Cardio-ankle Vascular Index Measurement Research Articles

Cardio-ankle vascular index may be an important marker of silent neuronal injury after percutaneous coronary angiography and intervention: a prospective observational study on diagnostic accuracy.

The relationship between silent neuronal injury (SNI) and arterial stiffness assessed by cardio-ankle vascular index (CAVI) has not been evaluated in patients treated with coronary angiography and intervention due to acute coronary syndrome (ACS). The aim of this study is to evaluate the value of CAVI in prediction of SNI after percutaneous coronary angiography and intervention in patients presented with ACS. Eighty-three consecutive patients presented with ACS, who underwent percutaneous coronary angiography and intervention, were included in this prospective observational study on diagnostic accuracy. Neuron specific enolase (NSE) was studied before and 18 hour after the coronary angiography and intervention. CAVI was measured by VaSera-1000 instrument. Clinical and echocardiographic characteristics were analyzed and independent predictors of SNI were evaluated. Chi-square, Student t-test, Mann-Whithney U test, correlation analysis and logistic regression analysis was used for statistical analysis. NSE levels significantly increased after cardiac catheterization (9.82±3.22 mg/dL vs. 13.15±8.55 mg/dL, p<0.001). CAVI (OR=2.992, 95% CI: 1.494-5.713, p=0.002), left ventricular ejection fraction (LVEF) (OR=0.911, 95% CI: 0.843-0.983, p=0.017) and undergoing percutaneous coronary intervention (OR=4.430, 95% CI: 1.034-18.97, p=0.045) were the independent predictors of SNI in logistic regression analysis. The cut-off value to show SNI for CAVI was 10.45 (sensitivity=71.8%, specificity=91.5%) in receiver operator charecteristic (ROC) curve analysis. The area under curve was 0.832 (95% CI=0.746-0.918, p<0.001). Besides undergoing PCI and having LVEF, measurement of CAVI may be a useful tool for predicting the development of SNI after percutaneous coronary angiography and intervention in patients with ACS.

Reproducibility of the Cardio-Ankle Vascular Index (CAVI) in Caucasians (SAPALDIA 3)

Purpose: This nested study of the second follow-up of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA 3) aimed at analysing the reproducibility of the arterial stiffness marker cardio-ankle vascular index (CAVI) in Caucasians. Methods: In 105 persons aged 50-80yrs (50 males, 55 females, 63.0±6.9yrs) two measurements of CAVI were taken on each of two days within 3 months using a VaseraVS-1500 vascular screening system (Fukuda Denshi) in supine position after 15 min of rest. The analyses involved mean coefficients of variation (CV), Bland-Altman Plots (BAP) and intraclass correlation coefficients (ICC). In order to allow for a fieldworker effect on the measurement of CAVI a mixed linear model with a fixed effect of time (i.e., first and second measurement day) and random effects for subject and time within subject (measurement date) and fieldworker was applied. Results: The CV was 4.4% and the ICC reflecting the ratio of between and within subject variability was 0.803 and when excluding subjects with differing fieldworker 4.3% and 0.805, respectively (N=82). The limits of agreement of the BAP were -1.155 to 1.445 with a mean difference of 0.145 (CI 0.019-0.271). The BAP displayed no particular dispersion pattern. The mixed linear model revealed that the random subject effect accounted for 75.7% of the variability of CAVI measurements, the subject-specific time effect for 14.1%, the fieldworker effect for 5.7% and short-term variability for 4.5%. ![Figure][1] Bland-Altman Plot of CAVI measurement Conclusions: These results are in line with previous findings in Asian populations and show that the measurement of CAVI is highly reproducible also in Caucasians. Since the fieldworker effect is negligible CAVI can be regarded as an easy-to-apply tool for population wide application. [1]: pending:yes

Serial assessment of arterial stiffness by cardio-ankle vascular index for prediction of future cardiovascular events in patients with coronary artery disease

