Threshold values of brachial cuff-measured arterial stiffness indices determined by comparisons with the brachial–ankle pulse wave velocity: a cross-sectional study in the Chinese population

Abstract

BackgroundArterial Velocity-pulse Index (AVI) and Arterial Pressure-volume Index (API), measured by a brachial cuff, have been demonstrated to be indicative of arterial stiffness and correlated with the risk of cardiovascular events. However, the threshold values of AVI and API for screening increased arterial stiffness in the general population are yet to be established.MethodsThe study involved 860 subjects who underwent general physical examinations (M/F = 422/438, age 53.4 ± 12.7 years) and were considered to represent the general population in China. In addition to the measurements of AVI, API and brachial-ankle pulse wave velocity (baPWV), demographic information, arterial blood pressures, and data from blood and urine tests were collected. The threshold values of AVI and API were determined by receiver operating characteristic (ROC) analyses and covariate-adjusted ROC (AROC) analyses against baPWV, whose threshold for diagnosing high arterial stiffness was set at 18 m/s. Additional statistical analyses were performed to examine the correlations among AVI, API and baPWV and their correlations with other bio-indices.ResultsThe area under the curve (AUC) values in ROC analysis for the diagnosis with AVI/API were 0.745/0.819, 0.788/0.837, and 0.772/0.825 (95% CI) in males, females, and all subjects, respectively. Setting the threshold values of AVI and API to 21 and 27 resulted in optimal diagnosis performance in the total cohort, whereas the threshold values should be increased to 24 and 29, respectively, in order to improve the accuracy of diagnosis in the female group. The AROC analyses revealed that the threshold values of AVI and API increased markedly with age and pulse pressure (PP), respectively.ConclusionsWith appropriate threshold values, AVI and API can be used to perform preliminary screening for individuals with increased arterial stiffness in the general population. On the other hand, the results of the AROC analyses imply that using threshold values adjusted for confounding factors may facilitate the refinement of diagnosis. Given the fact that the study is a cross-sectional one carried out in a single center, future multi-center or follow-up studies are required to further confirm the findings or examine the value of the threshold values for predicting cardiovascular events.

Arterial Stiffness and Cardiovascular Risk: The Role of Brachial Cuff-measured Index

“…Arterial velocity-pulse index (AVI) and arterial pressure-volume index (API) are non-invasive indices for assessing arterial stiffness, which are noninvasively measured using a single brachial oscillometric cuff operating similarly to that used in blood pressure measurement [11,12]. Previous studies have extensively demonstrated the significant correlations between AVI and API and PWV in healthy individuals [11], which suggests that AVI and API hold the potential to serve as viable alternatives to PWV for assessing arterial stiffness [13]. The device used to measure AVI and API (i.e., Portable Arterial Pulse Wave Detector (PASESA AVE-2000 Pro, DAIWA Healthcare, Shenzhen, China) has been certificated and put on the market in China since 2016.…”

“…The measurement is easier to implement than traditional arterial stiffness measurements, requires less time, and is more comfortable in terms of postural requirements. These merits make the device wellsuited for wide use in clinical settings and large-scale community screening [13,14].…”

“…AVI and API contain information not only related to arterial stiffness but also pertaining to cardiac systolic function, thus serving as potential indicators to alert about impending cardiovascular events [23]. Several studies have confirmed the clinical significance of AVI and API and their relevance to CVD [13,24]. Sasaki-Nakashima et al reported that API was independently associated with the FCVRS, suggesting that API is a valuable predictor of forthcoming CVD events [25].…”

“…AVI, which is derived from the morphology of cuff oscillation wave, is more prone to the influence of the thickness of soft tissue in the upper arm. Thicker upper arm tissue in overweighted subjects may blunt the transmission of brachial arterial lumen deformation (induced by blood pressure pulsation) to cuff bladder volume change leading to an underestimation of AVI [13,16,38].…”