Catherine Fortier1, Marie-Pier Desjardins1, Mohsen Agharazii1. 1. CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada.
Abstract
BACKGROUND: Aortic stiffness, measured by carotid-femoral pulse wave velocity (cf-PWV), is used for the prediction of cardiovascular risk. This mini-review describes the nonlinear relationship between cf-PWV and operational blood pressure, presents the proposed methods to adjust for this relationship, and discusses a potential place for aortic-brachial PWV ratio (a measure of arterial stiffness gradient) as a blood pressure-independent measure of vascular aging. SUMMARY: PWV is inherently dependent on the operational blood pressure. In cross-sectional studies, PWV adjustment for mean arterial pressure (MAP) is preferred, but still remains a nonoptimal approach, as the relationship between PWV and blood pressure is nonlinear and varies considerably among individuals due to heterogeneity in genetic background, vascular tone, and vascular remodeling. Extrapolations from the blood pressure-independent stiffness parameter β (β0) have led to the creation of stiffness index β, which can be used for local stiffness. A similar approach has been used for cardio-ankle PWV to generate a blood pressure-independent cardio-ankle vascular index (CAVI). It was recently demonstrated that stiffness index β and CAVI remain slightly blood pressure-dependent, and a more appropriate formula has been proposed to make the proper adjustments. On the other hand, the negative impact of aortic stiffness on clinical outcomes is thought to be mediated through attenuation or reversal of the arterial stiffness gradient, which can also be influenced by a reduction in peripheral medium-sized muscular arteries in conditions that predispose to accelerate vascular aging. Arterial stiffness gradient, assessed by aortic-brachial PWV ratio, is emerging to be at least as good as cf-PWV for risk prediction, but has the advantage of not being affected by operating MAP. KEY MESSAGES: The negative impacts of aortic stiffness on clinical outcomes are proposed to be mediated through attenuation or reversal of arterial stiffness gradient. Aortic-brachial PWV ratio, a measure of arterial stiffness gradient, is independent of MAP.
BACKGROUND: Aortic stiffness, measured by carotid-femoral pulse wave velocity (cf-PWV), is used for the prediction of cardiovascular risk. This mini-review describes the nonlinear relationship between cf-PWV and operational blood pressure, presents the proposed methods to adjust for this relationship, and discusses a potential place for aortic-brachial PWV ratio (a measure of arterial stiffness gradient) as a blood pressure-independent measure of vascular aging. SUMMARY: PWV is inherently dependent on the operational blood pressure. In cross-sectional studies, PWV adjustment for mean arterial pressure (MAP) is preferred, but still remains a nonoptimal approach, as the relationship between PWV and blood pressure is nonlinear and varies considerably among individuals due to heterogeneity in genetic background, vascular tone, and vascular remodeling. Extrapolations from the blood pressure-independent stiffness parameter β (β0) have led to the creation of stiffness index β, which can be used for local stiffness. A similar approach has been used for cardio-ankle PWV to generate a blood pressure-independent cardio-ankle vascular index (CAVI). It was recently demonstrated that stiffness index β and CAVI remain slightly blood pressure-dependent, and a more appropriate formula has been proposed to make the proper adjustments. On the other hand, the negative impact of aortic stiffness on clinical outcomes is thought to be mediated through attenuation or reversal of the arterial stiffness gradient, which can also be influenced by a reduction in peripheral medium-sized muscular arteries in conditions that predispose to accelerate vascular aging. Arterial stiffness gradient, assessed by aortic-brachial PWV ratio, is emerging to be at least as good as cf-PWV for risk prediction, but has the advantage of not being affected by operating MAP. KEY MESSAGES: The negative impacts of aortic stiffness on clinical outcomes are proposed to be mediated through attenuation or reversal of arterial stiffness gradient. Aortic-brachial PWV ratio, a measure of arterial stiffness gradient, is independent of MAP.
Authors: Kennedy Cruickshank; Lisa Riste; Simon G Anderson; John S Wright; Graham Dunn; Ray G Gosling Journal: Circulation Date: 2002-10-15 Impact factor: 29.690
Authors: Dean S Picone; Martin G Schultz; Rachel E D Climie; Velandai Srikanth; James E Sharman Journal: J Hypertens Date: 2016-06 Impact factor: 4.844
Authors: Gary F Mitchell; Helen Parise; Emelia J Benjamin; Martin G Larson; Michelle J Keyes; Joseph A Vita; Ramachandran S Vasan; Daniel Levy Journal: Hypertension Date: 2004-05-03 Impact factor: 10.190
Authors: Carmen de Keijzer; Maria Foraster; Xavier Basagaña; Cathryn Tonne; Lucia Alonso Garcia; Antònia Valentín; Mika Kivimäki; Mark J Nieuwenhuijsen; Jordi Alonso; Josep M Antó; Archana Singh-Manoux; Jordi Sunyer; Payam Dadvand Journal: Environ Health Perspect Date: 2020-06-26 Impact factor: 9.031
Authors: Keeron Stone; Simon Fryer; James Faulkner; Michelle L Meyer; Kevin Heffernan; Anna Kucharska-Newton; Gabriel Zieff; Craig Paterson; Kunihiro Matsushita; Timothy M Hughes; Hirofumi Tanaka; Lee Stoner Journal: J Hypertens Date: 2021-12-01 Impact factor: 4.844