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Noninvasive methods to assess pulse wave velocity: comparison with the invasive gold standard and relationship with organ damage

Weber, Thomasa,b; Wassertheurer, Siegfriedc; Hametner, Bernhardc; Parragh, Stephaniec; Eber, Bernda

doi: 10.1097/HJH.0000000000000518
ORIGINAL PAPERS: Blood vessels

Objectives: To compare noninvasive methods to assess pulse wave velocity (PWV) with the invasive gold standard in terms of absolute values, age-related changes, and relationship with subclinical organ damage.

Methods: Invasive aortic PWV (aoPWVinv) was measured in 915 patients undergoing cardiac catheterization (mean age 61 years, range 27–87 years). Carotid–femoral PWV (cfPWV) was measured with tonometry, using subtracted distance (cfPWVsub), body height-based estimated distance (cfPWVbh), direct distance × 0.8 (cfPWVdir0.8), and caliper-based distance (cfPWVcalip) for travel distance calculation. Aortic PWV was estimated (aoPWVestim) from single-point radial waveforms, age, and SBP.

Results: Invasive and noninvasive transit times were strikingly similar (median values 60.8 versus 61.7 ms). In the entire group, median value of aoPWVinv was 8.3 m/s, of cfPWVsub and cfPWVbh 8.1 m/s, and of aoPWVest 8.5 m/s. CfPWVsub overestimated aoPWVinv in younger patients by 0.7 m/s and underestimated aoPWVinv in older patients by 1.7 m/s, with good agreement from 50 to 70 years of age. AoPWVestim differed from aoPWVinv by no more than 0.4 m/s across all age groups. CfPWVdir0.8, measured in 632 patients, overestimated aoPWVinv by 1.7 m/s in younger patients, with good agreement in middle-aged and older patients. CfPWVcalip, measured in 336 patients, underestimated aoPWVinv in all ages. In 536 patients with preserved systolic function, aoPWVinv and aoPWVestim were superior to cfPWVs in predicting coronary atherosclerosis, renal function impairment, left atrial enlargement, and diastolic dysfunction.

Conclusion: CfPWVsub, cfPWVdir0.8, and aoPWVestim are reasonable surrogates for aoPWVinv. AoPWVinv predicts subclinical organ damage better than cfPWVs, and as good as aoPWVestim.

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aCardiology Department, Klinikum Wels-Grieskirchen, Wels

bParacelsus Medical University, Salzburg

cAustrian Institute of Technology, Vienna, Austria

Correspondence to Thomas Weber, MD, Associate Professor, Cardiology Department, Klinikum Wels-Grieskirchen, Grieskirchnerstrasse 42, 4600 Wels, Austria. Fax: +43 7242 415 3992; e-mail:

Abbreviations: aoPWVestim, estimated aortic pulse wave velocity; aoPWVinv, invasive aortic pulse wave velocity; AUC, area under the curve; CAD, coronary artery disease; cfPWVbh, body height-based carotid–femoral pulse wave velocity; cfPWVcalip, caliper-based carotid–femoral pulse wave velocity; cfPWVdir0.8, direct distance × 0.8-based carotid–femoral pulse wave velocity; cfPWVsub, subtracted distance-based carotid–femoral pulse wave velocity; LVEDP, left ventricular end-diastolic pressure; LVM, left ventricular mass; PWV, pulse wave velocity; ROC, receiver-operating curve

Received 9 July, 2014

Revised 10 December, 2014

Accepted 10 December, 2014

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