echocardiography in the evaluation of arterial stiffness, especially focusing on the methodological aspects.


Cardiovascular disease; Vascular stiffness; Echocardiographyx

MeSH Terms

Cardiovascular Diseases
Pulse Wave Analysis
Risk Factors
Vascular Stiffness*


  • FIG. 1 Aging related changes of the arterial tree. I: intima, M: media, P: atheromatous plaque.

  • FIG. 2 Measurement of systolic (dashed line) and diastolic (solid line) arterial diameter in the ascending aorta (A), descending throracic aorta (B), and common carotid artery (C).

  • FIG. 3 Measurement of arterial area during diastole (A) and systole (B).

  • FIG. 4 Measurements of pulse wave velocity (PWV) by Doppler echocardiographic recoding of 2 aortic sites. T1: time interval between the peak R wave on electrocardiography and the onset of PW Doppler signal of the descending thoracic aorta, T2: time interval between the peak R wave on electrocardiography and the onset of PW Doppler signal of the abdominal aortic bifurcation. D: distance between the beginning site of the descending thoracic aorta and the just above site of the abdominal aortic bifurcation. PWV can be calculated as (T2-T1)/(D).

  • FIG. 5 Measurements of circumferential strain of the descending thoracic aorta. Circumferential strain is significantly decreased in old hypertensive subject (B) than in young healthy subject (A).

  • FIG. 6 Measurements of global circumferential strain of the common carotid artery. Global circumferential strain is significantly decreased in old hypertensive subject (B) than in young healthy subject (A).


1. Faconti L, Bruno RM, Ghiadoni L, Taddei S, Virdis A. Ventricular and vascular stiffening in aging and hypertension. Curr Hypertens Rev. 2015; 11:100–109.
2. Kovacic JC, Moreno P, Hachinski V, Nabel EG, Fuster V. Cellular senescence, vascular disease, and aging: Part 1 of a 2-part review. Circulation. 2011; 123:1650–1660.
3. O'Rourke MF, Hashimoto J. Mechanical factors in arterial aging: a clinical perspective. J Am Coll Cardiol. 2007; 50:1–13.
4. Cavalcante JL, Lima JA, Redheuil A, Al-Mallah MH. Aortic stiffness: current understanding and future directions. J Am Coll Cardiol. 2011; 57:1511–1522.
5. Vlachopoulos C, Alexopoulos N, Stefanadis C. Aortic stiffness: prime time for integration into clinical practice? Hellenic J Cardiol. 2010; 51:385–390.
6. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006; 27:2588–2605.
7. London GM, Marchais SJ, Guerin AP, Pannier B. Arterial stiffness: pathophysiology and clinical impact. Clin Exp Hypertens. 2004; 26:689–699.
8. Weber T, Auer J, O'Rourke MF, Kvas E, Lassnig E, Berent R, et al. Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation. 2004; 109:184–189.
9. O'Rourke MF, Staessen JA, Vlachopoulos C, Duprez D, Plante GE. Clinical applications of arterial stiffness; definitions and reference values. Am J Hypertens. 2002; 15:426–444.
10. Izzo JL Jr, Shykoff BE. Arterial stiffness: clinical relevance, measurement, and treatment. Rev Cardiovasc Med. 2001; 2:29–34. 37–40.
11. Safar ME. Arterial aging--hemodynamic changes and therapeutic options. Nat Rev Cardiol. 2010; 7:442–449.
12. van Popele NM, Grobbee DE, Bots ML, Asmar R, Topouchian J, Reneman RS, et al. Association between arterial stiffness and atherosclerosis: the Rotterdam Study. Stroke. 2001; 32:454–460.
13. Lusis AJ. Atherosclerosis. Nature. 2000; 407:233–241.
14. Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014; 63:636–646.
15. Pereira T, Maldonado J, Polónia J, Silva JA, Morais J, Rodrigues T, et al. Participants in the Ediva Project. Aortic pulse wave velocity and HeartSCORE: improving cardiovascular risk stratification. a sub-analysis of the EDIVA (Estudo de DIstensibilidade VAscular) project. Blood Press. 2014; 23:109–115.
16. Imanishi R, Seto S, Toda G, Yoshida M, Ohtsuru A, Koide Y, et al. High brachial-ankle pulse wave velocity is an independent predictor of the presence of coronary artery disease in men. Hypertens Res. 2004; 27:71–78.
17. Rhee MY, Lee HY, Park JB. Measurements of Arterial Stiffness: Methodological Aspects. Korean Circ J. 2008; 38:343–350.
18. Nemes A, Geleijnse ML, Forster T, Soliman OI, Ten Cate FJ, Csanády M. Echocardiographic evaluation and clinical implications of aortic stiffness and coronary flow reserve and their relation. Clin Cardiol. 2008; 31:304–309.
19. Stefanadis C, Stratos C, Boudoulas H, Kourouklis C, Toutouzas P. Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with coronary artery disease. Eur Heart J. 1990; 11:990–996.
20. Yoon HJ, Kim KH, Lee SH, Yim YR, Lee KJ, Park KH, et al. Differences of aortic stiffness and aortic intima-media thickness according to the type of initial presentation in patients with ischemic stroke. J Cardiovasc Ultrasound. 2013; 21:12–17.
21. Dernellis J, Panaretou M. Aortic stiffness is an independent predictor of progression to hypertension in nonhypertensive subjects. Hypertension. 2005; 45:426–431.
22. Kim KH, Park JC, Yoon HJ, Yoon NS, Hong YJ, Park HW, et al. Usefulness of aortic strain analysis by velocity vector imaging as a new echocardiographic measure of arterial stiffness. J Am Soc Echocardiogr. 2009; 22:1382–1388.
23. Nemes A, Geleijnse ML, Soliman OI, Anwar AM, Vletter WB, ten Cate FJ. Real-time three-dimensional echocardiography for regional evaluation of aortic stiffness. Eur J Echocardiogr. 2007; 8:161–162.
24. Lee MY, Chu CS, Lee KT, Wu CM, Su HM, Lin SJ, et al. Validation of a new index for estimating arterial stiffness: measurement of the QPV interval by Doppler ultrasound. Clin Cardiol. 2006; 29:345–351.
25. Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr. 2015; 28:183–193.
26. 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. Echocardiography. 2008; 25:941–945.
27. Kawasaki T, Fukuda S, Shimada K, Maeda K, Yoshida K, Sunada H, et al. Direct measurement of wall stiffness for carotid arteries by ultrasound strain imaging. J Am Soc Echocardiogr. 2009; 22:1389–1395.
28. Park HE, Cho GY, Kim HK, Kim YJ, Sohn DW. Validation of circumferential carotid artery strain as a screening tool for subclinical atherosclerosis. J Atheroscler Thromb. 2012; 19:349–356.
29. Yim YR, Kim KH, Cho JY, Yoon HJ, Hong YJ, Park HW, et al. Effects of valsartan on carotid arterial stiffness in patients with newly diagnosed hypertension: a comparative study with global arterial stiffness. J Korean Soc Hypertens. 2014; 20:21–30.
Full Text Links
  • CMJ
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: