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Can pulse wave velocity (PWV) alone express arterial stiffness? A neglected tool for vascular function assessment

  • Mariarosaria De Luca EMAIL logo , Olimpia Iacono , Valeria Valente , Federica Giardino , Giulia Crisci , Maddalena Lettieri , Alberto Marra , Francesco Giallauria and Ugo Oliviero
Published/Copyright: July 20, 2021
Journal of Basic and Clinical Physiology and Pharmacology
From the journal Journal of Basic and Clinical Physiology and Pharmacology Volume 33 Issue 4

Abstract

Arterial stiffness, defined as the rigidity of the arterial wall, is the consequence of vascular aging and is associated with the full spectrum of cardiovascular diseases. Carotid-femoral pulse wave velocity (cf-PWV) is the gold standard method for arterial stiffness evaluation: it measures the velocity of the arterial pulse along the thoracic and abdominal aorta alongside arterial distensibility. Its value rises as stiffness progresses. Cf-PWV is helpful to assess residual cardiovascular risk (CVR) in hypertension (HT). In fact, an increase in pulsatility and arterial stiffness predicts CVR in patients affected by arterial HT, independently of other risk factors. Arterial stiffness can predict cardiovascular events in several other clinical conditions such as heart failure, diabetes, and pulmonary HT. However, cf-PWV has not been yet included in routine clinical practice so far. A possible reason might be its methodological and theoretical limitations (inaccuracy in the traveled distance, intra and interindividual variability, lack of well-defined references values, and age- and blood pressure-independent cutoff). To exceed these limits a strict adherence to guidelines, use of analytical approaches, and possibility of integrating the results with other stiffness examinations are essential approaches.

Keywords: arterial stiffness; cardiovascular risk; hypertension; pulse wave velocity
Corresponding author: Dr. Mariarosaria De Luca, Department of Translational Medical Sciences, “Federico II” University Hospital and School of Medicine, Via Pansini, 5 I-80131, Naples, Italy, Phone: +39 0817463492, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: Not applicable.

References

1. Virani, S, Chair, AA, Benjamin, EJ, Bittencourt, MS, Callaway, CW, Carson, AP, et al.. Heart disease and stroke statistics – 2020 update. A report from the American heart association. Circulation 2020;14:139–596. https://doi.org/10.1161/CIR.0000000000000757.Search in Google Scholar

2. Vlachopoulos, C, Aznaouridis, K, O’Rourke, MF, Safar, ME, Baou, K, Stefanadis, C. Prediction of cardiovascular events and all-cause mortality with central hemodynamics: a systematic review and meta-analysis. Eur Heart J 2010;31:1865–71. https://doi.org/10.1093/eurheartj/ehq024.Search in Google Scholar

3. Williams, B, Mancia, G, Spiering, W, Rosei, EA, Azizi, M, Burnier, M, et al.. 2018 ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European society of cardiology and the European society of hypertension: the task force for the management of arterial hypertension of the European society of cardiology and the European society of hypertension. J Hypertens 2018;36:1953–2041. https://doi.org/10.1097/hjh.0000000000001940.Search in Google Scholar

4. Safar, ME. Arterial stiffness as a risk factor for clinical hypertension. Nat Rev Cardiol 2018;15:97–105. https://doi.org/10.1038/nrcardio.2017.155.Search in Google Scholar

5. Blacher, J, Staessen, JA, Girerd, X, Gasowski, J, Thijs, L, Liu, L, et al.. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med 2000;160:1085–9. https://doi.org/10.1001/archinte.160.8.1085.Search in Google Scholar

6. Pannier, BM, Avolio, AP, Hoeks, A, Mancia, G, Takazawa, K. Methods and devices for measuring arterial compliance in humans. A m J Hypertens 2002;15:743–53. https://doi.org/10.1016/s0895-7061(02)02962-x.Search in Google Scholar

