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Rationale and Aim: This study is aimed at identifying possible patterns of vascular wall disarray and remodeling in radial arteries of patients with fibromuscular dysplasia (FMD), by means of ultrahigh frequency ultrasound (UHFUS). Methods: UHFUS scans of the radial arteries and of 30 FMD patients and 30 healthy controls were obtained by VevoMD (70 MHz probe, FUJIFILM, VisualSonics, Toronto, Canada). 10 end-diastolic frames for each subject were analyzed. 74 radiomic features and 4 engineered parameters were extracted: intima-media thickness (IMT) and adventitia thickness (AT), an adjunctive acoustic interface for each layer (IMT and AT triple signal). The extracted parameters were used to train classification models, using Support Vector Machine Linear (SVM), K-Nearest Neighbors (KNN), Logistic Regression, Linear Discriminant Analysis (LDA). The models were then tested on an independent validation population (38 FMD patients and 28 healthy subjects). Results: IMT (185 ± 46 vs 168 ± 37, p =) and AT (104 ± 34 vs 96 ± 35, p = 0.004) were significantly higher in FMD than in controls. IMT and AT triple signal were also more frequent in FMD than in control images (p < for both). The most accurate classification models were LDA (sensitivity = 0.67, specificity = 0.76, accuracy = 0.71, AUC = 0.71) and Logistic Regression (sensitivity = 0.71, specificity = 0.72, accuracy = 0.71, AUC = 0.71). The models showed and accuracy of about 70% when tested on the validation population. Conclusions: Wall ultrastructure of radial arteries of FMD patients is extensively altered: IMT and AT are thickened and the first and/or second layer of the arterial wall is splitted, showing a triple signal feature. Radiomic descriptors combined with engineered parameters allow to distinguish between radial images from FMD patients and controls with a 70% accuracy. more...

Background/Objectives: The baroreflex is a crucial mechanism acutely modulating vascular tone and heart rate response to maintain blood pressure (BP) in an optimal range. A decrease in baroreflex sensitivity (BRS) is associated with ageing, and pathological conditions such as hypertension and diabetes. Antihypertensive agents are generally known to have beneficial effect on the BRS, however it is still uncertain if the effect is mediated through a more compliant arterial wall or a sympathoinhibitory action. Methods: In the Paris Prospective Study III [1], spontaneous baroreflex, carotid stiffness and pharmacological drugs intake were available in 7967 adults (aged 55–75 years). The neural component of the baroreflex sensitivity (nBRS) was obtained with a cross-spectral analysis of variations in carotid distention rate and R-R intervals. Pharmacological classes were analysed according to the Anatomical Therapeutic Chemical (ATC) classification. Individuals with a BP lowering medication (BP-treated) were paired to non-BP treated individuals with a similar cardiovascular risk (controls) using a propensity score matching procedure (n = 1182 pairs). Results: Amongst pharmacological classes of BP lowering agents, only agents acting on the renin-angiotensin system (ACEi-ARB) were associated with nBRS (β = –0.08, p = 0.045). Compared to their matched controls, ACEi-ARB users had lower nBRS (2.79 ± 0.66 vs. 2.90 ± 0.62, p = 0.03). In multivariate analysis, ACEi-ARB remained significant (stdβ = –0.09, p = 0.025) after adjustment for carotid stiffness (stdβ = 0.25, p < 0.001) and systolic pressure (stdβ = –0.20, p < 0.001). Conclusion: In this epidemiological study, ACEi-ARB were negatively associated with nBRS. This effect is independent of BP and stiffness, which may suggest an inhibition of sympathetic activity by ACEi-ARB. more...

