Arterial stiffness

Arterial stiffness is commonly measured as carotid–femoral pulse wave velocity (cfPWV) or brachial–ankle PWV (baPWV). cfPWV is the standard for measuring large artery stiffness in Europe.{{Cite journal |last=Mancia |first=Giuseppe |last2=Kreutz |first2=Reinhold |last3=Brunström |first3=Mattias |last4=Burnier |first4=Michel |last5=Grassi |first5=Guido |last6=Januszewicz |first6=Andrzej |last7=Muiesan |first7=Maria Lorenza |last8=Tsioufis |first8=Konstantinos |last9=Agabiti-Rosei |first9=Enrico |last10=Algharably |first10=Engi Abd Elhady |last11=Azizi |first11=Michel |last12=Benetos |first12=Athanase |last13=Borghi |first13=Claudio |last14=Hitij |first14=Jana Brguljan |last15=Cifkova |first15=Renata |date=December 2023 |title=2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA) |url=https://journals.lww.com/jhypertension/fulltext/2023/12000/2023_esh_guidelines_for_the_management_of_arterial.2.aspx |journal=Journal of Hypertension |language=en-US |volume=41 |issue=12 |pages=1874 |doi=10.1097/HJH.0000000000003480 |issn=0263-6352|hdl=11379/603005 |hdl-access=free }} For baPWV, general cutoff values for cardiovascular risk assessment are <1400 cm/s for low risk, 1400–1800 cm/s for intermediate risk, and >1800 cm/s for high risk. Increased cfPWV and baPWV values predict an increased risk of new-onset hypertension in apparently healthy people.

When the heart contracts it generates a pulse or energy wave that travels through the circulatory system. The speed of travel of this pulse wave (pulse wave velocity{{Cite journal|last1=Nabeel|first1=P. M.|last2=Kiran|first2=V. Raj|last3=Joseph|first3=Jayaraj|last4=Abhidev|first4=V. V.|last5=Sivaprakasam|first5=Mohanasankar|date=2020|title=Local Pulse Wave Velocity: Theory, Methods, Advancements, and Clinical Applications|url=https://ieeexplore.ieee.org/document/8778763|journal=IEEE Reviews in Biomedical Engineering|volume=13|pages=74–112|doi=10.1109/RBME.2019.2931587|pmid=31369386|s2cid=199381680|issn=1937-3333}} (PWV)) is related to the stiffness of the arteries. Other terms that are used to describe the mechanical properties of arteries include elastance, or the reciprocal (inverse) of elastance, compliance. The relationship between arterial stiffness and pulse wave velocity was first predicted by Thomas Young in his Croonian Lecture of 1808 {{cite journal | author = Young | year = 1809 | title = On the function of the heart and arteries: The Croonian lecture | jstor = 109672| journal = Philos Trans R Soc | volume = 99 | pages = 1–31 | doi=10.1098/rstl.1809.0001| s2cid = 110648919 }} but is generally described by the Moens–Korteweg equationNichols WW, O'Rourke MF. Vascular impedance. In: McDonald's Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles. 4th ed. London, UK: Edward Arnold; 1998:54–97, 243–283, 347–395. or the Bramwell–Hill equation.{{cite journal |vauthors=Bramwell JC, Hill AV |title=The velocity of the pulse wave in man |journal=Proceedings of the Royal Society of London B |volume=93 |pages=298–306 |year=1922 |doi= 10.1098/rspb.1922.0022|jstor=81045 |issue=652|bibcode=1922RSPSB..93..298C |doi-access= |s2cid=120673490 }} Typical values of PWV in the aorta range from approximately 5 m/s to >15 m/s.{{Cite journal |last=The Reference Values for Arterial Stiffness' Collaboration |date=2010-10-01 |title=Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: ‘establishing normal and reference values’ |url=https://academic.oup.com/eurheartj/article/31/19/2338/441416 |journal=European Heart Journal |language=en |volume=31 |issue=19 |pages=2338–2350 |doi=10.1093/eurheartj/ehq165 |issn=1522-9645 |pmc=2948201 |pmid=20530030}}

