Functional versus morphological assessment of vascular age in patients with coronary heart disease

Tino Yurdadogan,Peter U Heuschmann,Carolin Malsch,Wolfgang Karmann,Stefan Störk,Kornelia Kotseva,Margret Breunig,Martin Wagner,Caroline Morbach,Götz Gelbrich,David Wood,Michiel L Bots,Georg Ertl,Lara Müller-Scholden,Rainer Leyh

doi:10.1038/s41598-021-96998-x

Abstract

Communicating cardiovascular risk based on individual vascular age (VA) is a well acknowledged concept in patient education and disease prevention. VA may be derived functionally, e.g. by measurement of pulse wave velocity (PWV), or morphologically, e.g. by assessment of carotid intima-media thickness (cIMT). The purpose of this study was to investigate whether both approaches produce similar results. Within the context of the German subset of the EUROASPIRE IV survey, 501 patients with coronary heart disease underwent (a) oscillometric PWV measurement at the aortic, carotid-femoral and brachial-ankle site (PWVao, PWVcf, PWVba) and derivation of the aortic augmentation index (AIao); (b) bilateral cIMT assessment by high-resolution ultrasound at three sites (common, bulb, internal). Respective VA was calculated using published equations. According to VA derived from PWV, most patients exhibited values below chronological age indicating a counterintuitive healthier-than-anticipated vascular status: for VAPWVao in 68% of patients; for VAAIao in 52% of patients. By contrast, VA derived from cIMT delivered opposite results: e.g. according to VAtotal-cIMT accelerated vascular aging in 75% of patients. To strengthen the concept of VA, further efforts are needed to better standardise the current approaches to estimate VA and, thereby, to improve comparability and clinical utility.

Highlights

Communicating cardiovascular risk based on individual vascular age (VA) is a well acknowledged concept in patient education and disease prevention
CIMT is more reliable in detecting patients with high risk for cardiovascular disease but only half of our study population fulfilled the requirements for the vascular age determination via normal values from the ARIC cohort
We investigated Spearmans rank correlations between the vascular ages derived from the carotid intima-media thickness (cIMT) measurement and the PWA

Summary

Introduction

Communicating cardiovascular risk based on individual vascular age (VA) is a well acknowledged concept in patient education and disease prevention. Whereas PWVcf has been measured in the past using time-consuming tonometric or piezo-electric methods, alternative approaches deploying only one blood pressure cuff around the upper arm (oscillometric method) are currently entering clinical r outine[9,10]. The latter technique allows to record peripheral arterial pressure waves, which can be transferred into central pressure waves via transfer functions[11]. The prognostic utility of the AI appears highest in younger adults

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