Markers of arterial stiffness in peripheral arterial disease

Abstract

Increased arterial stiffness results from reduced elasticity of the arterial wall and is an independent predictor for cardiovascular risk. The gold standard for assessment of arterial stiffness is the carotid-femoral pulse wave velocity. Other parameters such as central aortic pulse pressure and aortic augmentation index are indirect, surrogate markers of arterial stiffness, but provide additional information on the characteristics of wave reflection. Peripheral arterial disease (PAD) is characterised by its association with systolic hypertension, increased arterial stiffness, disturbed wave reflexion and prognosis depending on ankle-brachial pressure index. This review summarises the physiology of pulse wave propagation and reflection and its changes due to aging and atherosclerosis. We discuss different non-invasive assessment techniques and highlight the importance of the understanding of arterial pulse wave analysis for each vascular specialist and primary care physician alike in the context of PAD.

Association between arterial stiffness and peripheral artery disease as measured by radial artery tonometry

“…23 Because central AIX varies as a function of heart rate, all measurements were normalized to 75 beats per minute (bpm), consistent with previous studies. 11, 17 The quality index is a summary measure calculated by the proprietary SphygmoCor software and based on variability in the recorded waveforms (e.g. pulse height variation, etc.).…”

“…Because less wall compliance translates into higher velocity, PWV is considered the gold-standard measure of arterial stiffness. 11–13 As each pulse wave travels forward, some of it gets reflected in a retrograde fashion. 14 Pulse wave analysis (PWA) examines each waveform, which is the combination of a forward and reflected pulse wave.…”

Methods of Endothelial Function Assessment: Description and Applications

“…57 Since arterial stiffness is a strong evidence of cardiovascular disease, analysis of pulse wave in the clinical practice may identify changes that might be related to vascular health, even before the occurrence of signs and symptoms. 58 Limitations of the method are related to associated comorbidities, including metabolic syndrome, obesity and diabetes, which may affect the femoral pulse wave recordings. Besides, men with abdominal obesity and women with large breast size can cause errors in distance measurements.…”

“…The difference between the time for the onset of carotid pulse wave and femoral pulse wave, and the distance between the two transducers are used to calculate PWV. 51,57,58 Another method that has been widely recommended for pulse wave analysis is applanation tonometry. This technique is used to estimate aortic pulse wave from the common carotid artery or the radial artery pulse waves.…”

“…However, the carotid-femoral relation has been considered the gold standard in the literature, for its non-invasiveness and for expressing PWV values directly related to the aorta artery. [56][57][58] The method is performed with the individual in the supine position, and two transducers are used for the measurement, one is placed on the right common carotid artery and one on the right femoral artery. The difference between the time for the onset of carotid pulse wave and femoral pulse wave, and the distance between the two transducers are used to calculate PWV.…”