Measurement of aortic PWV provides some of the strongest evidence concerning the prognostic significance of large artery stiffening. Increased aortic PWV has been shown to predict cardiovascular, and in some cases all-cause, mortality in individuals with end stage kidney disease,{{cite journal | vauthors = Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM | title = Impact of aortic stiffness on survival in end-stage renal disease | journal = Circulation | volume = 99 | issue = 18 | pages = 2434–9 | date = May 1999 | pmid = 10318666 | doi = 10.1161/01.cir.99.18.2434 | doi-access = free }} hypertension,{{cite journal | vauthors = Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, Ducimetiere P, Benetos A | title = Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients | journal = Hypertension | volume = 37 | issue = 5 | pages = 1236–41 | date = May 2001 | pmid = 11358934 | doi = 10.1161/01.hyp.37.5.1236| citeseerx = 10.1.1.583.3137 | s2cid = 8417352 }} diabetes mellitus{{cite journal | vauthors = Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG | title = Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? | journal = Circulation | volume = 106 | issue = 16 | pages = 2085–90 | date = October 2002 | pmid = 12379578 | doi = 10.1161/01.cir.0000033824.02722.f7 | doi-access = free }} and in the general population.{{cite journal | vauthors = Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, Asmar R, Reneman RS, Hoeks AP, Breteler MM, Witteman JC | title = Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study | journal = Circulation | volume = 113 | issue = 5 | pages = 657–63 | date = February 2006 | pmid = 16461838 | doi = 10.1161/CIRCULATIONAHA.105.555235 | doi-access = free }}{{cite journal | vauthors = Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, Jeppesen J | title = Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population | journal = Circulation | volume = 113 | issue = 5 | pages = 664–70 | date = February 2006 | pmid = 16461839 | doi = 10.1161/CIRCULATIONAHA.105.579342 | doi-access = free }} However, at present, the role of measurement of PWV as a general clinical tool remains to be established. Devices are on the market that measure arterial stiffness parameters (augmentation index, pulse wave velocity). These include Complior, CVProfilor, PeriScope, Hanbyul Meditech, Mobil-O-Graph NG, BP Plus (Pulsecor), PulsePen, BPLab Vasotens, Arteriograph, Vascular Explorer, and SphygmoCor.{{cite journal | vauthors = Avolio A, Butlin M, Walsh A | year = 2009 | title = Arterial blood pressure measurement and pulse wave analysis - their role in enhancing cardiovascular assessment | journal = Physiological Measurement | volume = 31 | issue = 1| pages = R1–R47 | doi=10.1088/0967-3334/31/1/r01| pmid = 19940350 | s2cid = 20651222 }}

Also noted are newer pulse wave velocity measurement tools like the iHeart Internal Age device, a fingertip device that measures aortic pulse wave velocity and arterial stiffness through the pulse in the finger.

The primary sites of end-target organ damage following an increase in arterial stiffness are the heart, the brain (stroke, white matter hyperintensities (WMHs)), the placenta, and the kidneys (age-related loss of kidney function).{{Cite journal |last1=Chirinos |first1=Julio A. |last2=Segers |first2=Patrick |last3=Hughes |first3=Timothy |last4=Townsend |first4=Raymond |date=2019-09-03 |title=Large-Artery Stiffness in Health and Disease: JACC State-of-the-Art Review |url=https://linkinghub.elsevier.com/retrieve/pii/S0735109719358437 |journal=Journal of the American College of Cardiology |volume=74 |issue=9 |pages=1237–1263 |doi=10.1016/j.jacc.2019.07.012 |issn=0735-1097 |pmc=6719727 |pmid=31466622}}