Purpose: Arterial stiffness is a significant predictor of cardiovascular disease (CVD), which is modified by medications for atherosclerotic risk factors and life-style changes. Cardio-ankle vascular index (CAVI) provides noninvasive, objective information on arterial stiffness, independent of blood pressure. This study aimed to investigate changes in CAVI after management of atherosclerotic risk factors and their impact on future CVD outcome in patients with coronary artery disease (CAD). Methods: The study consisted of 211 CAD patients (65±10 years, 118 men) with impaired CAVI. CAVI examination was repeated 6 months later. Impaired CAVI was defined as > the mean plus 1 SD of the age- and gender-specific normal CAVI values, according to the results in 5,188 healthy subjects. All patients were followed for more than 1 year or until the occurrence of CVD event. Results: Of the 211 patients, CAVI improved 6 months later in 106 (50%) patients, but remained high in 105 (50%) patients. During follow-up (2.9±1.0 years), CVD events occurred in 28 (13%) patients. Persistently impaired CAVI was an independent predictor of future CVD events (p=0.003), independent of baseline CAVI. The CVD outcome was worse in patients with persistently impaired CAVI than in those with improved CAVI (p<0.001) (Figure). Patients with normalized CAVI after treatment (n=22) had only 1 CVD event. ![Figure][1] Kaplan-Meier curves for CVD events Conclusions: This study demonstrated for the first time that persistent impairment of arterial stiffness was an independent risk factor of future CVD events. Serial measurement of CAVI provides important prognostic information on patients with CAD in clinical practice. [1]: pending:yes

The relationship between dipper/nondipper pattern and cardioankle vascular index in hypertensive diabetic patients

24-h ambulatory blood pressure monitoring (24-h ABPM) is a better predictor of cardiovascular events (CVEs) than spot blood pressure (BP) measurements in hypertensive diabetic patients. In this patient group, the underlying mechanism of the relationship between a nondipper pattern determined with 24-h ABPM and increased incidence of CVE is unknown. Cardioankle vascular index (CAVI) is a new index of the overall arterial stiffness from the aorta to the ankle. The objective of the present study was to evaluate the relationship between a dipper/nondipper pattern and arterial stiffness in hypertensive diabetic patients using the CAVI method. We enrolled 99 hypertensive patients with type-2 diabetes mellitus. 24-h ABPM and CAVI measurements were performed for all patients. The relationship between a dipper/nondipper pattern and CAVI measurements was analyzed. Sixty-three (63.6%) patients had a nondipper pattern. In univariate analysis, CAVI, mean arterial pressure (MAP)-asleep, overall diastolic BP, overall systolic BP, duration of hypertension, and statin use were significantly higher among patients with a nondipper pattern than that in dippers. Multivariate linear regression analyses showed that the difference between MAP-asleep and MAP-awake was associated independently with CAVI (β coefficient=0.514, P<0.001). CAVI was correlated negatively with the nocturnal decrease in MAP (%) (r=-0.558 and P<0.001). The nondipper pattern determined with 24-h ABPM in hypertensive diabetic patients is associated with an increase in arterial stiffness. This patient group should be monitored closely for CVEs.

Assessment of the Cardioankle Vascular Index in Pregnant Women Complicated with Hypertensive Disorders

It was previously reported that the brachial-ankle pulse wave velocity (baPWV) is elevated in preeclamptic women. However, baPWV is strongly affected by blood pressure. Recently, a new index of vascular stiffness, the cardioankle vascular index (CAVI), was developed. CAVI is thought to be an index independent of blood pressure. We assessed CAVI in normotensive and hypertensive pregnant women. We studied a total of 109 Japanese women consisting of 23 nonpregnant healthy women (group A), 45 normotensive pregnant women (group B), 28 pregnant women complicated with established preeclampsia (group C), and 13 pregnant women with chronic hypertension (group D). The subject remained supine while the blood pressure, baPWV, and CAVI were recorded. No significant difference in baPWV was present between groups C and D, but the difference in CAVI was significantly high in group D. We believe that we can distinguish the vessel structural change between chronic hypertension and preeclampsia through simultaneous baPWV and CAVI measurements.

