Arterial stiffness index beta and cardio-ankle vascular index inherently depend on blood pressure but can be readily corrected

Spronck, Bart; Avolio, Alberto; Tan, Isabella; Butlin, Mark; Reesink, Koen D.; Delhaas, Tammo

doi:10.1097/hjh.0000000000001132

Cited by 116 publications

(152 citation statements)

References 19 publications

Supporting

Mentioning

142

Contrasting

Unclassified

Order By: Relevance

“…We recently set out to quantitatively assess the physiological confounders of PWV [1], investigating the magnitude of their effect and ways to correct for them. These confounders included blood pressure [6,7,8], heart rate [9,10], and axial stretch [11]. This mini-review will concentrate on blood pressure as a confounder of PWV, and will discuss several options to deal with the confounding effect.…”

Section: Arterial Stiffnessmentioning

confidence: 99%

“…In a recent Journal of Hypertension publication, we studied CAVI's relationship to blood pressure from a theoretical standpoint [7]. We showed that, on a theoretical basis, the use of equation 1 to obtain CAVI does not yield a fully pressure-independent index.…”

Section: Option 1: Converting Pwv Into Blood Pressure-independent Meamentioning

confidence: 99%

“…Consequently, β also varies with blood pressure. As CAVI is essentially a form of β, this blood pressure dependence is also present in CAVI [7]. Segers [35] acknowledges this effect in his editorial comment, in which he illustrates the blood pressure dependence of β by plotting In( P / P ref ) versus d / d ref .…”

Section: Option 1: Converting Pwv Into Blood Pressure-independent Meamentioning

confidence: 99%

“…To overcome the problem of CAVI's blood pressure dependence, we derived an updated index that is theoretically pressure-independent: CAVI₀[7]. CAVI₀ is based on β₀, as opposed to CAVI that is based on (Kawasaki's) β:…”

Section: Option 1: Converting Pwv Into Blood Pressure-independent Meamentioning

confidence: 99%

“…It is important that one, fixed value for P ref is chosen for all subjects in a study. The numerical value of P ref that is chosen is a matter of standardisation or consensus; P ref does not represent a physiological pressure [7]. Following Hayashi et al [19], we proposed to use P ref = 100 mm Hg in all subjects, in all studies.…”

Section: Option 1: Converting Pwv Into Blood Pressure-independent Meamentioning

confidence: 99%

See 4 more Smart Citations

Options for Dealing with Pressure Dependence of Pulse Wave Velocity as a Measure of Arterial Stiffness: An Update of Cardio-Ankle Vascular Index (CAVI) and CAVI0

Spronck

Delhaas

Butlin

et al. 2017

Pulse

Self Cite

View full text Add to dashboard Cite

Pulse wave velocity (PWV), a marker of arterial stiffness, is known to change instantaneously with changes in blood pressure. In this mini-review, we discuss two main approaches for handling the blood pressure dependence of PWV: (1) converting PWV into a pressure-independent index, and (2) correcting PWV per se for the pressure dependence. Under option 1, we focus on cardio-ankle vascular index (CAVI). CAVI is essentially a form of stiffness index β - CAVI is estimated for a (heart-to-ankle) trajectory, whereas β is estimated for a single artery from pressure and diameter measurements. Stiffness index β, and therefore also CAVI, have been shown to theoretically exhibit a slight residual blood pressure dependence due to the use of diastolic blood pressure instead of a fixed reference blood pressure. Additionally, CAVI exhibits pressure dependence due to the use of an estimated derivative of the pressure-diameter relationship. In this mini-review, we will address CAVI's blood pressure dependence theoretically, but also statistically. Furthermore, we review corrected indices (CAVI₀ and β₀) that theoretically do not show a residual blood pressure dependence. Under option 2, three ways of correcting PWV are reviewed: (1) using an exponential relationship between pressure and cross-sectional area, (2) by statistical model adjustment, and (3) through reference values or rule of thumb. Method 2 requires a population to be studied to characterise the statistical model, and method 3 requires a representative reference study. Given these limitations, method 1 seems preferable for correcting PWV per se for its blood pressure dependence. In summary, several options are available to handle the blood pressure dependence of PWV. If a blood pressure-independent index is sought, CAVI₀ is theoretically preferable over CAVI. If correcting PWV per se is required, using an exponential pressure-area relationship provides the user with a method to correct PWV on an individual basis.

show abstract

Section: Arterial Stiffnessmentioning

confidence: 99%

Section: Option 1: Converting Pwv Into Blood Pressure-independent Meamentioning

confidence: 99%

Section: Option 1: Converting Pwv Into Blood Pressure-independent Meamentioning

confidence: 99%

Section: Option 1: Converting Pwv Into Blood Pressure-independent Meamentioning

confidence: 99%

Section: Option 1: Converting Pwv Into Blood Pressure-independent Meamentioning

confidence: 99%

See 3 more Smart Citations

Options for Dealing with Pressure Dependence of Pulse Wave Velocity as a Measure of Arterial Stiffness: An Update of Cardio-Ankle Vascular Index (CAVI) and CAVI0

Spronck

Delhaas

Butlin

et al. 2017

Pulse

Self Cite

View full text Add to dashboard Cite

show abstract

Pulse Wave Velocity and Arterial Stiffness Assessment

Salvi

2016

Pulse Waves

View full text Add to dashboard Cite

Compliance

Westerhof¹,

Stergiopulos²,

Noble³

et al. 2018

Snapshots of Hemodynamics

View full text Add to dashboard Cite

Arterial stiffness index beta and cardio-ankle vascular index inherently depend on blood pressure but can be readily corrected

Abstract: β and CAVI as currently implemented are inherently BP-dependent, potentially leading to erroneous conclusions in arterial stiffness trials. BP-independent forms are presented to readily overcome this problem.

Cited by 116 publications

References 19 publications

Options for Dealing with Pressure Dependence of Pulse Wave Velocity as a Measure of Arterial Stiffness: An Update of Cardio-Ankle Vascular Index (CAVI) and CAVI0

Options for Dealing with Pressure Dependence of Pulse Wave Velocity as a Measure of Arterial Stiffness: An Update of Cardio-Ankle Vascular Index (CAVI) and CAVI0

Pulse Wave Velocity and Arterial Stiffness Assessment

Compliance

Contact Info

Product

Resources

About