7. Van Bortel, LM, Laurent, S, Boutouyrie, P, Chowienczyk, P, Cruickshank, JK, De Backer, T, et al.. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. Hypertension 2012;30:445–8. https://doi.org/10.1097/hjh.0b013e32834fa8b0.Search in Google Scholar

8. Milutinović, A, Šuput, D, Zorc-Pleskovič, R. Pathogenesis of atherosclerosis in the tunica intima, media, and adventitia of coronary arteries: an updated review. Bosn J Basic Med Sci 2020;20:21–30. https://doi.org/10.17305/bjbms.2019.4320.Search in Google Scholar PubMed PubMed Central

9. Vlachopoulos, C, Xaplanteris, P, Aboyans, V, Brodmann, M, Cífková, R, Cosentino, F, et al.. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European society of cardiology working group on peripheral circulation: endorsed by the association for research into arterial structure and physiology (ARTERY) society. Atherosclerosis 2015;241:507–32. https://doi.org/10.1016/j.atherosclerosis.2015.05.007.Search in Google Scholar PubMed

10. Greenland, P, Alpert, JS, Beller, GA, Benjamin, EJ, Budoff, MJ, Fayad, ZA, et al.. ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American college of cardiology foundation/American heart association task force on practice guidelines. J Am Coll Cardiol 2010;56:e50–103. https://doi.org/10.1016/j.jacc.2010.09.001.Search in Google Scholar PubMed

11. McEniery, CM, Yasmin, WS, Maki-Petaja, K, McDonnell, B, Sharman, JE, et al.. Increased stroke volume and aortic stiffness contribute to isolated systolic hypertension in young adults. Hypertension 2005;46:221–6. https://doi.org/10.1161/01.hyp.0000165310.84801.e0.Search in Google Scholar PubMed

12. Mitchell, GF, Vita, JA, Larson, MG, Parise, H, Keyes, MJ, Warner, E, et al.. Cross-sectional relations of peripheral micro-vascular function, cardiovascular disease risk factors, and aortic stiffness: the Framingham heart study. Circulation 2005;112:3722–8. https://doi.org/10.1161/circulationaha.105.551168.Search in Google Scholar

13. Mitchell, GF, Hwang, SJ, Vasan, RS, Larson, MG, Pencina, MJ, Hamburg, NM, et al.. Arterial stiffness and cardiovascular events: the Framingham heart study. Circulation 2010;121:505–11. https://doi.org/10.1161/circulationaha.109.886655.Search in Google Scholar PubMed PubMed Central

14. Sutton-Tyrrell, K, Najjar, SS, Boudreau, RM, Venkitachalam, L, Kupelian, V, Simonsick, EM, et al.. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation 2005;111:3384–90. https://doi.org/10.1161/circulationaha.104.483628.Search in Google Scholar

15. Meaume, S, Benetos, A, Henry, OF, Rudnichi, A, Safar, ME. Aortic pulse wave velocity predicts cardiovascular mortality in subjects >70 years of age. Arterioscler Thromb Vasc Biol 2001;21:2046–50. https://doi.org/10.1161/hq1201.100226.Search in Google Scholar PubMed

16. Reference Values for Arterial Stiffness' Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: 'establishing normal and reference values. Eur Heart J 2010;31:2338–50. https://doi.org/10.1093/eurheartj/ehq165.Search in Google Scholar PubMed PubMed Central

17. Mattace-Raso, van der Cammen, TJ, Hofman, A, van Popele, NM, Bos, ML, Schalekamp, MA, et al.. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation 2006;113:657–63. https://doi.org/10.1161/circulationaha.105.555235.Search in Google Scholar

18. Zhong, Q, Hu, MJ, Cui, YJ, Liang, L, Zhou, MM, Yang, YW, et al.. Carotid-femoral pulse wave velocity in the prediction of cardiovascular events and mortality: an updated systematic review and meta-analysis. Angiology 2018;69:617–29. https://doi.org/10.1177/0003319717742544.Search in Google Scholar PubMed

