Arterial Stiffness in the Young: Assessment, Determinants, and Implications

Abstract

Arterial stiffness describes the rigidity of the arterial wall. Its significance owes to its relationship with the pulsatile afterload presented to the left ventricle and its implications on ventricular-arterial coupling. In adults, the contention that arterial stiffness as a marker and risk factor for cardiovascular morbidity and mortality is gaining support. Noninvasive methods have increasingly been adopted in both the research and clinical arena to determine local, segmental, and systemic arterial stiffness in the young. With adoption of these noninvasive techniques for use in children and adolescents, the phenomenon and significance of arterial stiffening in the young is beginning to be unveiled. The list of childhood factors and conditions found to be associated with arterial stiffening has expanded rapidly over the last decade; these include traditional cardiovascular risk factors, prenatal growth restriction, vasculitides, vasculopathies associated with various syndromes, congenital heart disease, and several systemic diseases. The findings of arterial stiffening have functional implications on energetic efficiency, structure, and function of the left ventricle. Early identification of arterial dysfunction in childhood may provide a window for early intervention, although longitudinal studies are required to determine whether improvement of arterial function in normal and at-risk paediatric populations will be translated into clinical benefits.

Effects of early-life environment and epigenetics on cardiovascular disease risk in children: highlighting the role of twin studies

“…By the preschool years, low-birth-weight infants have early signs of impaired vascular health, including thicker carotid intima-media thickness (3) and increased arterial stiffness (20). These infants also have higher levels of CVD risk factors such as adiposity, insulin resistance, and dyslipidemia as compared with those with normal birth weight (21).…”

Elastic Properties of the Ascending Aorta in Healthy Children and Adolescents

“…36 Increasing evidence suggests a role of the endothelium in the regulation of arterial stiffness through the release of vasoactive mediators that affect smooth muscle tone. 10 Age-related reductions in arterial compliance are well known independently of confounding factors such as atherosclerosis and hypertension, leading to an increase in SBP in the aorta, a major risk factor for the development of heart failure and neurological complications.…”

“…16 In several congenital heart defects abnormalities of the tunica media with elastic fiber fragmentation have been histological identified. 10 Cono-truncal malformations such as tetralogy of Fallot, common arterial trunk, complete transposition of the great arteries, double outlet ventricles, univentricular hearts and aortic coarctation should be noted. 10 In tetralogy of The intraobserver differences were small.…”

“…10 Cono-truncal malformations such as tetralogy of Fallot, common arterial trunk, complete transposition of the great arteries, double outlet ventricles, univentricular hearts and aortic coarctation should be noted. 10 In tetralogy of The intraobserver differences were small. There was no systematic difference between the 2 ratings of the same rater for distensibility and stiffness index.…”

“…1 Decreased aortic compliance and increased wall stiffness alter myocardial blood flow by a decrease in diastolic perfusion pressure, 2,3 and cardiac performance may be reduced by an increase in ventricular workload. 4, 5 A number of pathological conditions in childhood can potentially induce changes in arterial properties, having profound effects on prognosis, as could be demonstrated in patients with arterial hypertension, 6-8 vasculitis and vasculopathies, 9 in patients with aortic coarctation, 10 with congenital heart disease, 11 in diabetes mellitus type I, 12 in patients after anthracycline chemotherapy 13 and in obese children. 14 Aortic wall elasticity may also be of importance in the follow-up of patients with fibrillinopathies such as Marfan and Williams syndromes 15, 16 and in individuals with bicuspid aortic valve, 17,18 prone to develop aortic aneurysm.…”