Arterial stiffness has been known as a sign of cardiovascular risk since the 19th century. Despite this, accurate measurement and clinical utility have only emerged in recent times. Arterial stiffness and its hemodynamic consequences are now established as predictors of adverse cardiovascular outcome. They are easily and reliably measured using a range of noninvasive techniques, which can be used readily by risk assessment facilities or individual practitioners. The techniques described in this review are based on the pulsatility of the cardiovascular system, utilizing the timing of pulse travel along major arteries and the magnitude of wave reflection. These have enabled better understanding of the ill effects of arterial stiffening, not only on large arteries and the left ventricle, but also on tiny arteries in highly perfused organs such as brain and kidneys. Treatment options, which directly target the consequences of arterial stiffening, as opposed to arbitrary reduction of brachial blood pressure, have proved clinical superiority; optimal therapy entails use of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium-channel blockers, as well as vasodilating β-blockers. Arterial stiffness will undoubtedly contribute to cardiovascular assessment and management in future clinical practice. Reviews such as this will hopefully increase awareness of the mounting evidence underlying this transition, and the relevant theory and methodology. As we begin the second decade of the 21st century, we are finally collectively coming to realize what pioneers such as Osler, Roy, Bramwell and Hill foresaw in the 19th and 20th centuries.

Recent studies have reported cardiac abnormalities in patients with coronavirus disease 2019 . 1 Echocardiography remains an essential diagnostic tool in this climate, particularly with emerging data that myocardial injury appears to be associated with adverse prognosis 2 and that echocardiography may add important prognostic information. 3,4 We present our institutional experience with echocardiography in the current pandemic with the goal of assessing the prevalence and reversibility of left ventricular (LV) dysfunction.Requests for echocardiograms in patients with COVID-19 were screened for appropriateness by echocardiography laboratory physicians; all performed studies (n = 125 patients over 49 days, all hospitalized) were included in this report. Studies were performed on standard (EPIQ; Philips Healthcare, Andover, MA), laptop-sized (Vivid I; GE Healthcare, Milwaukee, WI), or tablet (Lumify; Philips Healthcare) machines. Echocardiographic measurements were made according to society guidelines. 5 Echocardiographic data were extracted from the clinical report and clinical information from the medical record.Average patient age was 64 6 15 years, and 50 (40%) were women. The most common comorbidities included hypertension (60%), diabetes mellitus (41%), and obesity (50%; mean body mass index, 31 6 7 kg/m 2 ). The majority (n = 85 [69%]) of patients were in the intensive care unit at time of echocardiography, with 75 (88%) requiring mechanical ventilation and 60 (71%) vasopressor support.

Abstract-Aortic systolic and pulse pressure rise with age because of aortic stiffening. Two factors are responsible: a larger incident wave because of increased aortic characteristic impedance and premature return of wave reflection from peripheral sites. This study aimed to determine the relative contribution of each factor before and after age 60 years. Aortic pressure waveforms were generated for 3682 healthy subjects using a generalized transfer function applied to radial pressure waveforms recorded by applanation tonometry. Linear regression and product of coefficient mediation analysis were performed in the cross-sectional cohort to determine the yearly contribution of the incident and reflected waves (waves measured as first systolic peak and augmented pressure, respectively) to aortic systolic and pulse pressure elevation with age. This was done separately for subjects Յ60 and Ͼ60 years of age, with both sexes initially pooled and subsequently separated. Analyses were repeated with correction for height, weight, heart rate, and mean arterial pressure. Before age 60 years, the reflected wave was a greater (PϽ0.05) contributor to age-related aortic systolic and pulse pressure elevations, with no significant contribution of the incident wave in this age group in sex-pooled analysis. After age 60 years, both incident and reflected waves were significant (PϽ0.05) and comparable contributors (P difference Ͼ0.05) to age-related aortic systolic and pulse pressure elevations. This general pattern was observed in both sexes and persisted after correction for confounders. Wave reflection is important across the life span, whereas aortic characteristic impedance contributes significantly only beyond age 60 years. Key Words: aging Ⅲ blood pressure Ⅲ arterial stiffening Ⅲ hypertension Ⅲ aorta A ge-related increases in systolic and pulse pressures 1,2 contribute to progressively rising cardiovascular risk and cardiovascular morbidity and mortality. 3,4 As part of the normal aging process, the aorta undergoes structural changes, progressively stiffening because of cyclic strain, causing fracture of elastin lamellae in the tunica media and fibrous remodeling of the aortic wall. 5 Aortic stiffening is deemed responsible for age-related increases in systolic and pulse pressures 5,6 and exerts direct and indirect effects. 7 Directly, aortic stiffness increases aortic characteristic impedance and, therefore, increases the magnitude of the peripherally traveling (incident) pressure wave generated by ventricular ejection. Indirectly, increased aortic stiffness alters the timing and magnitude of wave reflection from the periphery, such that the aorta is subjected to progressively early return of a larger reflected pressure wave with advancing age. The phenomenon of wave reflection forms the traditional view regarding age-related blood pressure elevation. 8,9 Mitchell et al, 10,11 however, have suggested that wave reflection is irrelevant in women over age 60 years and minor in men over age 60 years and propose that the incident...