19. Kim, J, Song, TJ, Song, D, Lee, KJ, Kim, EH, Lee, HS, et al.. Brachial-ankle pulse wave velocity is a strong predictor for mortality in patients with acute stroke. Hypertension 2014;64:240–6. https://doi.org/10.1161/hypertensionaha.114.03304.Search in Google Scholar

20. Vlachopoulos, C, Ioakeimidis, N, Aznaouridis, K, Terentes-Printzios, D, Rokkas, K, Aggelis, A, et al.. Prediction of cardiovascular events with aortic stiffness in patients with erectile dysfunction. Hypertension 2014;64:672–8. https://doi.org/10.1161/hypertensionaha.114.03369.Search in Google Scholar

21. Han, J, Wang, X, Ye, P, Cao, R, Yang, X, Xiao, W, et al.. The predictive value of arterial stiffness on major adverse cardiovascular events in individuals with mildly impaired renal function. Clin Interv Aging 2016;11:1175–81. https://doi.org/10.2147/CIA.S109009.Search in Google Scholar PubMed PubMed Central

22. Feistritzer, HJ, Klug, G, Reinstadler, SJ, Reindl, M, Niess, L, Nalbach, T, et al.. Prognostic value of aortic stiffness in patients after ST-elevation myocardial infarction. J Am Heart Assoc 2017;6: e005590. https://doi.org/10.1161/JAHA.117.005590.Search in Google Scholar PubMed PubMed Central

23. Sharif, S, Visseren, FLJ, Spiering, W, de Jong, PA, Bots, ML, Westerink, J. SMART study group. Arterial stiffness as a risk factor for cardiovascular events and all-cause mortality in people with type 2 diabetes. Diabet Med 2019;36:1125–32. https://doi.org/10.1111/dme.13954.Search in Google Scholar PubMed PubMed Central

24. Cardoso, CRL, Salles, GC, Salles, GF. Prognostic impact of aortic stiffness in patients with resistant hypertension. Hypertension 2019;73:728–35. https://doi.org/10.1161/hypertensionaha.118.12367.Search in Google Scholar PubMed

25. Bosso, G, De Luca, M, Oliviero, U. Echocardiographic assessment of aortic pulse wave velocity for left ventricular diastolic dysfunction. Minerva Cardiol Angiol 2020;69:9–11. 10.23736/S0026-4725.20.05314-1.10.23736/S2724-5683.20.05314-1Search in Google Scholar PubMed

26. Pandey, A, Khan, H, Newman, AB, Lakatta, EG, Forman, DE, Butler, J, et al.. Arterial stiffness and risk of overall heart failure, heart failure with preserved ejection fraction, and heart failure with reduced ejection fraction: the health ABC study (health, aging, and body composition). Hypertension 2017;69:267–74. https://doi.org/10.1161/hypertensionaha.116.08327.Search in Google Scholar

27. Ooi, H, Chung, W, Biolo, A. Arterial stiffness and vascular load in heart failure. Congest Heart Fail 2008;14:31–6. https://doi.org/10.1111/j.1751-7133.2008.07210.x.Search in Google Scholar PubMed

28. Graham, MR, Evans, P, Davies, B, Baker, JS. Arterial pulse wave velocity, inflammatory markers, pathological GH and IGF states, cardiovascular and cerebrovascular disease. Healthc Risk Manag 2008;4:1361–71. https://doi.org/10.2147/vhrm.s3220.Search in Google Scholar PubMed PubMed Central

29. Graham, MR, Evans, P, Thomas, NE, Davies, B, Baker, JS. Changes in endothelial dysfunction and associated cardiovascular disease morbidity markers in GH-IGF axis pathology. Am J Cardiovasc Drugs 2009;9:371–81. https://doi.org/10.2165/11312100-000000000-00000.Search in Google Scholar PubMed