Purpose: There is a need for new tools to screen large populations for cardiovascular disease risk. The CARDIS consortium (European Union H2020 funding) developed an easy-to-use, non-contact device for measuring carotid to femoral pulse wave velocity (cfPWV). It consists in a laser doppler vibrometer (LDV), which measures skin vibrations induced by large artery pulses. Pulse waveforms can be tracked and transit time (TT) can be calculated. This study aimed at comparing LDV-cfPWV with the reference cfPWV measured by applanation tonometry (Sphygmocor). Methods: We included 100 patients with mild to stage 3 hypertension, controlled or not. Reflective tapes were applied on the carotid and femoral arteries to measure LDV-cfPWV 4 times. TT was measured by the foot-to-foot method from the maximum of 2nd derivative using in-house algorithms not requiring ECG, and compared to Sphygmocor (3 acquisitions). Results: LDV-cfPWV was obtained in 100% of patients. Mean age was 47 ± 19 (range 19–85). Hypertensives were well controlled (119/65 mmHg). Mean value of LDV-cfPWV was 6.9 ± 1.7 m/s, compared to 7.5 ± 1.7 m/s with Sphygmocor, bias 0.65 ± 1.27, R value 0.72 (Figure 1), which qualifies agreement as acceptable according to the guidelines from the ARTERY Society [1]. Reproducibility was good with a median coefficient of variation of 5.6%. LDV-cfPWV showed similar associations with age and blood pressure than tonometry (r = 0.68, p < 0.001 and r = 0.44, p < 0.001, respectively). Figure 1 Conclusion: Non-contact measurement of pulse wave velocity by laser doppler vibrometry is feasible, fast and easy to perform, and provides acceptable agreement with reference technique. more...

Background: In patients with Vascular Ehlers-Danlos syndrome (vEDS), an abnormally low carotid intima-media thickness (CIMT) may increase the risk of arterial dissection and rupture. Thus its accurate assessment by ultra–high frequency ultrasound (UHFUS), thanks to its higher spatial resolution, may be clinically relevant. Aim: To assess the feasibility and reproducibility of carotid parameters, assessed by UHFUS in vESD patients, and to evaluate the agreement with the gold standard technique, echotracking by radiofrequency. Methods: 16 vEDS patients were recruited (6 women, 40 ± 11 years, BP 115 ± 6/62 ± 6 mmHg). Common carotid parameters were assessed by echotracking (Esaote, Artlab software) and UHFUS (VevoMD, Visualsonics; CVSuite software, Quipu srl), to evaluate agreement. The coefficient of variation between two consecutive clips was computed. The results were compared to those of 16 age-, sex- and BP-matched healthy individuals. Results: In all 16 patients the acquisition and automated analysis of carotid clips was feasible. Correlation between echotracking and UHFUS was satisfactory (diameter r = 0.63, p = 0.001; CIMT r = 0.65, p = 0.006; distension r = 0.84, p < 0.001). Bland-Altman plots showed a good agreement between the two techniques, with a non significant bias either for diameter [110 μm (−184; 404)] or CIMT [27 μm (−10; 75)]. Intra-operator coefficient of variation was 3.26% (diameter), 7.11% (CIMT) and 5.65% (distension). vEDS patients had reduced CIMT (419 ± 85 vs 522 ± 97 μm, p = 0.004) and distension (453 ± 150 vs 613 ± 176 μm, p = 0.01) than controls and tended to have a reduced diameter (6558 ± 525 vs 6945 ± 653 μm, p = 0.08), while carotid-femoral pulse wave velocity was similar (7.38 ± 1.08 vs 7.46 ± 1.396 m/s, p = 0.78). Conclusion: UHFUS is feasible, accurate and reproducible for the evaluation of carotid parameters in vEDS. more...

Background: Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease involving medium-sized muscular arteries, whose pathophysiology is still unknown. Objectives: We aimed at identifying systemic vascular alterations in usually non-affected arteries of patients with multifocal renal FMD by a deep imaging-based phenotyping. Methods: This cross-sectional study included FMD patients (n = 50, 84% hypertensives), age-, sex and BP-matched patients with primary hypertension (PH, n = 50) and healthy normotensive subjects (HS, n = 50). Brachial artery (BA) endothelium-dependent flow-mediated dilation (EDD) and endothelium-independent vasodilation (EID) were studied. Aortic stiffness was assessed by carotid-to-femoral pulse wave velocity (PWV). We quantified abnormal echographic patterns in the common carotid wall by the triple signal score. Common carotid Young’s incremental elastic modulus (Einc)/stress curves were also plotted. Results: FMD patients had impaired EID compared to PH and HS (p = 0.008, after adjustment for confounders p = 0.002), smaller BA diameter but comparable EDD and PWV. The prevalence of triple signal score >6 was 56%, 40%, 24% in FMD, PH and HS respectively (p = 0.005). FMD, but not PH, was significantly associated with triple signal (beta = 0.143, p = 0.022, r2 = 0.058). Impaired EDD was only present in FMD patients with triple signal score>6 (p for interaction=0.047). For a given stress value of 80 kPa, Einc was higher in the presence of a triple signal score >6, especially in FMD patients. Conclusions: Non-affected musculo-elastic and muscular arteries in patients with multifocal renal FMD exhibit a cluster of functional and structural abnormalities, while elastic arteries are preserved. Triple signal in FMD may identify a distinct vascular phenotype. more...

