Measuring the Carotid to Femoral Pulse Wave Velocity (Cf-PWV) to Evaluate Arterial Stiffness
Summary
This protocol describes a method to standardize the measurements of carotid-femoral pulse wave velocity to evaluate arterial stiffness.
Abstract
For the elderly, arterial stiffening is a good marker for aging evaluation and it is recommended that the arterial stiffness be determined noninvasively by the measurement of carotid to femoral pulse wave velocity (cf-PWV) (Class I; Level of Evidence A). In literature, numerous community-based or disease-specific studies have reported that higher cf-PWV is associated with increased cardiovascular risk. Here, we discuss strategies to evaluate arterial stiffness with cf-PWV. Following the well-defined steps detailed here, e.g., proper position operator, distance measurement, and tonometer position, we will obtain a standard cf-PWV value to evaluate arterial stiffness. In this paper, a detailed stepwise method to record a good quality PWV and pulse wave analysis (PWA) using a non-invasive tonometry-based device will be discussed.
Introduction
Arterial stiffening is a good marker for vascular aging evaluation1,2. The measurement of arterial stiffening is traditionally conducted using a pulse wave velocity (PWV) methodology that is an important and reliable measure of arterial stiffness1,3,4,5. Specifically, PWV represents the stiffness of a specific arterial segment. The pulse wave is transmitted through the arterial vessels in a specific segment, and its speed is inversely related to the viscoelastic properties of the wall itself6. PWV value increases with arterial stiffening.
Carotid-femoral PWV (cf-PWV) and brachial-ankle PWV (ba-PWV) are the 2 most frequently applied PWV measurements. They are widely used in clinical practice, where cf-PWV is popular in western countries and ba-PWV is popular in Asian countries.7,8. In fact, cf-PWV has been considered as the 'gold-standard' measurement of arterial stiffness1. For cf-PWV, it is taken as representative of the PWV for the entire aorta. Besides, for ba- PWV, there is no true arterial pathway linking the measurement sites (brachial to ankle). The estimated ba-PWV represents the PWV for the entirety of the central and peripheral arterial system9. A previous study has reported that cf-PWV is superior to ba-PWV in associations with asymptomatic hypertensive target organ damage (TOD)10 (Figure 1).
Non-invasive devices for regional stiffness equipped with a specific tonometer are increasingly being used to measure the stiffness of the carotid to femoral segment1. In cf-PWV measurements, this device and a handheld tonometer create a steady waveform on the computer that can record high resolution digital waveform images and the specific PWV values (Figure 2). All these measurements need to be standardized. Here, we show how to record a good quality cf-PWV with this non-invasive tonometry-based device in a real-world setting.
Some established cardiovascular risk prediction models such as the Framingham risk score and the SCORE Risk Charts are mainly calculated and sorted by conventional risk factors11,12. However, some novel biomarkers should be added into the risk assessment model to improve the risk stratification13. In literature, arterial stiffening is considered as an intermediate state between conventional risk factors and clinical cardiovascular events14. Thus, adding cf-PWV into the risk assessment model may be a tool for risk stratification15,16.
Here, we generate a methodology plan to assess participants' cf-PWV, together with PWA, to establish a standard protocol for arterial stiffening assessment.
Protocol
Representative Results
Discussion
Here, we demonstrate a widely accessible methodology to assess the participants' novel preclinical vascular TOD, arterial stiffness, evaluated by cf-PWV. In order to compare PWs with minimal hemodynamic differences between measurements done prior to devices, only accept data when the brachial systolic and diastolic BP varied by less than 3 mmHg. This reduces the deviation caused by human manipulation. In this protocol, the critical steps are to have standardized patient conditions using 80% of the direct straight dis…
Divulgations
The authors have nothing to disclose.
Acknowledgements
This work is under the financial support from National key research and development program of China (Grant No. 2017YFC0111800) and the Shanghai municipal government (Grant ID. 2013ZYJB0902 and 15GWZK1002). Dr. Yi Zhang was supported by the National Nature Science Foundation of China (Grant ID. 81300239 and 81670377).
Materials
| SphygmoCor tonometry-based device | AtCor Medical, Australia | For central blood pressures and cf-PWV | |
| Electrodes | AtCor Medical, Australia | To record the ECG | |
| Semiautomatic Oscillometric device | OMRON Healthcare, kyoto, Japan | To measure brachial BP |
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