30. Arcopinto, M, Salzano, A, Giallauria, F, Bossone, E, Isgaard, J, Marra, AM, et al.. Growth hormone deficiency is associated with worse cardiac function, physical performance, and outcome in chronic heart failure: insights from the T.O.S.CA. GHD study. Plos One 2017;12: e0170058. https://doi.org/10.1371/journal.pone.0170058.Search in Google Scholar PubMed PubMed Central

31. Arcopinto, M, Salzano, A, Isgaard, J, Cittadini, A. Hormone replacement therapy in heart failure. Curr Opin Cardiol 2015;30:277–84. https://doi.org/10.1097/hco.0000000000000166.Search in Google Scholar

32. Arcopinto, M, Bobbio, E, Bossone, E, Perrone-Filardi, P, Napoli, R, Sacca, L, et al.. The GH/IGF-1 axis in chronic heart failure. Endocr Metab Immune Disord - Drug Targets 2013;13:76–91. https://doi.org/10.2174/1871530311313010010.Search in Google Scholar PubMed

33. Arcopinto, M, Salzano, A, Bossone, E, Ferrara, F, Bobbio, E, Sirico, D, et al.. Multiple hormone deficiencies in chronic heart failure. Int J Cardiol 2015;184:421–3. https://doi.org/10.1016/j.ijcard.2015.02.055.Search in Google Scholar PubMed

34. Radchenko, GD, Zhyvylo, IO, Titov, EY, Sirenko, YM. Systemic arterial stiffness in new diagnosed idiopathic pulmonary arterial hypertension patients. Vasc Health Risk Manag 2020;16:29–39. https://doi.org/10.2147/vhrm.s230041.Search in Google Scholar

35. Marra, AM, Arcopinto, M, Bossone, E, Ehlken, N, Cittadini, A, Grünig, E. Pulmonary arterial hypertension- related myopathy: an overview of current data and future perspectives. Nutr Metabol Cardiovasc Dis 2015;25:131–9. https://doi.org/10.1016/j.numecd.2014.10.005.Search in Google Scholar PubMed

36. Marra, AM, Halank, M, Benjamin, N, Bossone, E, Cittadini, A, Eichstaedt, CA, et al.. Right ventricular size and function under riociguat in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (the RIVER study). Respir Res 2018;19:258. https://doi.org/10.1186/s12931-018-0957-y.Search in Google Scholar PubMed PubMed Central

37. De Luca, M, Bosso, G, Guardasole, VVA, Botta, A, Carbone, V, et al.. Management of patients with chronic heart failure and type 2 diabetes mellitus: the SCODIAC-II study. Intern Emerg Med 2021;16:895–903. https://doi.org/10.1007/s11739-020-02528-4.Search in Google Scholar PubMed

38. Giallauria, F, Ling, SM, Schreiber, C, Maggio, M, Shetty, V, Muller, D, et al.. Arterial stiffness and bone demineralization: the Baltimore longitudinal study of aging. Am J Hypertens 2011;24:970–5. https://doi.org/10.1038/ajh.2011.80.Search in Google Scholar PubMed PubMed Central

39. Giallauria, F, Milaneschi, Y, Tanaka, T, Maggio, M, Canepa, M, Elango, P, et al.. Arterial stiffness and vitamin D levels: the Baltimore longitudinal study of aging. J Clin Endocrinol Metab 2012;97:3717–23. https://doi.org/10.1210/jc.2012-1584.Search in Google Scholar PubMed PubMed Central

40. Sacca, F, Puorro, G, Marsili, A, Antenora, A, Pane, C, Casali, C, et al.. Long-term effect of epoetin alfa on clinical and biochemical markers in friedreich ataxia. Mov Disord 2016;31:734–41. https://doi.org/10.1002/mds.26552.Search in Google Scholar PubMed

