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Updated: May 5, 2026
Non-invasive Assessment of Microvascular and Endothelial Function
Published on: January 29, 2013
Non-Invasive Assessment of Vascular Damage Through Pulse Wave Velocity and Superb Microvascular Imaging in
Julia Martín-Vírgala1,2,3, Beatriz Martín-Carro1,2,3, Sara Fernández-Villabrille1,2,3
1Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain.
Insights
Non-invasive techniques like pulse wave velocity (PWV) and Superb Microvascular Imaging (SMI) ultrasound can detect vascular damage in Chronic Kidney Disease (CKD) patients before dialysis. These methods show potential for preventing cardiovascular events in CKD progression.
Area of Science:
- Cardiovascular research
- Nephrology
- Medical imaging
Background:
- Cardiovascular disease is a major cause of mortality in Chronic Kidney Disease (CKD).
- Simple, non-invasive tools are needed to detect vascular damage in pre-dialysis CKD patients.
- Assessing vascular damage progression is crucial for managing CKD patients.
Purpose of the Study:
- To evaluate non-invasive techniques for assessing vascular damage in CKD stages 2-5.
- To compare carotid-femoral pulse wave velocity (PWV) for aortic stiffness and Superb Microvascular Imaging (SMI) ultrasound for neovascularization.
- To assess the progression of vascular damage over 18 months in CKD patients.
Main Methods:
- Study included 43 CKD patients (stages 2-5) and 38 controls, with an 18-month follow-up.
- Carotid-femoral PWV measured aortic stiffness; SMI ultrasound assessed carotid intima-media thickness (cIMT) and adventitial neovascularization.
- Abdominal aortic calcification was quantified using the Kauppila index from X-rays.
Main Results:
- Vascular impairment, including increased aortic stiffness (PWV) and adventitial neovascularization (SMI), was significant in CKD stages 4-5.
- CKD-5 patients exhibited greater abdominal aortic calcification.
- A negative correlation was observed between serum soluble Klotho (sKlotho) and cIMT in CKD patients.
Conclusions:
- Non-invasive PWV and SMI ultrasound are potentially useful for evaluating vascular damage in pre-dialysis CKD patients.
- These techniques may aid in preventing cardiovascular events in CKD.
- Further research is needed to clarify the clinical application of PWV and SMI in CKD management.
Abstract:
Background/Objectives: Cardiovascular disease is the main cause of morbidity and mortality in Chronic Kidney Disease (CKD), so it is of great importance to find simple and non-invasive tools to detect vascular damage in pre-dialysis CKD patients. This study aimed to assess the applicability of non-invasive techniques to evaluate vascular damage in stages CKD-2 to CKD-5 and its progression after an 18-month follow-up using (A) carotid-femoral pulse wave velocity (PWV) to assess aortic stiffness and (B) Superb Microvascular Imaging (SMI) ultrasound to assess adventitial neovascularization compared with other traditional techniques to evaluate vascular damage, such as carotid intima-media thickness and Kauppila index. Methods: The study involved 43 CKD patients in stages CKD-2 to CKD-5 and a group of 38 sex- and age-matched controls, studied at baseline and at an 18-month follow-up. Age, sex, body mass index, arterial pressure, pharmacological treatments, and blood and urinary parameters were collected. Aortic stiffness was determined by carotid-femoral PWV and abdominal aortic calcification was assessed in lateral lumbar X-rays and quantified by the Kauppila index. Carotid intima-media thickness (cIMT), the number of carotid plaques, and adventitial neovascularization were evaluated by SMI. Results: Vascular impairment was mostly detected in CKD-4 and CKD-5 stages, with increased aortic stiffness measured by PWV and increased carotid plaques and adventitial neovascularization measured by SMI ultrasound. Furthermore, CKD-5 patients showed greater abdominal aortic calcification. Interestingly, CKD patients displayed a negative correlation between serum soluble Klotho (sKlotho) and cIMT. Finally, CKD patients showed no progression of vascular impairment after the 18-month follow-up, with the exception of carotid plaques. Conclusions: Performing non-invasive PWV and SMI ultrasound might be useful to evaluate vascular damage in CKD before entering dialysis, possibly helping to prevent cardiovascular events, although future studies should clarify the use of these techniques in clinical practice.
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