Influence of blood pressure on cardio-ankle vascular index (CAVI) examined based on percentage change during general anesthesia

Cardio-ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV) are non-invasive methods for estimating arterial distensibility. The purpose of this study is to evaluate whether CAVI as an index of true arterial stiffness is superior to baPWV based on the percentage change in hemodynamics under general anesthesia. CAVI (segment from heart to ankle), k-CAVI (heart to knee) and baPWV (brachial to ankle) in 30 oral surgery patients were measured to compare the decreased blood pressure (BP) after 10 min of tracheal intubation during general anesthesia with the control BP (after 5 min of rest). General anesthesia was performed under endotracheal intubation through intravenous injection of propofol, fentanyl and vecuronium or rocuronium. In both the elderly (65 years) and middle-aged (<65 years) groups, CAVI and k-CAVI did not change during general anesthesia, whereas baPWV and systolic BP (SBP) showed a statistically significant decrease. Thus, the changes in CAVI (ΔCAVI) and k-CAVI (Δk-CAVI) showed no significant correlations with those of SBP (ΔSBP), whereas the changes in baPWV (ΔbaPWV) were significantly correlated with ΔSBP. ΔCAVI and Δk-CAVI showed no significant differences between the two groups, whereas ΔbaPWV and ΔSBP in the elderly group was much higher than that in the middle-aged group. Measurement of CAVI was not affected by the decrease in BP during general anesthesia. In contrast, baPWV was significantly influenced by changes in BP. These findings suggest that CAVI is a useful index of true arterial stiffness and is superior to baPWV.

Association of Cardio-Ankle Vascular Index with Cardiovascular Disease Risk Factors and Coronary Heart Disease among Japanese Urban Workers and their Families

Purpose: Recently the cardio-ankle vascular index (CAVI) has been developed to represent the extent of arteriosclerosis in the artery from the aortic valve to the ankle. The aim of the study is to examine the association of CAVI scores with the established cardiovascular disease (CVD) risk factors and coronary heart disease (CHD). Methods: Subjects were 9,881 men and 12,033 women of company employees and their families between 20 and 70 years of age and over who participated in CVD screening in Japan. The screening included measurements of CAVI, electrocardiogram, blood pressure, lipids, serum glucose, hemoglobin A1c, height, weight, and questions on smoking and drinking status. Persons having CHD were defined as those having history of CHD and/or having abnormal Q wave and/or ischemic change in ECG. After converting CAVI scores to binary variables (normal or abnormally high CAVI scores), logistic regression analysis was conducted. Results: After adjusting for age, significant odds ratios (ORs) of abnormally high CAVI scores among men were found with diabetes mellitus (10.02, p<0.001), hypertension (8.37, p<0.001), triglycerides (2.76, p<0.001, for 150-199mg/dL and 2.85, p<0.001, for ≥200mg/dL, as reference:<150mg/dL), high density lipoprotein cholesterol (0.19, p<0.001, for 40-59mg/dL and 0.20, p<0.001 for ≥60mg/dL, as reference: <40mg/dL), body mass index (2.04, p<0.001, for <20, 2.31, p<0.001, for 28-29.9 and 3.37, p<0.001, for ≥30 as reference:20-22.9), and ex-smokers (1.20, p<0.01, as reference: non-smokers). Almost identical results were found among women, except a significant OR with current smokers (2.25, p<0.001). The significant association between CHD and abnormally high CAVI scores was found: OR=3.87, p<0.001 for men and 1.45, p<0.01 for women after adjusting for CVD risk factors. Conclusions: Our results confirmed that CAVI scores are a reliable indicator of arteriosclerosis reflecting the extent of arterial stiffness and atherosclerosis in the major artery between the aortic valve and the ankle.

