Establishing the interchangeability of arterial stiffness but not endothelial function parameters in healthy individuals

Abstract

Background Development of instruments capable of detecting early stage vascular disease has increased interest in employing arterial stiffness (e.g. pulse wave velocity (PWV), augmentation index (AIx)) and endothelial dysfunction (e.g. reactive hyperemia index (RHI)) to diagnose atherosclerotic disease before occurrence of a cardiovascular event. However, amongst the equipment designed for this purpose, there is insufficient information regarding each of these parameters to establish appropriate cutoffs to distinguish between healthy and unhealthy blood vessels. To address these limitations, the study was designed to establish the upper arterial stiffness and endothelial function thresholds in a healthy population, by comparing the outputs from different instruments capable of measuring PWV, AIx and RHI. Methods A systematic comparison of PWV, AIx and RHI was conducted to determine the inter-relationships between these parameters of vascular functionality. Outputs were obtained non-invasively using three instruments, the VP-1000 (VP), SphygmoCor (SC), and EndoPAT (EP), in 40 apparently healthy males and females. Results Correlations were found between the brachial-ankle PWV and radial-ankle PWV (by VP and SC), and PWV (VP) with AIx (SC). The interchangeability of these outputs was demonstrated by the Bland Altman test, making it feasible to extrapolate cut-offs for radial-ankle PWV and AIx equivalent to brachial-ankle PWV that signify healthy vessels. In contrast, RHI showed no association with AIx, suggesting these endothelial and arterial parameters are functionally distinct. Conclusions It was concluded that it is possible to compare the vascular function outputs of different instruments and identify healthy from unhealthy vessels, even though the approaches for quantifying the underlying physiological processes may differ. In this way, non-invasive determination of arterial function could be a new paradigm for detecting existing early stage asymptomatic atherosclerotic disease in individuals using techniques that are amenable to the clinical setting. Electronic supplementary material The online version of this article (10.1186/s12872-019-1167-3) contains supplementary material, which is available to authorized users.

The association between baseline circulating progenitor cells and vascular function: The role of aging and risk factors

“…This finding is consistent with previous reports among individuals without a history of cardiovascular disease. 43 Linear associations were found between increasing number of risk factors and worsening vascular function (higher PWV and lower RHI) after adjusting for age, sex, and race (Figure 2).…”

Associations Between Depression, Arterial Stiffness, and Metabolic Syndrome Among Adults in the UK Biobank Population Study

“…Consistent with the key role of AS in predicting MACE incidence, carotid pulse wave velocity represents the criterion-standard measure for central AS, and several other noninvasive techniques (eg, photoplethysmography) are available as indicators of specific AS parameters (eg, wave reflections) . While the interchangeability of these measures needs further research, they were found to be independently associated with incident MACE across different subgroups . Therefore, a key unanswered question for public health is the extent to which the adverse effect of depression on MACE might be mitigated by targeting modifiable metabolic mediators.…”

Vascular phenotypes in early hypertension

“…FMD and EndoPAT™-2000® are not inter-changeable techniques [ 25 ], reflecting macro- and micro-vascular function, respectively. Longitudinal data have demonstrated increased prevalence of hypertension and elevated PWV in impaired FMD [ 26 , 27 ], but contrasting evidence from both healthy and untreated hypertensive individuals shows no association with incident hypertension [ 27 ] or arterial stiffness, and suggests that no excess of microvascular dysfunction exists among otherwise healthy incident hypertensive individuals [ 28 – 30 ]. Indeed, the hypertensive subgroup demonstrated positive correlation of LnRHI with 24 h SBP, suggesting that the endothelium may demonstrate early compensation in hypertension and arterial stiffening.…”