Methodological approaches and the clinical utility of noninvasive estimated pulse wave velocity

Arterial stiffness, as measured by carotid-femoral pulse wave velocity (cfPWV), is an independent cardiovascular risk factor. Arterial stiffness measurement requires the acquisition of pulse waveforms at two arterial sites. This technique is often constrained to clinical or laboratory settings. Estimated PWV (ePWV) addresses these limitations by only requiring the measurement of a single pulse, or no pulse at all, providing a wider application for cardiovascular health monitoring. The aim of this systematic literature review is to investigate the various approaches and clinical utility of ePWV as a surrogate measure of arterial stiffness. The literature search followed the PRISMA guidelines and was conducted in the following databases: Embase, MEDLINE, PubMed, and Scopus. The initial search identified 409 papers: Embase (n = 38), MEDLINE (n = 98), PubMed (n = 93), and Scopus (n = 180). After screening and applying the exclusion criteria, 131 eligible papers remained. Peak topic publication occurred in 2024 (30%). Most papers (69%) used regression-based approaches in ePWV while 34% used a pulse wave analysis (PWA)-based approach. Most PWA approaches (57%) used an oscillometric cuff. There were few validation studies (12%). Validation studies presented correlations (r) from 0.35 to 0.92 and standard deviations reaching ±2.54 m/s. The use of ePWV as a surrogate for arterial stiffness is positively observed across the literature. However, validation studies reveal substantial individual differences hidden within acceptable population averages, underscoring the need to refine estimation algorithms for greater precision.NEW & NOTEWORTHY This structured literature review provides a collective overview of the various indirect approaches that have been used for noninvasive estimation of pulse wave velocity (PWV), along with the various clinical applications they have been used in. It focuses on the vast use of simple regression-based approaches, the individual differences hidden in the population averages, and how the inclusion of pulse wave analysis (PWA), currently underutilized, may enhance the assessment of arterial stiffness.