Brachial-ankle vs carotid-femoral pulse wave velocity as a determinant of cardiovascular structure and function

Abstract

Carotid-femoral pulse wave velocity (cf-PWV) is a validated marker of arterial stiffening over the central arteries. Brachial-ankle pulse wave velocity (ba-PWV) integrates the mechanical properties from both the central and peripheral arteries and may be more representative than cf-PWV as arterial load for left ventricle (LV). We compared ba-PWV with cf-PWV for the association of cardiovascular structure and function in 320 subjects with various degrees of abnormality in cardiac structure and function. ba-PWV (by oscillometric technique) and cf-PWV (by tonometric technique) were measured simultaneously, and were highly correlated (r ¼ 0.79, Po0.001). Both ba-PWV and cf-PWV were significantly correlated with LV mass, but the correlation was better with ba-PWV (r ¼ 0.29 vs r ¼ 0.22, P ¼ 0.0219). While ba-PWV and cf-PWV were similarly significantly correlated with LV end-systolic elastance and mitral E/A ratio, ba-PWV had better correlation with isovolumic relaxation constant (r ¼ 0.34 vs r ¼ 0.27, P ¼ 0.0202) than cf-PWV. In addition, the correlation was also significantly stronger with ba-PWV than with cf-PWV for other indices of arterial stiffness, including carotid incremental modulus (r ¼ 0.59 vs 0.50, P ¼ 0.0013), effective arterial elastance (r ¼ 0.41 vs r ¼ 0.33, P ¼ 0.0081) and carotid augmentation index (r ¼ 0.38 vs r ¼ 0.32, P ¼ 0.0368). In conclusion, ba-PWV correlates better with LV mass and diastolic function and other indices of arterial function than cf-PWV, probably because ba-PWV encompasses a greater territory of arterial tree than cf-PWV.

Factors associated with brachial-ankle pulse wave velocity in the general population

“…Indeed, baPWV has been reported to be a better marker of cardiac load than carotid-femoral PWV. 32 Previous studies have demonstrated that baPWV predicts cardiovascular events in individuals at high risk, including those with acute coronary syndrome, 33 the elderly, 34 those on hemodialysis 35 and those with coronary artery disease. 36 We have further extended the clinical significance of baPWV by showing that this index provides important information for the screening of low-to-moderate risk individuals.…”

Elevated circulating endothelial microparticles and brachial–ankle pulse wave velocity in well-controlled hypertensive patients

“…Finally, we used baPWV, the surrogate marker of aortic PWV to evaluate the large artery elasticity, because baPWV has been proved closely related to aortic PWV and has been used as a well-accepted surrogate end point predicting cardiovascular events in earlier studies. 16,17,38 However, large sample and prospective studies will still be needed to further confirm its usefulness in clinical practice. Further investigation is now being performed in our laboratory to answer this question.…”

“…15 baPWV has been testified to be the alternative of aortic PWV and shown to be a better marker for the clinical evaluation of vascular abnormality. 16,17 Circulating EMPs emerged as the sensitive marker of endothelial perturbation in response to adverse stimuli. 18 It has been reported that in patients with hypertension, increased EMPs and reduced artery elasticity are present.…”

Independent and Joint Effect of Brachial-Ankle Pulse Wave Velocity and Blood Pressure Control on Incident Stroke in Hypertensive Adults

“…be more representative than cfPWV of arterial load. [31][32][33][34] One published validation study of baPWV demonstrated both validity and reproducibility of baPWV when compared with aortic PWV. 35 The utility of baPWV versus cfPWV in stroke risk assessment is worth mentioning.…”