Background: Ankylosing spondylitis (AS) is an inflammatory autoimmune disease. AS is a prototype form of spondyloarthropathies (SpA). The precise ethology of AS has not been fully understood. But Inflammation has a critical role in the pathogenesis of the disease. Extra skeletal organs may also be affected by this disease and is also associated with an increase of cardiovascular risk. The effect of large arteries appears by a stiffness that can be an element of disease monitoring. Objective: The objective of this study was to evaluate the finger-toe Pulse Wave Velocity (ftPWV) in patients with AS. Methods: Finger-toe pulse wave velocity (ft-PWV) was measured by pOpmetre® allowed to explore arterial stiffness. Results: Demographic and clinical characteristics are presented in Table 1. Twenty-two patients with AS and 24 controls were included in our study, subjects with AS exhibited greater pSBP (p < 0.001), pDBP (p < 0.001), pPP (p < 0.001) and MBP (p < .001) compared to controls. Moreover, in the AS group we observed a higher ftPWV with a mean difference of 1.63 (p < 0.006, 95% CI of .50 to 2.7). No significant difference was observed in pPP. Conclusions: Individuals with ankylosing spondylitis showed increased ftPWV, central and peripheral blood pressure, this contributes to explain the higher risk of cardiovascular disease in this pathology. pOpmètre® is a no operator depended, simple and practical device, highlighted an increase in arterial stiffness in patients with AS by measuring the ft-PWV. It could play a role in this disease monitoring and in prediction of cardiovascular complications. more...

Objective: PWV measurement devices are technically demanding, expensive and prone to artefacts, thus limiting the measurement of arterial stiffness in primary care. The CARDIS consortium developed a non-contact device based on the detection of skin movements induced by arterial pulses through a laser Doppler vibrometer (CARDIS-LDV). Our objective is to validate CARDIS-LDV against reference techniques. Methods: This study sponsored by INSERM will include 100 essential hypertensives, males and females, grade I–III, aged 18–80. The CARDIS-LDV comprises two rows of 6 laser beams spaced 5 mm (2.5 cm wide). These rows are either situated 2.5 cm apart for local PWV measurement or can be split in two for carotid to femoral measurement. To calculate PWV, the time delay between the two rows is assessed by analyzing the corresponding skin displacement signals. Aortic stiffness is measured by the Sphygmocor® technique and carotid stiffness by echotracking ArtLab® Results: Measurements by CARDIS-LDV are easy and fast to perform. A simple palpation of pulse is enough to position the device and obtain good signals thanks to the 6-beam array. Figure 1 shows an example of a carotid-femoral recording on a healthy volunteer (age 28). PWV is 5.88 ± 0.30 m/s using the maximum of 1st derivative method, compared with 5.96 ± 0.40 m/s with tonometry. Data on larger sample size will be presented at the meeting. Conclusion: CARDIS-LDV is a promising technique to assess arterial stiffness; we expect to demonstrate its good agreement with reference techniques and that it improves the screening of cardiovascular risk in large populations. more...

The vascular system is subject to continual variation in mechanical stresses, both physiological and pathological. Vascular remodeling via changes in vessel wall properties, including thickness and stiffness, is a major feature of aging and cardiovascular disease. A more detailed understanding of the interplay between mechanical stress, aging, CVD and vascular remodeling will aid prevention of increased cardiovascular risk following long term microgravity. This study aims at assessing vascular remodeling processes resulting from a 60-day head-down-tilt bed-rest period during the European Space Agency Study (Toulouse, France). We hypothesize that arterial remodeling processes are modified by long term bed- rest and constitute a significant cardiovascular risk in the long term for astronauts. Applanation tonometry is used to assess carotid to femoral pulse wave velocity (PWV) and non-invasive ultrasound imaging are used to assess arterial remodelling processes at the carotid, femoral, brachial and popliteal arteries.Measurements are performed at baseline; at day 29 and 52 of bed-rest; and at day 6 and 30 of the recovery period. The preliminary results including 10 first subjects, demonstrate a strong effect of bed- rest on arterial PWV.The average PWV at baseline equals 7,6±1.4m/s and is increased to 9.0±1.9m/s after 29 days, and, 9.3±1.8m/s after 52 days bed-rest. This increase is significantly different between baseline, and, 29 and 52 days bed-rest (p < 0.005). Increase in PWV suggests a rapid and significant stiffening of the central arteries, which on healthy subjects corresponds to an aging process wich occurs many years. Low gravity conditions as during bed-rest induce significant arterial stiffening that could be linked to long term CVD risks for either patients in bed-rest or astronauts. more...

