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.

Keywords: Arteriosclerosis; Children.

Fig. 1

Derivation of local arterial stiffness by measurement of (A) diameter changes in the cardiac cycle using two-dimensional ultrasound, and (B) arterial pressure using applanation tonometry.

Fig. 2

Simultaneous registration of arterial pulse waveforms by pressure sensors placed at different parts of body for calculation of pulse transit time.

Fig. 3

Derivation of pulse transit time from the feet of the proximal and distal pulse waves.