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Pulse wave velocity as a diagnostic index: The effect of wall thickness
1Department of Mathematics, Texas A&M University, Kingsville, TX 78363, USA.
Insights
Pulse wave velocity (PWV) measurements for vascular stiffening can be inaccurate if the arterial wall is thick. A new thick-wall model improves accuracy for vessels where wall thickness exceeds 25% of the radius.
Area of Science:
- Biomedical Engineering
- Cardiovascular Physiology
- Medical Diagnostics
Background:
- Vascular compliance significantly influences pulse wave velocity (PWV), a key indicator for detecting vascular stiffening and hypertension risk.
- Current PWV measurement relies on the thin-wall assumption (wall thickness negligibly small compared to radius), which may not hold true across the diverse cardiovascular system.
- Inaccurate PWV assessment due to unaddressed wall thickness variations can lead to misinterpretation of vascular stiffness.
Purpose of the Study:
- To develop an analytical method for assessing arterial wall stiffness that overcomes the limitations of the thin-wall assumption.
- To investigate the impact of varying vessel wall thickness-to-radius ratios on PWV calculations.
- To enhance the clinical reliability of PWV measurements in diagnosing vascular stiffening.
Main Methods:
- Analysis of PWVs using various wall models, considering different ratios of wall thickness to vessel radius.
- Comparison of PWV values calculated with the classic thin-wall theory versus thick-wall models.
- Evaluation of the influence of wall thickness on wave propagation dynamics.
Main Results:
- The classic thin-wall theory for PWV estimation is unreliable when the vessel wall thickness exceeds approximately 25% of the vessel radius.
- Overestimation of PWV can occur with the thin-wall theory for thicker arterial walls, potentially leading to false positives in clinical hypertension assessments.
- The study highlights the dominance of wall stresses over inertia in thicker arterial walls.
Conclusions:
- The thin-wall assumption in PWV measurement is a significant limitation for arteries with substantial wall thickness.
- A thick-wall model is necessary for accurate PWV assessment when the wall thickness-to-radius ratio is significant (e.g., >25%).
- Implementing a thick-wall model can improve the diagnostic accuracy of PWV for vascular stiffening and related cardiovascular conditions.
Abstract:
Vascular compliance is a major determinant of wave propagation within the vascular system, and hence the measurement of pulse wave velocity (PWV) is commonly used clinically as a method of detecting vascular stiffening. The accuracy of that assessment is important because vascular stiffening is a major risk factor for hypertension. PWV is usually measured by timing a pressure wave as it travels from the carotid artery to the femoral or radial artery and estimating the distance that it traveled in each case to obtain the required velocity. A major assumption on which this technique is based is that the vessel wall thickness h is negligibly small compared with the vessel radius a. The extent to which this assumption is satisfied in the cardiovascular system is not known because the ratio h/a varies widely across different regions of the vascular tree and under different pathological conditions. Using the PWV as a diagnostic test without knowing the effect of wall thickness on the measurement could lead to error when interpreting the PWV value as an index of vessel wall compliance. The aim of the present study was to extend the validity of the current practice of assessing wall stiffness by developing a method of analysis that goes beyond the assumption of a thin wall. We analyzed PWVs calculated with different wall models, depending on the ratio of wall thickness to vessel radius and the results showed that PWV is not reliable when it is estimated with the classic thin wall theory if the vessel wall is not around 25% of vessel radius. If the arterial wall is thicker than 25% of vessel radius, then the wave velocity calculated with the thin wall theory could be overestimated and in the clinical setting, this could lead to a false positive. For thicker walls, a thick wall model presented here should be considered to account for the stresses within the wall thickness that become dominant compared with the wall inertia.
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