Patients with chronic severe psoriasis are at increased cardiovascular risk (CVR). Modern systemic treatments of psoriasis involve anti-TNF alpha (ATNF) and more recently introduced anti-IL12/IL-23 (ustekinumab, AIL12/23) which, by interfering with IL-17, a possibly vasculoprotective cytokine, may increase CVR. We characterized large arteries remodeling and stiffness during longitudinal follow-up under ATNF and AIL12/23. We included 31 patients. Followed-up was 13 ± 3 months with a mean number of 3 visits. Patients were treated either by ATNF (n = 13) or by AIL12/23 (n = 18). Mean age was 49 (27–71) 50% were females, 89% were overweight, 55% smokers and 32% (well controlled) hypertensives. Patients did not differ for severity scores of psoriasis or baseline characteristics. Carotid to femoral pulse wave velocity (PWV) and central pressure (applanation tonometry), carotid PWV and IMT (echotracking) were measured at each visit. Blood pressure and heart rate did not change with either treatment. Carotid diameter did not change during follow-up, IMT increased more with AIL12/23 than in ATNF group (diff. à 18 months 75 μm, p = 0.10). Carotid distension and carotid distensibility decreased significantly under AIL12/23, whereas it increased with ATNF, independently of BP. Carotid PWV and CF-PWV increased independently of BP with AIL12-23 and decreased with ATNF (18 months diff. +1.60 m/s and +1.15 m/s, p < 0.05, respectively). We documented an increased in stiffness and hypertrophy of large arteries during longitudinal follow-up of patients under antiinterleukin 12/23 treatment for psoriasis, compared to antiTNFalpha. Whether this is due to a protective effect of ATNF and/or adverse effect of AIL12-23 remains to be determined. more...

Arterial stiffness may influence the contour of the peripheral pulse, suggesting that contour analysis of the digital volume pulse (DVP) might be used to estimate peripheral blood pressure and a stiffness index (SI). The objective is to establish a transfer function that estimates the peripheral blood pressure using the PPG pulse, calibrated with a brachial pressure cuff, and then to deduce a stiffness index using the established parameters. We positioned the photodiode sensor on the finger. Brachial blood pressure measurement was performed with a cuff adapted to the arm circumference and an oscillometric device (Omron M10 -IT). Pulse wave velocity (PWV) measurements were performed with the pOpmètre® system. DVP waveforms were recorded over a 10 s period and ensemble-averaged to obtain a single waveform from which DT (DVP) was determined as the time between the first systolic peak and the early diastolic peak/inflection point in the waveform. The SI is the ratio of the subject’s height to the DT (DVP). 69 subjects were included: 24 healthy subjects and 45 patients with essential hypertension. The correlation between the estimated peripheral diastolic pressure and the brachial one was good and significant (r2 = 0.51; p < 0.001). A better correlation was found in terms of peripheral systolic pressure (r2 = 0.56; p < 0.001). The correlation between the SI and the ft-PWV was significant (r = 0.5; p < 0.001) classifying the estimation as good agreement. The estimation of the peripheral blood pressure and a stiffness index with the PPG signal qualifies as good agreement with the reference technique. more...

Objective: Because measurement of arterial stiffness is highly dependent on blood pressure (BP), methods independent of BP are required. Shear wave elastography (SWE, Supersonic Imagine, Aix-en-Provence, France) enables to assess local tissue stiffness by tracking the propagation of shear waves generated into the tissue using ultrafast imaging. This method has never been tested against classical Echotracking (Artlab, Esaote, Maastricht, NL) and carotid to femoral pulse wave velocity (cf-PWV, Sphygmocor, AtCor, Sydney, Australia). Methods: We included 25 subjects, 14 normotensives (NT) and 11 essential hypertensives (HT), matched for age and sex. We optimized SWE algorithms for carotid wall tracking and shear wave group velocity calculation for the anterior (a-SWV) and posterior wall (p-SWV). 8 ultrasonic pushes were triggered at intervals of 200 ms to study the variations of stiffness during the cardiac cycle. Results: p-SWV showed no association with carotid PWV, cf-PWV nor BP. Mean a-SWV over the cardiac cycle was strongly associated with carotid PWV measured by Echotracking (r = 0.56, p = 0.003) and cf·PWV (r = 0.66, p < 0.001). a-SWV strongly increased with BP level during the cardiac cycle (p < 10−6). Similar associations between a-SWV and BP were found in NT and HT although HT had higher values of a-SWV throughout all BP levels. However, when a common BP value (100 mmHg) was considered, no significant difference was found between NT and HT. Conclusion: We have demonstrated with a method independent of BP that the increased arterial stiffness in HT is entirely due to the BP increase. SWE seams a promising technique for assessing arterial stiffness. more...

