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Updated: Oct 16, 2025
Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness
Published on: May 3, 2018
Predictive Ability of Pressure-Corrected Arterial Stiffness Indices: Comparison of Pulse Wave Velocity, Cardio-Ankle
Bart Spronck1,2, Mary Jo Obeid3, Mahati Paravathaneni3
1Department of Biomedical Engineering, School of Engineering & Applied Science, Yale University, New Haven, Connecticut, USA.
Insights
Blood pressure-corrected arterial stiffness metrics like CAVI do not improve risk prediction for heart failure outcomes compared to standard pulse wave velocity (PWV). Standard PWV remains the most effective metric for predicting adverse cardiovascular events.
Area of Science:
- Cardiovascular physiology
- Biomedical engineering
- Clinical risk assessment
Background:
- Pulse wave velocity (PWV) is influenced by blood pressure (BP), prompting development of BP-corrected metrics like cardio-ankle vascular index (CAVI) and CAVI0.
- Assessing the predictive value of these novel metrics against traditional measures is crucial for cardiovascular risk stratification.
Purpose of the Study:
- To evaluate the risk prediction capabilities of heart-to-ankle PWV (haPWV), CAVI, and CAVI0 for adverse cardiovascular outcomes in a US population.
- To compare the predictive performance of BP-corrected arterial stiffness metrics versus conventional PWV.
Main Methods:
- 154 participants (94.8% male, 47.7% African American) with and without heart failure (HF) were enrolled.
- Left and right haPWV, CAVI, and CAVI0 were measured using the VaSera 1500N device.
- Prospective follow-up for a mean of 2.56 years assessed the composite endpoint of death or HF-related hospital admission (DHFA).
Main Results:
- Unadjusted analyses showed haPWV, CAVI, and CAVI0 all significantly predicted DHFA, with predictive ability decreasing as BP correction increased.
- Right-sided metrics trended towards stronger prediction than left-sided metrics.
- After adjusting for HF status, MAGGIC score, and systolic BP, only right haPWV and CAVI remained significant predictors of DHFA.
Conclusions:
- BP-corrected arterial stiffness metrics (CAVI, CAVI0) do not provide superior prediction of DHFA compared to conventional arterial stiffness metrics.
- These BP-corrected metrics do not independently predict DHFA beyond systolic BP.
- Standard PWV is supported as the primary arterial stiffness metric for outcome prediction.
Background:
Pulse wave velocity (PWV) is blood pressure (BP) dependent, leading to the development of the BP-corrected metrics cardio-ankle vascular index (CAVI) and CAVI0. We aimed to assess risk prediction by heart-to-ankle PWV (haPWV), CAVI, and CAVI0 in a US population.
Methods:
We included 154 subjects (94.8% male; 47.7% African American) with and without heart failure (HF). Left and right haPWV, CAVI, and CAVI0 were measured with the VaSera 1500N device. We prospectively followed participants for a mean of 2.56 years for the composite endpoint death or HF-related hospital admission (DHFA).
Results:
Left and right haPWV, CAVI, and CAVI0 values did not differ significantly. In unadjusted analyses, haPWV (left standardized hazard ratio [HR] = 1.51, P = 0.007; right HR = 1.66, P = 0.003), CAVI (left HR = 1.45, P = 0.012; right HR = 1.58, P = 0.006), and CAVI0 (left HR = 1.39, P = 0.022; right HR = 1.44, P = 0.014) significantly predicted DHFA. Predictive ability showed a decreasing trend from haPWV to CAVI to CAVI0; in line with the increasing amount of BP correction in these metrics. In Cox models, right-sided metrics showed a trend toward stronger predictive ability than left-sided metrics. After adjustment for baseline HF status, the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score, and systolic BP, right haPWV (HR = 1.58, P = 0.025) and CAVI (HR = 1.44, P = 0.044), but no other stiffness metrics, remained predictive.
Conclusions:
Although conceptually attractive, BP-corrected arterial stiffness metrics do not offer better prediction of DHFA than conventional arterial stiffness metrics, nor do they predict DHFA independently of systolic BP. Our findings support PWV as the primary arterial stiffness metric for outcome prediction.
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