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Measuring the Carotid to Femoral Pulse Wave Velocity (Cf-PWV) to Evaluate Arterial Stiffness
Published on: May 3, 2018
Carotid pressure is a better predictor of coronary artery disease severity than brachial pressure
T K Waddell1, A M Dart, T L Medley
1Alfred and Baker Medical Unit, Baker Medical Research Institute, Prahran, Australia.
Insights
Central blood pressures and arterial stiffness are better indicators of coronary artery disease severity than brachial measurements. This finding highlights the importance of central hemodynamics in assessing cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
- Clinical Physiology
Background:
- Pulse pressure is linked to cardiovascular outcomes, potentially reflecting coronary disease severity.
- Central pulse pressure and large-artery stiffness may offer a closer correlation to disease severity than brachial measurements.
- Understanding these relationships is crucial for accurate cardiovascular risk assessment.
Purpose of the Study:
- To investigate the association between large-artery stiffness, central (carotid) and peripheral (brachial) blood pressures, and coronary artery disease (CAD) severity.
- To compare the predictive value of central versus brachial hemodynamics for CAD severity.
- To identify optimal hemodynamic markers for assessing the extent of coronary atherosclerosis.
Main Methods:
- Systemic arterial compliance and carotid-femoral pulse wave velocity were used to assess large-artery stiffness.
- Carotid and brachial blood pressures were measured in male patients with established CAD and healthy controls.
- Patients were stratified based on the degree of maximum coronary stenosis (moderate vs. severe).
Main Results:
- Systemic arterial compliance was inversely related to CAD severity, while carotid pulse pressure increased with severity.
- Pulse wave velocity was significantly higher in patients with severe CAD compared to moderate CAD and controls.
- Central blood pressures and systemic arterial compliance independently predicted CAD severity, unlike brachial pressures.
Conclusions:
- Central blood pressures and systemic arterial compliance are more sensitive indicators of coronary artery disease severity than brachial blood pressures.
- Large-artery stiffness, reflected in central hemodynamics, plays a significant role in the progression of coronary atherosclerosis.
- These findings suggest that central hemodynamic parameters should be prioritized for assessing CAD severity and guiding clinical management.
Abstract:
The mechanisms relating pulse pressure to cardiovascular outcome may include surrogacy for coronary disease severity. Although pulse pressure is typically measured at the brachial artery, central pulse pressure and its principal determinant, large-artery stiffness, may relate more closely to disease severity. This study aimed to determine the relationships between large-artery stiffness and carotid and brachial blood pressures and coronary artery disease severity. One hundred fourteen male patients with coronary artery disease (age 60+/-8 years, mean+/-SD) and 57 age-matched healthy male controls (age 59+/-9 years) were recruited. Patients were classified into 2 groups based on the magnitude of their maximum coronary stenosis: moderate (50% to 89%) and severe (>/=90%). Large-artery stiffness was assessed as systemic arterial compliance and carotid-femoral pulse wave velocity. Mean pressure was not different between the 3 groups. Systemic compliance and carotid pulse pressure were significantly different between all 3 groups, with compliance lowest and pressure highest in the severe group (P<0.05). Pulse wave velocity was higher in patients with severe stenosis than in those with moderate stenosis (P<0.01) and those in the control group (P<0.001). Brachial pulse pressure was higher in patients than in controls (P<0.05), but there was no difference between the 2 disease groups. In separate multivariate analyses, carotid pressures and systemic arterial compliance were determinants of coronary artery disease severity, independent of age, smoking status, body mass index, mean arterial pressure, heart rate, cholesterol levels (total, LDL, and HDL), triglycerides, and beta-antagonist and lipid-lowering therapy (P<0.001), whereas brachial pressures and pulse wave velocity were not. In conclusion, central blood pressures and systemic arterial compliance are more sensitive markers of coronary artery disease severity than brachial pressures.
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