Better Management of Cardiovascular Diseases by Pulse Wave Velocity: Combining Clinical Practice with Clinical Research using Evidence-Based Medicine

Abstract

Arterial stiffness measured by pulse wave velocity (PWV) is an accepted strong, independent predictor of cardiovascular events and mortality. However, lack of a reliable reference range has limited its use in clinical practice. In this evidence-based review, we applied published data to develop a PWV risk stratification model and demonstrated its impact on the management of common clinical scenarios. After reviewing 97 studies where PWV was measured, 5 end-stage renal disease patients, 5 hypertensives, 2 diabetics, and 2 elderly studies were selected. Pooling the data by the "fixed-effect model" demonstrated that the mortality and cardiovascular event risk ratio for one level increment in PWV was 2.41 (1.81-3.20) or 1.69 (1.35-2.11), respectively.There was a significant difference in PWV between survived and deceased groups, both in the low and high risk populations. Furthermore, risk comparison demonstrated that 1 standard deviation increment in PWV is equivalent to 10 years of aging, or 1.5 to 2 times the risk of a 10 mmHg increase in systolic blood pressure. Evidence shows that PWV can be beneficially used in clinical practice for cardiovascular risk stratification. Furthermore, the above risk estimates could be incorporated into currently used cardiac risk scores to improve their predictive power and facilitate the clinical application of PWV.

Measurement of pulse wave velocity in children and young adults: a comparative study using three different devices

“…5 In this context, it has been widely recognized that aortic pulse wave velocity (aPWV) is a sensitive marker of arterial stiffness and, consequently, of cardiovascular outcome. [6][7][8][9] In a previous work, including more than 1000 children and teenagers, we provided reference values for pulse wave velocity (PWV), thereby constituting a suitable tool for longitudinal clinical studies assessing subgroups of children who are at long-term risk of cardiovascular disease. 10 A multitude of various methods and techniques have been used to assess PWV in adults such as applanation tonometry, 11,12 ultrasound, 13,14 methods using mechanotransducers 15 and computerized oscillometry; 16 furthermore, a number of comparative studies with diverging results have been published concerning the comparability of the different methods.…”

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“…A stiff artery could result from either or both of the following conditions: 1) physiologic impairment of the arterial tissue, 2) occlusion inside the artery, i.e., atherosclerosis. Arterial stiffness is an accepted, strong, independent predictor of cardiovascular events and mortality [50]. While direct measurement of PWV is the "gold standard" requiring physician skill and time, a new method based on photoplethysmography is available.…”

Pulse Wave Velocity Testing in the Baltimore Longitudinal Study of Aging

“…Research is being conducted to correlate arterial stiffness with cognitive disorders, renal disease 16 , diabetes, and arthritis. Advances in the technique of performing PWV will serve to facilitate research in these areas by making measurements easier, less operator dependent, and improving reproducibility within individuals.…”