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Updated: Sep 30, 2025
Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness
Published on: May 3, 2018
Arterial stiffness in acute coronary syndrome as a potential triage tool: a prospective observational study
Sebastian Schnaubelt1, Julia Oppenauer2, Mathias Bader2
1Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria - sebastian.schnaubelt@meduniwien.ac.at.
Insights
Pulse-wave velocity (PWV) can help prioritize care for patients with acute coronary syndrome (ACS). Higher PWV values indicate more severe coronary artery disease and predict complex percutaneous coronary intervention (PCI).
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Diagnosis and percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) are time-sensitive, requiring effective risk stratification.
- Existing risk prediction tools are valuable, but additional methods are needed to predict coronary pathologies and PCI complexity.
- Pulse-wave velocity (PWV) is a non-invasive measure of arterial stiffness, but its role in ACS evaluation is not fully understood.
Purpose of the Study:
- To investigate the utility of brachial-ankle (ba)PWV and carotid-femoral (cf)PWV in assessing coronary pathologies and PCI complexity in patients with ACS.
- To determine if PWV can serve as a novel tool for triaging and prioritizing patients with suspected non-ST-elevation ACS (NSTE-ACS).
Main Methods:
- Prospective measurement of baPWV and cfPWV in 58 patients undergoing coronary angiography (CA) for ACS evaluation at a tertiary university hospital.
- Correlation of PWV measurements with established risk scores (GRACE, CRUSADE, TIMI), cardiac enzymes, and angiographic findings.
- Statistical analysis, including adjusted odds ratios and CART analysis, to identify independent predictors of coronary artery disease severity and PCI complexity.
Main Results:
- Patients with pathological PWV ranges exhibited significantly higher risk scores, cardiac enzymes, and prevalence of three-vessel disease.
- Adjusted analysis revealed that baPWV independently predicted relevant left anterior descending (LAD) artery stenosis (cut-off 15.5 m/s) and total occlusion (cut-off 19.6 m/s).
- Higher PWV values were associated with increased complexity and duration of CA and PCI procedures.
Conclusions:
- Pathological PWV, reflecting arterial stiffness and atherosclerotic burden, correlates with established ACS risk scores and predicts significant coronary pathologies.
- BaPWV emerged as an independent predictor of relevant LAD stenotic lesions and total occlusions.
- PWV shows promise as a novel, non-invasive tool for triage and prioritization of patients with suspected NSTE-ACS in emergency settings.
Background:
Diagnosis and percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) are time-sensitive. Triage and algorithms identify patients at high-risk. However, additional prediction tools are warranted for prioritized care based on predicted coronary pathologies and PCI complexity. Pulse-wave velocity (PWV) is a non-invasive measurement related to cardiovascular morbidity, and their exact value in ACS evaluation is unclear.
Methods:
In patients undergoing coronary angiography (CA) and - if warranted - PCI for ACS evaluation at a tertiary university hospital in Vienna, Austria, brachial-ankle (ba)PWV and carotid-femoral (cf)PWV were prospectively measured from January 2020 to January 2021.
Results:
PWV was measured in 58 patients (60.3% male; 65 [61-69] years). Risk prediction scores (GRACE, CRUSADE, TIMI), cardiac enzymes, and fraction of patients with a three-vessel disease were significantly higher in the pathological PWV ranges. Adjusted for age and comorbidities, baPWV independently predicted the LAD being relevantly stenotic (crude OR=1.416 [1.143-1.755], P=0.001; adjusted OR=1.340 [1.039-1.727], P=0.024; cut-off 15.5 m/s in CART-analysis), being the culprit lesion (crude OR=1.320 [1.094-1.594], P=0.004; adjusted OR=1.311 [1.037-1.657], P=0.024; cut-off 15.5 m/s), and being totally occluded (crude OR=1.422 [1.113-1.818], P=0.005; adjusted OR=1.677 [1.189-2.366], P=0.003; cut-off 19.6 m/s). Moreover, CA or PCI complexity were associated with higher PWV.
Conclusions:
Pathological PWV as a surrogate for arterial stiffness, polyvascular disease and a larger atherosclerotic burden was associated with GRACE, CRUSADE, and TIMI scores, and PCI duration and complexity. BaPWV independently predicted relevant LAD pathologies, and is suggested as a potential novel triage and prioritization tool for suspected NSTE-ACS in emergency departments.
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