41. Campo, D, Khettab, H, Yu, R, Genain, N, Edouard, P, Buard, N, et al.. Measurement of aortic pulse wave velocity with a connected bathroom scale. Am J Hypertens 2017;30:876–83. https://doi.org/10.1093/ajh/hpx059.Search in Google Scholar PubMed PubMed Central

42. Dumor, K, Shoemaker-Moyle, M, Nistala, R, Whaley-Connell, A. Arterial stiffness in hypertension: an update. Curr Hypertens Rep 2018;4;20:72. https://doi.org/10.1007/s11906-018-0867-x.Search in Google Scholar PubMed

43. Van der Heijden-Spek, JJ, Staessen, JA, Fagard, RH, Hoeks, AP, Boudier, HA, van Bortel, LM. Effect of age on brachial artery wall properties differs from the aorta and is gender dependent: a population study. Hypertension 2000;35:637–42. https://doi.org/10.1161/01.hyp.35.2.637.Search in Google Scholar PubMed

44. Laogun, AA, Gosling, RG. In vivo arterial compliance in man. Clin Phys Physiol Meas 1982;3:201–12. https://doi.org/10.1088/0143-0815/3/3/004.Search in Google Scholar PubMed

45. Willum-Hansen, T, Staessen, JA, Torp-Pedersen, C, Rasmussen, S, Thijs, L, Ibsen, H, et al.. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006;113:664–70. https://doi.org/10.1161/circulationaha.105.579342.Search in Google Scholar

46. Asmar, R, Topouchian, J, Pannier, B, Benetos, A, Safar, M. Pulse wave velocity as endpoint in large-scale intervention trial. The complior study. Scientific, quality control, coordination and investigation committees of the complior study. J Hypertens 2001;19:813–18. https://doi.org/10.1097/00004872-200104000-00019.Search in Google Scholar PubMed

47. Asmar, R, Benetos, A, Topouchian, J, Laurent, P, Pannier, B, Brisac, AM, et al.. Assessment of arterial distensibility by automatic pulse wave velocity measurement. Validation and clinical application studies. Hypertension 1995;26:485–90. https://doi.org/10.1161/01.hyp.26.3.485.Search in Google Scholar PubMed

48. Gavish, B, Izzo, JLJr. Arterial stiffness: going a step beyond. J Hypertens 2016;29:1223–33. https://doi.org/10.1093/ajh/hpw061.Search in Google Scholar PubMed

49. Van der Heijden-Spek, JJ, Staessen, JA, Fagard, RH, Hoeks, AP, Boudier, HA, van Bortel, LM. Effect of age on brachial artery wall properties differs from the aorta and is gender dependent: a population study. Hypertension 2000;35:637–42. https://doi.org/10.1161/01.hyp.35.2.637.Search in Google Scholar

50. Giannattasio, C, Mancia, G. Arterial distensibility in humans. Modulating mechanisms, alterations in diseases and effects of treatment. J Hypertens 2002;20:1889–99. https://doi.org/10.1097/00004872-200210000-00001.Search in Google Scholar PubMed

51. Cerbone, M, Capalbo, D, Wasniewska, M, Alfano, S, Mattace Raso, G, Oliviero, U, et al.. Effects of L-thyroxine treatment on early markers of atherosclerotic disease in children with subclinical hypothyroidism. Eur J Endocrinol 2016;175:11–9. https://doi.org/10.1530/eje-15-0833.Search in Google Scholar
Received: 2021-06-25
Accepted: 2021-07-05
Published Online: 2021-07-20

