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Abstract
Pulse wave velocity, a common metric of arterial stiffness, is an established predictor for cardiovascular events and mortality. However, its intrinsic pressure-dependency complicates the discrimination of acute and chronic impacts of increased blood pressure on arterial stiffness. Cardio-ankle vascular index (CAVI) represented a significant step towards the development of a pressure-independent arterial stiffness metric. However, some potential limitations of CAVI might render this arterial stiffness metric less pressure-independent than originally thought. For this reason, we later introduced CAVI0. Nevertheless, advantages of one approach over the other are left debated. This review aims to shed light on the pressure (in)dependency of both CAVI and CAVI0. By critically reviewing results from studies reporting both CAVI and CAVI0 and using simple analytical methods, we show that CAVI0 may enhance the pressure-independent assessment of arterial stiffness, especially in the presence of large inter-individual differences in blood pressure.
Highlights
Arterial stiffness measures based on pulse wave velocity (PWV) have become established predictors for cardiovascular disease and mortality [1,2]
modified CAVI (CAVI0) to investigate arterial stiffness independently of blood pressure (BP), and the advantages of one technique over the other are still subject of debate
In 2017, we proposed a modified metric, CAVI0, that aimed to improve pressure-independency by targeting two critical points: b is based on the individual-specific DBP and is, intrinsically pressure-dependent, and the use of a linearized Bramwell–Hill equation over the noninfinitesimal DBP-toSBP pressure range introduces inaccuracies
Summary
Arterial stiffness measures based on pulse wave velocity (PWV) have become established predictors for cardiovascular disease and mortality [1,2]. When Pref is fixed to a constant value and Eq 1 is used to fit the P-D relationships of different individuals, b0 becomes a pressure-normalized index of arterial stiffness. In 2006, Shirai et al [15] introduced cardio-ankle vascular index (CAVI), followed in 2017 by the introduction of CAVI0 by our group [16] Both CAVI and CAVI0 aim to provide a pressure-independent arterial stiffness index, similar to Hayashi’s b0; representing the entire heartto-ankle arterial bed. Pressure-dependent b and the pressure-normalized b0 as a function of the ratio DBP/Pref, providing an example of how this difference can affect the inter-individual comparison between clinical groups with inherent differences in DBP. As mentioned, choosing a fixed Pref makes b0 and, CAVI0 pressure-normalized indices of arterial stiffness but these are still pressure (Pref)dependent. We created a conversion tool/calculator to simplifiy this conversion while taking into account the different values of a and b as a function of CAVI [22]
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