Expert Consensus on the Clinical Use of Pulse Wave Velocity in Asia

Abstract

Arterial stiffness is a progressive aging process that predicts cardiovascular disease. Pulse wave velocity (PWV) has emerged as a noninvasive, valid, and reliable measure of arterial stiffness and an independent risk predictor for adverse outcomes. However, up to now, PWV measurement has mostly been used as a tool for risk prediction and has not been widely used in clinical practice. This consensus paper aims to discuss multiple PWV measurements currently available in Asia and to provide evidence-based assessment together with recommendations on the clinical use of PWV. For the methodology, PWV measurement including the central elastic artery is essential and measurements including both the central elastic and peripheral muscular arteries, such as brachial-ankle PWV and cardio-ankle vascular index, can be a good alternative. As Asian populations are rapidly aging, timely detection and intervention of "early vascular aging" in terms of abnormally high PWV values are recommended. More evidence is needed to determine if a PWV-guided therapeutic approach will be beneficial to the prevention of cardiovascular diseases beyond current strategies. Large-scale randomized controlled intervention studies are needed to guide clinicians.

Keywords: Arterial stiffness; Asia; Cardiovascular disease; Pulse wave velocity.

Fig. 1

Path length formula for baPWV (source, see ref. 22).

Fig. 2

Determination of the cardio-ankle vascular index (CAVI). Ps, systolic blood pressure of brachial artery; Pd, diastolic blood pressure; haPWV, pulse wave velocity from the origin of the aorta to the ankle at mid pressure; ∆P, Ps-Pd; ρ, blood density; a and b, constants to convert the values of CAVI to those of Hasegawa's hfPWV; T, time of the pulse from aortic valve to the ankle; L, length of the arterial tree from the origin of aorta to the ankle.

Fig. 3

Clinical implications of CAVI and improving methods. ARB, angiotensin receptor antagonist; CCB, calcium channel blocker; CPAP, continuous positive airway pressure; SAS, sleep apnea syndrome.

Fig. 4

Measurement schematic diagram of carotid-femoral pulse wave velocity, aortic arch-femoral pulse wave velocity, and aortic pulse wave velocity. The surface distance between the recording sites of right common carotid artery and right femoral artery is depicted as the straight red line. The path of the pulse wave travelling from the aortic arch (near the bifurcation of the brachiocephalic artery) to the recording site of right femoral artery is depicted as the red curved line. The path of the pulse wave travelling from the aortic root to the end of abdominal aorta (near the bifurcation of the right and left common iliac arteries) is depicted as the thick black curved line.

Fig. 5

Concept and biomarkers of the systemic hemodynamic atherothrombotic syndrome. AI, augmentation index; BNP, B-type natriuretic peptide; CAVI, cardio-ankle vascular index; FMD, flow-mediated dilation; UACR, urinary albumin/creatinine ratio. (Source: Kario. Nat Rev Nephrol. 2013;9:726–738 and Kario. Prog Cardiovasc Dis. 2016;59:262–281.)