Clinical applications of arterial stiffness; definitions and reference values

Abstract

Arterial stiffening is the most important cause of increasing systolic and pulse pressure, and for decreasing diastolic pressure beyond 40 years of age. Stiffening affects predominantly the aorta and proximal elastic arteries, and to a lesser degree the peripheral muscular arteries. While conceptually a Windkessel model is the simplest way to visualize the cushioning function of arteries, this is not useful clinically under changing conditions when effects of wave reflection become prominent. Many measures have been applied to quantify stiffness, but all are approximations only, on account of the nonhomogeneous structure of the arterial wall, its variability in different locations, at different levels of distending pressure, and with changes in smooth muscle tone. This article summarizes the methods and indices used to estimate arterial stiffness, and provides values from a survey of the literature, followed by recommendations of an international group of workers in the field who attended the First Consensus Conference on Arterial Stiffness, which was held in Paris during 2000, under the chairmanship of M.E. Safar and E.D. Frohlich.

Impact of Vascular Hemodynamics on Aortic Stenosis Evaluation: New Insights Into the Pathophysiology of Normal Flow—Small Aortic Valve Area—Low Gradient Pattern

“…Arterial stiffening has been associated with hypertension, dyslipidemia, diabetes mellitus, and atherosclerosis 29, 30, 31, 32, 33. The buffering action of the systemic arterial system is reduced with rAC.…”

“…The buffering action of the systemic arterial system is reduced with rAC. rAC is a major contributor to the development of systolic hypertension, contributing to LV afterload and decreased coronary flow during diastole, and it has been shown to be a strong predictor of LV dysfunction and adverse events 30, 31, 32, 33, 34. Patients with AS already have increased LV afterload because of valvular stenosis, and it has been demonstrated that rAC has a significant additive effect and contributes to LV dysfunction and occurrence of adverse outcomes 22, 35.…”

Changes of central haemodynamic parameters during mental stress and acute bouts of static and dynamic exercise

“…The ageassociated stiffening results in increased central systolic blood pressure (SBP) because the cushioning function to accommodate the systolic volume ejected by the left ventricle cannot be performed without a significant increase in peak blood pressure (BP). 2 The contribution of reflected pulse wave is of critical importance in this respect. When arteries are compliant and elastic, the reflected wave merges with the outgoing wave in the late systolic or diastolic phase and there is little or no effect on central SBP.…”

Relationship between blood pressure parameters and pulse wave velocity in normotensive and hypertensive subjects: invasive study

“…15 Although there are many measures to quantify stiffness, none of them is a gold standard, but approximations. 16,17 It is believed that the most reliable (and still probably the best) measure of arterial stiffness is pulse wave velocity (PWV). 16 PWV is known to be associated with age, gender, blood pressure (BP), heart rate, salt intake, genetic factors and others.…”

“…16,17 It is believed that the most reliable (and still probably the best) measure of arterial stiffness is pulse wave velocity (PWV). 16 PWV is known to be associated with age, gender, blood pressure (BP), heart rate, salt intake, genetic factors and others. Although BP is one of the strongest factors influencing PWV, varying correlation coefficients have been reported between the various PWV (aorta-leg-arm) and BP (systolic, diastolic, mean, pulse) using non-invasive methods.…”