Predictive Ability of Pressure-Corrected Arterial Stiffness Indices: Comparison of Pulse Wave Velocity, Cardio-Ankle Vascular Index (CAVI), and CAVI0

Abstract

BACKGROUND Pulse wave velocity (PWV) is blood pressure (BP) dependent, leading to the development of the BP-corrected metrics cardio-ankle vascular index (CAVI) and CAVI0. We aimed to assess risk prediction by heart-to-ankle PWV (haPWV), CAVI, and CAVI0 in a US population. METHODS We included 154 subjects (94.8% male; 47.7% African American) with and without heart failure (HF). Left and right haPWV, CAVI, and CAVI0 were measured with the VaSera 1500N device. We prospectively followed participants for a mean of 2.56 years for the composite endpoint death or HF-related hospital admission (DHFA). RESULTS Left and right haPWV, CAVI, and CAVI0 values did not differ significantly. In unadjusted analyses, haPWV (left standardized hazard ratio [HR] = 1.51, P = 0.007; right HR = 1.66, P = 0.003), CAVI (left HR = 1.45, P = 0.012; right HR = 1.58, P = 0.006), and CAVI0 (left HR = 1.39, P = 0.022; right HR = 1.44, P = 0.014) significantly predicted DHFA. Predictive ability showed a decreasing trend from haPWV to CAVI to CAVI0; in line with the increasing amount of BP correction in these metrics. In Cox models, right-sided metrics showed a trend toward stronger predictive ability than left-sided metrics. After adjustment for baseline HF status, the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score, and systolic BP, right haPWV (HR = 1.58, P = 0.025) and CAVI (HR = 1.44, P = 0.044), but no other stiffness metrics, remained predictive. CONCLUSIONS Although conceptually attractive, BP-corrected arterial stiffness metrics do not offer better prediction of DHFA than conventional arterial stiffness metrics, nor do they predict DHFA independently of systolic BP. Our findings support PWV as the primary arterial stiffness metric for outcome prediction.

Cardio-Ankle Vascular Index and Aging: Differences between CAVI and CAVI0

“…Our study moves from the assumption that CAVI is a valid estimate of arterial stiffening in older ages [25]. Although guidelines endorse the use of cfPWV as the gold standard for arterial stiffness evaluation [3], there has been increasing interest in CAVI and CAVI0 [26]. As compared to cfPWV, which is a particular measurement of the central aortic segments, CAVI is known to be representative of a wider proportion of the arterial tree, including both central and peripheral segments [13].…”

Predictive ability of arterial stiffness parameters for renal function decline: a retrospective cohort study comparing cardio-ankle vascular index, pulse wave velocity and cardio-ankle vascular index0

“…Therefore, the formula for estimating haPWV-relevant BP is incorrect, and there is no basis for the claim that the BP is almost P d . Also, they claim that the negative correlation with BP is because of high pulse pressure among the individuals with lower P d , who are supposed to have stiffer blood vessels [29]. However, a negative relationship is observed even in healthy people with pulse pressure less than 50 mmHg [34].…”

“…The superiority of CAVI compared with the other two parameters identified in the present study seems to be inconsistent to the findings of Spronck et al . [29] compared the same three arterial stiffness parameters in 154 individuals. They reported that the predictive ability of the composite endpoint [death ( n = 21) and heart failure hospitalization ( n = 18)] showed a decreasing trend of haPWV to CAVI to CAVI 0 , and the investigators attributed these results to the increasing amount of BP correction of the parameters.…”

The Correlation of Arterial Stiffness Parameters with Aging and Comorbidity Burden

“…The remarkable relationship between age and CAVI was previously demonstrated by Shirai et al [ 46 ], who described increased CAVI in elderly subjects as a possible expression of age-related arterial wall sclerosis. Although PVW-cf is still considered as the primary arterial stiffness evaluation technique for outcome prediction [ 47 ], CAVI could be also considered as a more reliable index in the elderly, due to its lower dependence from blood pressure [ 48 ].…”