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Updated: Dec 22, 2025
Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness
Published on: May 3, 2018
Does vascular stiffness predict white matter hyperintensity burden in ischemic heart disease with preserved ejection
Christopher S Balestrini1, Baraa K Al-Khazraji2, Neville Suskin3,4
1Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Insights
Patients with ischemic heart disease (IHD) show increased carotid and cerebrovascular stiffness. This stiffness, particularly carotid β-stiffness and cerebrovascular pulse wave transit time (ccPWTT), is independently associated with white matter lesions, even if IHD itself doesn't increase lesion volume.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Biology
Background:
- Increasing survival rates in ischemic heart disease (IHD) lead to a higher incidence of neurological complications.
- The underlying mechanisms linking IHD survivors to increased neurological risk remain largely unknown.
- Vascular stiffness, both peripheral and cerebrovascular, is a potential contributor to neurological complications.
Purpose of the Study:
- To test the hypothesis that patients with IHD exhibit greater carotid and cerebrovascular stiffness.
- To determine if these stiffness indexes predict white matter small vessel disease (WMLv).
Main Methods:
- Ultrasound imaging of the common carotid artery (CCA) and middle cerebral artery (MCA) to assess vascular stiffness (β-stiffness, ccPWTT, PI, RI).
- Magnetic resonance imaging (T1, T2-FLAIR) to quantify white matter lesion volume (WMLv).
- Study included 30 IHD patients (preserved ejection fraction) and 20 healthy controls.
Main Results:
- IHD patients demonstrated significantly greater carotid β-stiffness and MCA pulsatility and resistive indexes compared to controls.
- No significant difference in white matter lesion volume (WMLv) was observed between IHD patients and controls.
- In pooled data, WMLv correlated with carotid β-stiffness and cerebrovascular ccPWTT; both independently associated with WMLv in multivariate analysis.
Conclusions:
- Patients with IHD exhibit increased peripheral and cerebral microvascular resistance.
- IHD itself did not increase the risk for white matter lesions or cerebrovascular stiffness in this cohort.
- Carotid and cerebrovascular stiffness are independently associated with white matter damage, irrespective of IHD status.
Abstract:
The survival rate of patients with ischemic heart disease (IHD) is increasing. However, survivors experience increased risk for neurological complications. The mechanisms for this increased risk are unknown. We tested the hypothesis that patients with IHD have greater carotid and cerebrovascular stiffness, and these indexes predict white matter small vessel disease. Fifty participants (age, 40-78 yr), 30 with IHD with preserved ejection fraction and 20 healthy age-matched controls, were studied using ultrasound imaging of the common carotid artery (CCA) and middle cerebral artery (MCA), as well as magnetic resonance imaging (T1, T2-FLAIR), to measure white matter lesion volume (WMLv). Carotid β-stiffness provided the primary measure of peripheral vascular stiffness. Carotid-cerebral pulse wave transit time (ccPWTT) provided a marker of cerebrovascular stiffness. Pulsatility index (PI) and resistive index (RI) of the MCA were calculated as measures of downstream cerebrovascular resistance. When compared with controls, patients with IHD exhibited greater β-stiffness [8.5 ± 3.3 vs. 6.8 ± 2.2 arbitrary units (AU); P = 0.04], MCA PI (1.1 ± 0.20 vs. 0.98 ± 0.18 AU; P = 0.02), and MCA RI (0.66 ± 0.06 vs. 0.62 ± 0.07 AU; P = 0.04). There was no difference in WMLv between IHD and control groups (0.95 ± 1.2 vs. 0.86 ± 1.4 mL; P = 0.81). In pooled patient data, WMLv correlated with both β-stiffness (R = 0.34, P = 0.02) and cerebrovascular ccPWTT (R = -0.43, P = 0.02); however, β-stiffness and ccPWTT were not associated (P = 0.13). In multivariate analysis, WMLv remained independently associated with ccPWTT (P = 0.02) and carotid β-stiffness (P = 0.04). Patients with IHD expressed greater β-stiffness and cerebral microvascular resistance. However, IHD did not increase risk of WMLv or cerebrovascular stiffness. Nonetheless, pooled data indicate that both carotid and cerebrovascular stiffness are independently associated with WMLv.NEW & NOTEWORTHY This study found that patients with ischemic heart disease (IHD) with preserved ejection fraction and normal blood pressures exhibit greater carotid β-stiffness, as well as middle cerebral artery pulsatility and resistive indexes, than controls. White matter lesion volume (WMLv) was not different between vascular pathology groups. Cerebrovascular pulse wave transit time (ccPWTT) and carotid β-stiffness independently associate with WMLv in pooled participant data, suggesting that regardless of heart disease history, ccPWTT and β-stiffness are associated with structural white matter damage.
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