Background: Large artery stiffness is recognized as a strong, independent marker of cardiovascular risk, mainly through aortic pulse wave velocity (PWV). pOpmètre® is a new non-invasive method, which estimates aortic PWV through finger-toe (FT) wave analysis. In a previous study, Alivon et al. have shown an acceptable correlation (r2 = 0.43 for PWV) between pOpmètre® and the reference method Sphygmocor. However this study led to the necessity to optimize the algorithm and the procedures because of the presence of several outliers involving mainly obese and elderly subjects. Materials and Methods: The pOpmètre® has 2 photodiodes sensors, positioned on the finger and on the toe. A particular attention was drawn on positioning of the toe sensor so that the pulp was in contact with the photodiode. Different signal processing chains were applied and no cut-off value was used for pulse height. Applanation tonometry was performed for CF PWV measurements. Results: 45 subjects were included: 18 healthy subjects and 27 patients with essential hypertension aged 32± 7 years and 58 ±18 years respectively. The correlation between FT PWV and CF PWV was good and significant (r2 = 0.77 p more...

Fibromuscular dysplasia (FMD) is a non-atherosclerotic non-inflammatory arterial disease of unknown origin. We previously showed the presence of triple signal (TS) at ultrasound within common carotid artery (CCA) wall. We aimed at coupling TS presence with microconstituents of the vessel wall. We included 50 patients with multifocal FMD, 50 essential hypertensive (HT) patients and 50 healthy subjects (HS) matched for age, sex, ethnicity and BP (HT and FMD). TS score from the right and left CCA were assessed from 15-MHz echotracking system coupled with aplanation tonometry. 14 microconstituents of the CCA, representing geometry, perivascular tethering, and wall material coefficients were derived from fitting of the pressure-diameter curve. In multivariate analysis, age, hypercholesterolemia and IMT were significantly associated with TS, explaining 9.5% of its variance. TS was more frequent in FMD than HS (49% vs 16%, p more...

Background: Measurement of arterial stiffness (AS) is still considered difficult. We developed a non- invasive technique to assess AS from a connected bathroom scale, based on ballistocardiography (BCG) and impedance plethysmography (IPG). Methods: We included 192 subjects and patients, 106 for calibration study (cal), 86 for validation study (val), 33% hypertensives, mean age 48±17 years, 48% women. The scale pulse transit time (WS- PTT) was calculated as the difference between BCG systolic signals and IPG blood flow in the foot. Distance was estimated from body height and PWV was calculated. Carotid to femoral transit time (CF-PTT) was measured using SphygmoCor. Spearman and robust multivariate regressions were used. Results: The WS-PTT correlated well with CF-PTT with R=0.73 in pooled population (cal 0.79, val 0.66). WS-PWV correlated with CF-PWV with R=0.76 (cal 0.80, val 0.70). The standard deviation of difference was 1.39 m/s with a bias of 0.25 m/s compared with CF-PWV. Correlations of WS-PWV with age and blood pressure were similar (R= 0.72 and 0.59, resp.) to those of CF-PWV (R=0.67 and 0.61, resp.). These good correlations were non-trivial given the differences in wave paths, the fact that measurements are made in orthostatic position and totally investigator-free. Conclusion: We show in two distinct populations that a simple user-oriented instrument such as a connected bathroom scale can estimate arterial stiffness with accuracy close to healthcare-oriented systems. Because these devices will be used by the general population, the availability of arterial stiffness data on very large, non-medicalized populations will change our management of well-being and health. more...