Firstly, stiffened arteries compromise the Windkessel effect of the arteries.{{cite book|author1=Nicolaas Westerhof|author2=Nikolaos Stergiopulos|author3=Mark I.M. Noble|title=Snapshots of Hemodynamics: An Aid for Clinical Research and Graduate Education|url=https://books.google.com/books?id=fqWIm8RmVYsC&pg=PA181|date=2 September 2010|publisher=Springer Science & Business Media|isbn=978-1-4419-6363-5|pages=181–}} The Windkessel effect buffers the pulsatile ejection of blood from the heart converting it into a more steady, even outflow. This function depends on the elasticity of the arteries and stiffened arteries require a greater amount of force to permit them to accommodate the volume of blood ejected from the heart (stroke volume). This increased force requirement equates to an increase in pulse pressure. The increase in pulse pressure may result in increased damage to blood vessels in target organs such as the brain or kidneys.{{cite journal|last1=Mitchell|first1=Gary F.|title=Arterial stiffness|journal=Current Opinion in Nephrology and Hypertension|volume=24|issue=1|year=2015|pages=1–7|issn=1062-4821|doi=10.1097/MNH.0000000000000092|pmid=25470012|s2cid=23321317|doi-access=free}}{{cite journal|last1=Fernandez-Fresnedo|first1=G.|last2=Rodrigo|first2=E.|last3=de Francisco|first3=A. L. M.|last4=de Castro|first4=S. S.|last5=Castaneda|first5=O.|last6=Arias|first6=M.|title=Role of Pulse Pressure on Cardiovascular Risk in Chronic Kidney Disease Patients|journal=Journal of the American Society of Nephrology|volume=17|issue=12_suppl_3|year=2006|pages=S246–S249| pmid = 17130269 |issn=1046-6673|doi=10.1681/ASN.2006080921|doi-access=free}} This effect may be exaggerated if the increase in arterial stiffness results in reduced wave reflection and more propagation of the pulsatile pressure into the microcirculation.

An increase in arterial stiffness also increases the load on the heart, since it has to perform more work to maintain the stroke volume. Over time, this increased workload may cause left ventricular hypertrophy and left ventricular remodelling, which can lead to heart failure.{{cite journal|last1=Cheng|first1=S.|last2=Vasan|first2=R. S.|title=Advances in the Epidemiology of Heart Failure and Left Ventricular Remodeling|journal=Circulation|volume=124|issue=20|year=2011|pages=e516–e519|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.111.070235|pmid=22083151|pmc=3621875}} The increased workload may also be associated with a higher heart rate, a proportionately longer duration of systole and a comparative reduction of duration of diastole.{{cite journal|last1=Whelton|first1=S. P.|last2=Blankstein|first2=R.|last3=Al-Mallah|first3=M. H.|last4=Lima|first4=J. A. C.|last5=Bluemke|first5=D. A.|last6=Hundley|first6=W. G.|last7=Polak|first7=J. F.|last8=Blumenthal|first8=R. S.|last9=Nasir|first9=K.|last10=Blaha|first10=M. J.|title=Association of Resting Heart Rate With Carotid and Aortic Arterial Stiffness: Multi-Ethnic Study of Atherosclerosis|journal=Hypertension|volume=62|issue=3|year=2013|pages=477–484|issn=0194-911X|doi=10.1161/HYPERTENSIONAHA.113.01605|pmid=23836802|pmc=3838105}} This decreases the amount of time available for perfusion of cardiac tissue, which largely occurs in diastole.

Arterial stiffness may also affect the time at which pulse wave reflections return to the heart. As the pulse wave travels through the circulation it undergoes reflection at sites where the transmission properties of the arterial tree change (i.e. sites of impedance mismatch). These reflected waves propagate backward towards the heart. The speed of propagation (i.e. PWV) is increased in stiffer arteries and consequently reflected waves will arrive at the heart earlier in systole. This increases the load on the heart in systole.{{Cite journal|last=Pavelescu|first=Carmen|title=www.mdpi.com|journal=Diagnostics (Basel, Switzerland)|year=2021|volume=12|issue=1|doi=10.3390/diagnostics12010071|pmid=35054238|pmc=8774385|doi-access=free}} Elevated PWV could represent an important parameter for identifying children with CKD and high cardiovascular risk.{{cite book|author1=Wilmer W. Nichols|author2=Michael F. O'Rourke|title=McDonald's Blood Flow in Arteries 5Ed: Theoretical, experimental and clinical principles|url=https://books.google.com/books?id=F8RpQgAACAAJ|date=25 February 2005|publisher=Taylor & Francis|isbn=978-0-340-80941-9}}

• Compliance (physiology)
• John R. Cockcroft
• Pulse wave velocity

• https://www.mdpi.com/2075-4418/12/1/71

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Category:Hypertension

Category:Vascular diseases