Aortic Pulse Wave Velocity Improves Cardiovascular Event Prediction

Early detection of subclinical atherosclerosis is important to reduce patients’ cardiovascular risk. However, current diagnostic strategy focusing on traditional risk factors or using risk scoring is not satisfactory. Non-invasive imaging tools also have limitations such as cost, time, radiation hazard, renal toxicity, and requirement for specialized techniques or instruments. There is a close interaction between arterial stiffness and atherosclerosis. Increased luminal pressure and shear stress by arterial stiffening causes endothelial dysfunction, accelerates the formation of atheroma, and stimulates excessive collagen production and deposition in the arterial wall, leading to the progression of atherosclerosis. Pulse wave velocity (PWV), themost widely usedmeasure of arterial stiffness, has emerged as a useful tool for the diagnosis and risk stratification of cardiovascular disease (CVD). The measurement of PWV is simple, non-invasive, and reproducible. There have been many clinical studies and meta-analyses showing the association between PWV and coronary/cerebral/carotid atherosclerosis. More importantly, longitudinal studies have shown that PWV is a significant risk factor for future CVD independent of well-known cardiovascular risk factors. The measurement of PWV may be a useful tool to select subjects at high risk of developing subclinical atherosclerosis or CVD especially in mass screening.

The most widely used measure of arterial stiffness is pulse wave velocity (PWV). As PWV is the measure of the speed of arterial pressure waves traveling along the aorta and large arteries, it is usually calculated by dividing distance with pressure wave transit time at the two points of recording arteries.

PWV becomes faster in stiffened artery, and PWV value is elevated. The measurement of PWV is clinically valuable because it is simple, non-invasive, inexpensive, and reproducible .

The predictive value of PWV for the occurrence of CVD has been reported in the general population and patients with various clinical conditions.Mattace-Raso et al. investigated 2,835 community healthy subjects and showed that cfPWV is an independent predictor of coronary heart disease and stroke during 4 years of clinical follow-up. Another population study involving 1,678 community subjects over a median followup of 9.4 years, showed a similar finding that aortic PWV predicted composite cardiovascular outcomes beyond traditional risk factors. PWV also play a role as an independent predictor of future CVD in patients with hypertension, diabetes, end-stage renal disease, stroke, and CAD.

Conclusion: PWV is well-correlated with the presence and extent of coronary, cerebral, and carotid atherosclerosis. More importantly, PWV had a predictive value in CVD beyond traditional risk factors in the general population and patients with various diseases. Considering its non-invasiveness, simplicity and abundant clinical data, measurement of PWV may be a useful tool to select subjects at a high risk of developing atherosclerosis especially in mass screening.

 (Kim, 2019)