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Minireview
  3. Can pulse wave velocity (PWV) alone express arterial stiffness? A neglected tool for vascular function assessment
  4. Review
  5. Hyponatremia in heart failure: not just 135 to 145
  6. Original Articles
  7. Effects of berberine on cholinesterases and monoamine oxidase activities, and antioxidant status in the brain of streptozotocin (STZ)-induced diabetic rats
  8. Paradoxical sleep deprivation induces oxidative stress in the submandibular glands of Wistar rats
  9. Terminalia arjuna supplementation ameliorates high fat diet-induced oxidative stress in nephrotoxic rats
  10. Decreased expression of annexin A2 and loss of its association with vascular endothelial growth factor leads to the deficient trophoblastic invasion in preeclampsia
  11. Algogen-induced vasosensory reflexes modulate short-term heart rate variability parameters in experimental rat models
  12. Assessment of sleep quality and its predictors among newly diagnosed psychiatric patients
  13. Ovalbumin/lipopolysaccharide induced vasculitis in rats: a new predictive model
  14. Dose-dependent and time-dependent metabolic, hemodynamic, and redox disturbances in dexamethasone-treated Wistar rats
  15. Effects of sleeve gastrectomy on neutrophil–lymphocyte ratio
  16. Effect of luteolin on the gene level expression of apoptosis-associated speck-like protein containing a caspase recruitment domain of NLRP3 inflammasome and NF-κB in rats subjected to experimental pancreatitis – influence of HSP70
  17. Effects of Onosma dichroanthum Boiss. root extract on AGS human gastric cancer cell-line
  18. Feasibility, face, and content validity of quantitative computed tomography in interstitial lung disease related to connective tissue diseases
  19. In vitro anticoagulant activity of selected medicinal plants: potential interactions with warfarin and development of new anticoagulants
  20. Normal reference value of orthodromic and antidromic sensory nerve conduction velocity of median nerve with intact palmaris longus tendon in apparently healthy individuals
  21. Short Communication
  22. Chemokine receptor antagonists with α1-adrenergic receptor blocker activity
https://doi.org/10.1515/jbcpp-2021-0193
Keywords for this article
arterial stiffness; cardiovascular risk; hypertension; pulse wave velocity

Articles in the same Issue

  1. Frontmatter
  2. Minireview
  3. Can pulse wave velocity (PWV) alone express arterial stiffness? A neglected tool for vascular function assessment
  4. Review
  5. Hyponatremia in heart failure: not just 135 to 145
  6. Original Articles
  7. Effects of berberine on cholinesterases and monoamine oxidase activities, and antioxidant status in the brain of streptozotocin (STZ)-induced diabetic rats
  8. Paradoxical sleep deprivation induces oxidative stress in the submandibular glands of Wistar rats
  9. Terminalia arjuna supplementation ameliorates high fat diet-induced oxidative stress in nephrotoxic rats
  10. Decreased expression of annexin A2 and loss of its association with vascular endothelial growth factor leads to the deficient trophoblastic invasion in preeclampsia
  11. Algogen-induced vasosensory reflexes modulate short-term heart rate variability parameters in experimental rat models
  12. Assessment of sleep quality and its predictors among newly diagnosed psychiatric patients
  13. Ovalbumin/lipopolysaccharide induced vasculitis in rats: a new predictive model
  14. Dose-dependent and time-dependent metabolic, hemodynamic, and redox disturbances in dexamethasone-treated Wistar rats
  15. Effects of sleeve gastrectomy on neutrophil–lymphocyte ratio
  16. Effect of luteolin on the gene level expression of apoptosis-associated speck-like protein containing a caspase recruitment domain of NLRP3 inflammasome and NF-κB in rats subjected to experimental pancreatitis – influence of HSP70
  17. Effects of Onosma dichroanthum Boiss. root extract on AGS human gastric cancer cell-line
  18. Feasibility, face, and content validity of quantitative computed tomography in interstitial lung disease related to connective tissue diseases
  19. In vitro anticoagulant activity of selected medicinal plants: potential interactions with warfarin and development of new anticoagulants
  20. Normal reference value of orthodromic and antidromic sensory nerve conduction velocity of median nerve with intact palmaris longus tendon in apparently healthy individuals
  21. Short Communication
  22. Chemokine receptor antagonists with α1-adrenergic receptor blocker activity
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