Aortic Distensibility and Aortic Intima-Media Thickness in Patients without Clinical Manifestation of Atherosclerotic Cardiovascular Disease Zafer Elbasan, M.D.,* Durmus ß Yıldıray S ßahin, M.D.,* Mustafa Gür, M.D.,* Gülhan Yüksel Kalkan, M.D.,* Ali Yıldız, M.D.,† Zekeriya Kaya, M.D.,† Ali Kıvrak, M.D.,* Gökhan Gözübüyük, M.D.,* Ibrahim Özdo gru, M.D.,‡ and Murat Çaylı, M.D.* *Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey; †Department of Cardiology, School of Medicine, Harran University, Şanlıurfa, Turkey; and ‡Department of Cardiology, School of Medicine, Erciyes University, Kayseri, Turkey Background: There is growing evidence that aortic distensibility (AD) is a subclinical marker of early ath- erosclerosis. Aortic intima-media thickness (IMT) was an earlier marker than carotid IMT of preclinical atherosclerosis. In this study, we aimed to assess the relationship between thoracic aortic IMT and AD. Methods: We studied 192 patients (mean age: 45.5 ± 8.4 years) who underwent transesophageal echocardiography (TEE) for various indications. Four different grades were determined according to IMT of thoracic aorta (Grade 1 < 1 mm; 1 mm  Grade 2 < 3 mm; 3 mm  Grade 3 < 5 mm; 5 mm  Grade 4). AD was calculated from the echocardiographically derived ascending aorta diame- ters and hemodynamic pressure measurements in all patients. High sensitive C-reactive protein (hsCRP) and other biochemical markers were measured using an automated chemistry analyzer. Results: TEE evaluation characterized thoracic aortic intimal morphology as grade 1 in 71 patients (37%), grade 2 in 57 patients (29.7%), grade 3 in 34 patients (17.7%), and grade 4 in 30 (15.6%) patients. The lowest AD level was observed in grade 4 group compared with grade 1 and grade 2 groups (P < 0.001, P = 0.009, respectively). AD level of grade 3 group was lower than grade 1 and grade 2 group (P < 0.001, P = 0.021, respectively). In multiple linear regression analysis, AD was independently associ- ated with age (b = 0.138, P = 0.029), hsCRP (b = 0.209, P = 0.001), and aortic IMT (b = 0.432, P < 0.001). Conclusion: AD is independently associated with age, thoracic aortic IMT, and hsCRP. Impaired elasticity index of the aorta might be an independent predictor for the severity of thoracic atherosclerosis. (Echocardiography 2013;30:407-413) Key words: aorta, intima-media, distensibility, echocardiography, hsCRP Normal aortic function is compromised when the aorta loses its elasticity, resulting in stiffening of the aorta. 1 There is growing evidence that aor- tic stiffness is a subclinical marker of early atherosclerosis 1–4 and predicts future risk of hypertension 5 and cardiovascular events, 6 inde- pendent of traditional risk factors. Aortic distensi- bility (AD) is a measurement of vascular elasticity, which reflects the stiffness of aorta. 7 AD has been shown to be inversely proportional to disease severity and presence of cardiovascular risk factors. 8,9 Transesophageal echocardiography (TEE), which provides high-resolution imaging of the thoracic aorta, is a reliable tool to determine the degree of thoracic aortic atherosclerosis. 10,11 The detection of atherosclerotic lesions in the aorta by TEE is a marker of diffuse atherosclerotic disease. 10,12,13 Furthermore, it was reported that aortic intima-media thickness (IMT) was an earlier marker than carotid IMT of preclinical atheroscle- rosis. 14 Previous studies showed that AD was signifi- cantly related with the subclinical coronary and carotid atherosclerosis. 15,16 Although both coro- nary and carotid atherosclerosis related to AD, the possible relationship between thoracic aortic IMT and AD was not investigated in humans. We hypothesized that AD may be related to thoracic aortic IMT. Therefore, in this study, we aimed to Address for correspondence and reprint requets: Durmus ß Yıldıray S ßahin, Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey. Fax: +90-322-338-33-69; E-mail: dysahin79@hotmail.com 407 © 2012, Wiley Periodicals, Inc. DOI: 10.1111/echo.12066 Echocardiography