Background: Measurement of arterial stiffness (AS) is still considered difficult. We developed a non-invasive technique to assess AS from a connected bathroom scale, based on ballistocardiography (BCG) and impedance plethysmography (IPG). Methods: We included 198 subjects and patients, 111 for calibration study (cal), 88 for validation study (val), 34% hypertensives, mean age 48±17 years, 50% women. The scale pulse transit time (WS-PTT) was calculated as the difference between BCG systolic signals and IPG blood flow in the foot. Distance was estimated from body height and PWV was calculated. Carotid to femoral transit time (CF-PTT) was measured using Sphygmocor. Spearman and robust multivariate regressions were used. Results: The WS-PTT correlated well with CF-PTT with R=0.69 in pooled population (cal 0.73, val 0.60). WS-PWV correlated with CF-PWV with R=0.73 (cal 0.67, val 0.59). The standard deviation of difference was 1.19 m/s with no significant bias compared with CF-PWV. Correlations of WS-PWV with age and blood pressure were similar (R= 0.69 and 0.60, resp.) to those of CF-PWV (R=0.67 and 0.60, resp.). These good correlations were non-trivial given the differences in wave paths, the fact that measurements are made in orthostatic position and totally investigator-free. Conclusion: We show in two distinct populations that a simple user-oriented instrument such as a connected bathroom scale can estimate arterial stiffness with accuracy close to healthcare-oriented systems. Because these devices will be used by the general population, the availability of arterial stiffness data on very large, non-medicalized populations will change our management of well-being and health. more...

Objective: Pulse Wave Velocity (PWV) can be measured between different sites. Here we used two different aspects to assess the PWV; the standard method Carotid-Femoral (CF) Sphygmocor (AtCorMedical – Australia) and the pOpmetre ® (Axelife SAS – France) which uses the Finger to Toe (FT) signals. The aim of this study was to evaluate the agreement between FT-PWV and CF-PWV and to test the robustness of pOpmetre ® build-in algorithm. Design and method: CF and FT PWV was measured in 150 subjects. MatLab was used to calculate FT-PWV from pOpmetre ® waveforms using four methods: maximum of second derivative (used by pOpmetre ®), intersecting tangents, 10% threshold and the cross correlation method. Results: Using built in algorithms, the comparisons of the PWVs and transit times showed a good agreement between the two methods. FT-PWV correlated with CF-PWV (r2=0.51; p more...

The recognized reference method for endothelial function assessment is brachial artery diameter echo-tracking during flow mediated dilation (FMD) induced by reactive hyperaemia (RH). From the Mons-Korteweg equation, FMD should also reduce upper limb pulse wave velocity (PWV). The aim of our study was to compare echo-tracking FMD with PWV changes after RH. Brachial diameter was assessed by echo-tracking (MyLAb 70, Easote, Italy) before and after 7 min of ischemia induced by inflating a cuff on the right wirst 50mmHg above subject’s systolic blood pressure. Carotid-left radial and carotid-right radial PWVs were also simultaneously measured with Complior Analyse (Alam Medical, France) at baseline (in triplicate), 30sec, 1, 3 and 5 min end of ischemia. Measurements were performed in 15 healthy subjects (10M/5F, 31±11 yrs). Maximum PWV changes happened 1min after cuff deflation in the ischemic arm (ΔPWV=2,1±1,4m/s, p more...

Because measurement of arterial stiffness is highly dependent on blood pressure (BP), methods independent of BP are required. Ultrafast echography (UFE, Supersonic Imagine, Aix en Provence, France) makes use of very fast sampling rate (up to 10 kHz), so transient events such as pressure wave arrival can be tracked. This method has never been tested against classical echotracking (Artlab, Esaote, Maastricht, NL) and carotid-femoral pulse wave velocity (cf-PWV, Sphygmocor, AtCor, Sydney, Australia). We included 56 subjects, 27 normotensives (NT) and 29 essential hypertensives (HT), matched for age and sex. We optimized UFE algorithms for pressure wave detection and tracking, for both foot of the wave (FW) and dicrotic notch (DN) PWV. Feasibility appears good (FW: 78%, DN: 96%). The relations of arterial stiffness with age and blood pressure were stronger for echotracking and cf-PWV than for UFE. DN wave fronts appeared better associated with cf-PWV (r = 0.32, p < 0.001) and carotid PWV (r = 0.47, p < 0.001). FW was not associated with cf-PWV nor with carotid PWV. The residuals between DN and carotid PWV were not associated with BP or age. Similar associations between DN and cf-PWV/carotid PWV were found in NT and HT. Conclusion: After optimizing algorithms for wave front identification and tracking, UFE appears as a promising technique for assessing arterial stiffness. DN showed the best associations with echotracking, whereas FW did not provide meaningful data. As previously shown by Hermeling et al (J Hypertens 2008 and 2009), FW is not appropriate for local stiffness measurement likely because of very early wave reflections. more...