Noninvasive Estimation of Aortic Stiffness Through Different Approaches

Abstract

Aortic pulse wave velocity is a worldwide accepted index to evaluate aortic stiffness and can be assessed noninvasively by several methods. This study sought to determine if commonly used noninvasive devices can all accurately estimate aortic pulse wave velocity. Pulse wave velocity was estimated in 102 patients (aged 65±13 years) undergoing diagnostic coronary angiography with 7 noninvasive devices and compared with invasive aortic pulse wave velocity. Devices evaluating carotid-femoral pulse wave velocity (Complior Analyse, PulsePen ET, PulsePen ETT, and SphygmoCor) showed a strong agreement between each other ( r >0.83) and with invasive aortic pulse wave velocity. The mean difference ±SD with the invasive pulse wave velocity was −0.73±2.83 m/s ( r =0.64) for Complior-Analyse: 0.20±2.54 m/s ( r =0.71) for PulsePen-ETT: −0.04±2.33 m/s ( r =0.78) for PulsePen ET; and −0.61±2.57 m/s ( r =0.70) for SphygmoCor. The finger-toe pulse wave velocity, evaluated by pOpmètre, showed only a weak relationship with invasive aortic recording (mean difference ±SD =−0.44±4.44 m/s; r =0.41), and with noninvasive carotid-femoral pulse wave velocity measurements ( r <0.33). Pulse wave velocity estimated through a proprietary algorithm by BPLab (v.5.03 and v.6.02) and Mobil-O-Graph showed a weaker agreement with invasive pulse wave velocity compared with carotid-femoral pulse wave velocity (mean difference ±SD =−0.71±3.55 m/s, r =0.23; 1.04±2.27 m/s, r =0.77; and −1.01±2.54 m/s, r =0.71, respectively), revealing a negative proportional bias at Bland-Altman plot. Aortic pulse wave velocity values provided by BPLab and Mobil-O-Graph were entirely dependent on age-squared and peripheral systolic blood pressure (cumulative r 2 =0.98 and 0.99, respectively). Thus, among the methods evaluated, only those assessing carotid-femoral pulse wave velocity (Complior Analyse, PulsePen ETT, PulsePen ET, and SphygmoCor) appear to be reliable approaches for estimation of aortic stiffness.

Comparing oscillometric and tonometric methods to assess pulse wave velocity: a population-based study

“…Our results, indicating a strong dependence of o-PWV estimates on age and SBP (r 2 0.88), confirm data of previous studies, in which a comparable correlation was found [21,22,33].…”

“…In our study, we compared two non-invasive devices for the assessment of PWV based on two different techniques, a tonometric and an oscillometric one. As discussed above, several studies have previously confirmed a good agreement between the two methods and with the invasive intra-aortic measurements (gold standard) [33,[35][36][37][38]. It is however important to note that the two techniques use two different methodologies for the assessment of PWV, which can in part explain the difference in the PWV estimates provided [39,40].…”

“…As stated by the producer the algorithm used for the o-PWV estimate is based on three integrated components: age, systolic blood pressure, and data derived from pulse wave analysis [18]. However, considering the derivative nature of o-PWV estimates, which could be the underlying cause of the strong association with age and blood pressure, and despite the close relationship between o-PWV values assessed by Mobil-O-Graph and carotid-femoral PWV measurements, the reliability of o-PWV assessments was recently questioned [22,33,34].…”

Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper—accessibility, clinical use and cost effectiveness of ABPM in Latin America in year 2020

“…Recent evidence emphasizes the limitations of the algorithmic approach used by these ABPM devices in measuring central BP and PWV, because in some devices the algorithmic estimate of PWV is only based on squared age values and arm cuff systolic BP and is not really measured, thus being unable to pick‐up alterations in aortic wall properties in specific types of patients, for example, in Marfan's syndrome patients …”

Aortic Stiffness and Heart Failure in Chronic Kidney Disease

“…There are several different tools to non-invasively assess PWV, including tonometric and oscillometric methods as well as CMR-based techniques [49,50]. Many studies focus on comparing different approaches to PWV assessment and try to determine the simplest and most reliable methods that could be helpful in everyday practice [49,51,52]. Recent research, dedicated to comparing different CMR-based techniques of aortic stiffness evaluation in hemodialysis patients, demonstrated excellent inter-and intra-observer variability of ascending and descending AD as well as aortic PWV measurements.…”