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    Topic review

    Pulse Wave Velocity

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    Submitted by: Iván Cavero Redondo
    (This entry belongs to Entry Collection "Hypertension and Cardiovascular Diseases ")

    Definition

    Pulse wave velocity (PWV) is a simple, reproducible and non-invasive technique to assess arterial stiffness. It estimates the velocity of arterial wave propagation to travel a known distance between two anatomic sites within the arterial system [1]. PWV has been established as an independent predictor of cardiovascular mortality and is consequently used for diagnosis and prognosis in patients at risk of atherosclerotic cardiovascular disease [2]; however, PWV's significance relies on the fact that arterial stiffness, specially of muscular arteries can be modified by interventions that improve endothelial function such as exercise training, which makes PWV an important tool for cardiovascular risk management [3].

    1. Definition

    Pulse wave velocity (PWV) is a simple, reproducible and non-invasive technique to assess arterial stiffness. It estimates the velocity of arterial wave propagation to travel a known distance between two anatomic sites within the arterial system [1]. PWV has been established as an independent predictor of cardiovascular mortality and is consequently used for diagnosis and prognosis in patients at risk of atherosclerotic cardiovascular disease [2]; however, PWV's significance relies on the fact that arterial stiffness, specially of muscular arteries can be modified by interventions that improve endothelial function such as exercise training, which makes PWV an important tool for cardiovascular risk management [3].

    2. Introduction

    Pulse wave velocity (PWV) is considered the gold standard method for assessing aortic stiffness [4][5]. Arterial stiffness measures, and carotid femoral PWV (cfPWV) in particular, are being included in the routine clinical assessment of patients and within the framework of large-scale clinical studies [4] as new instrumental solutions that allow the PWV assessment, such as photoplethysmography or magnetic resonance emerge [6] (Table 1). Nevertheless, an introduction into clinical practice has not been implemented further due to the fact that there is a lack of established reference values based on a large population and due to the absence of a standardized methodology for PWV assessment [7].

    3. Methods used to Determine PWV

    Table 1. Methods used to determine PWV. aPWV: aortic pulse wave velocity; baPWV: brachial-ankle pulse wave velocity; cfPWV: carotid-femoral pulse wave velocity; DVP: digital volume pulse; ECG: electrocardiogram; PWV: pulse wave velocity.

     

    Method

    Description

    Measure

    Non-invasive methods

    Applanation tonometry

    Apply a pressure sensor through the skin and applanate a superficial artery by applying a downward pressure sufficient to flatten the artery.

    baPWV, cfPWV

    Computerized oscillometry

    Simultaneous acquisition and analysis of the pulsation of the artery, which is caused by the heart, as the pressure oscillation in the cuff.

    Heart-brachial PWV, heart-ankle PWV, brachial-ankle PWV,

    cfPWV

    Mechanotransducer

    Two dedicated piezoelectric pressure mechanotransducers directly applied to the skin in a simultaneous measurement of pressure pulses

    carotid–femoral, carotid–brachial or femoral–dorsalis pedis PWV

    Ultrasound

    Doppler pulses are recorded sequentially in 2 different arterial sites and compared

    using the R-wave of the ECG

    baPWV, cfPWV

    Photoplethysmography

    DVP measured by the photoplethysmography transducer

    DVP associated with aPWV

    Magnetic Resonance Imaging

    Assessment of the blood flow velocity with an enough temporal and spatial resolution to study the propagation of the aortic systolic flow wave

    Local PWV

    Invasive methods

    Aortic angiography

    Intra-aortic catheter measurements

    Local PWV

    Previous meta-analyses have attempted to calculate quantitative estimates of the predictive value of PWV for different outcomes. However, to the best of our knowledge, no previous meta-analysis has estimated the predictive performance (diagnostic odds ratio (dOR), sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR)) of PWV considering the thresholds for a higher risk of cardiovascular or all-cause mortality estimated using hierarchical summary receiver operating characteristic (HSROC) models. Moreover, reference values for PWV have been established through cross-sectional studies [7] or expert consensus [8], in which subjects by age and blood pressure categories with no additional identified cardiovascular risk factors were considered.

    The entry is from 10.3390/jcm9072080

    References

    1. James Oliver; David J. Webb; Noninvasive Assessment of Arterial Stiffness and Risk of Atherosclerotic Events. Arteriosclerosis, Thrombosis, and Vascular Biology 2003, 23, 554-566, 10.1161/01.atv.0000060460.52916.d6.
    2. Tomoki Shokawa; Michinori Imazu; Hideya Yamamoto; Mamoru Toyofuku; Naohito Tasaki; Tomokazu Okimoto; Kiminori Yamane; Nobuoki Kohno; Pulse Wave Velocity Predicts Cardiovascular Mortality. Circulation Journal 2005, 69, 259-264, 10.1253/circj.69.259.
    3. Michael F. O’Rourke; Junichiro Hashimoto; Arterial Stiffness. Journal of Cardiopulmonary Rehabilitation and Prevention 2008, 28, 225-237, 10.1097/01.hcr.0000327179.21498.38.
    4. G. Mancia; G. De Backer; Anna Dominiczak; Renata Cífková; R. Fagard; Giuseppe Germano; Guido Grassi; Anthony Heagerty; S. E. Kjeldsen; Stéphane Laurent; et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal 2006, 28, 1462-1536, 10.1093/eurheartj/ehm236.
    5. Raymond Townsend; Ian B. Wilkinson; Ernesto L. Schiffrin; Alberto P. Avolio; Julio A. Chirinos; John R. Cockcroft; Kevin S. Heffernan; Edward G. Lakatta; Carmel M. McEniery; Gary F. Mitchell; et al. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association.. Hypertension 2015, 66, 698-722, 10.1161/HYP.0000000000000033.
    6. Tania Pereira; Carlos Correia; João Cardoso; Novel Methods for Pulse Wave Velocity Measurement. Journal of Medical and Biological Engineering 2015, 35, 555-565, 10.1007/s40846-015-0086-8.
    7. Reference Values for Arterial Stiffness' Collaboration; The 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'.. European Heart Journal 2010, 31, 2338-50, 10.1093/eurheartj/ehq165.
    8. Luc M. Van Bortel; Stéphane Laurent; Pierre Boutouyrie; Phil Chowienczyk; J.K. Cruickshank; Tine De Backer; Jan Filipovsky; Sofie Huybrechts; Francesco U.S. Mattace-Raso; Athanase D Protogerou; et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. Journal of Hypertension 2012, 30, 445-448, 10.1097/hjh.0b013e32834fa8b0.
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