Effects of Personal Exposure to Particulate Matter and Ozone on Arterial Stiffness and Heart Rate Variability in Healthy Adults

The effects on heart rate variability (HRV) and arterial stiffness from exposure to ambient particulate matter and ozone have not been studied simultaneously. The aim of this study was to analyze these effects with refined exposure estimates from personal measurements of ozone and size-resolved particulate matter mass concentrations. The authors recruited 17 mail carriers in a panel study in Taipei County, Taiwan, during February-March, 2007, and each subject was followed for 5-6 days. Personal ozone and size-fractionated particulate matter exposures were monitored during working hours while carriers delivered mail outdoors. Cardiovascular effects were evaluated with heart rate variability (HRV) indices and an arterial stiffness index, the cardio-ankle vascular index (CAVI). The authors used linear mixed models to examine the association between personal exposure data and the HRV index and CAVI. They found that an interquartile range increase in personal exposure to ozone and particulate matter of between 1.0 and 2.5 microm was associated with a 4.8% and 2.5% increase in CAVI, respectively, in the single-pollutant models. In contrast, the personal exposure data showed no significant effects on HRV. In 2-pollutant models, personal ozone exposure remained significantly associated with the CAVI measurements. The study results indicate that vascular function may be more sensitive to air pollutants than the autonomic balance.

The effects of menstrual cycle on cardiovascular response to mental stress and arterial stiffness

The present study examined the effects of menstrual cycle on arterial blood pressure and heart rate (HR) responses to mental stress and cardio‐ankle vascular index (CAVI). The CAVI is a new index of arterial stiffness recently developed by measurement of pulse wave velocity and blood pressure. Eight healthy young women performed the color word test for 2 min followed by CAVI measurement approximately every three days over three menstrual cycles. The differences between the baseline value and the averaged value of systolic (ΔSBP), mean (ΔMBP) and diastolic blood pressures during stress as well as HR during stress (ΔHR) were calculated, respectively. Compared to those during other phases, ΔSBP and ΔMBP showed a tendency to increase during the early follicular and late luteal phases, and these changes correlated with scores on the menstrual distress questionnaire (p&lt;0.05) in a few subjects. The ΔHR and CAVI did not vary with the menstrual cycle. The pressor response to stress did not relate to the CAVI either. Our findings suggest that the effect of the menstrual cycle on pressor response to mental stress differs from person to person and may relate to premenstrual and menstrual symptoms and estrogen action, but arterial stiffness was not affected by the menstrual cycle.

Cardio-Ankle Vascular Index is Independently Associated with the Severity of Coronary Atherosclerosis and Left Ventricular Function in Patients with Ischemic Heart Disease

The cardio-ankle vascular index (CAVI) has been proposed as a new noninvasive marker of arterial stiffness independent of blood pressure. We investigated the association of the CAVI with coronary atherosclerosis and left ventricular (LV) systolic and diastolic function in patients with ischemic heart disease (IHD). A total of 206 consecutive subjects undergoing coronary angiography were enrolled. CAVI measurement and echocardiography were performed simultaneously. Patients having significant coronary stenosis were classified into the IHD group. CAVI in the IHD group (n=133) was significantly higher than in the non-IHD group(n=73)(9.1+/-1.3 vs. 8.7+/-1.2, p=0.02). In all IHD patients, CAVI was negatively correlated with LV ejection fraction (LVEF)(r=-0.31, p<0.01), LV mass index (r=0.24, p<0.01) and angiographic scores of coronary atherosclerosis. Stepwise regression analysis revealed that CAVI was independently associated with LVEF, along with a history of myocardial infarction, LV mass index, and left atrial diameter in all IHD patients (p<0.01). In the sub-analysis of IHD patients with preserved LVEF, CAVI was correlated with echocardiographic parameters regarding LV diastolic function. Multivariate analysis demonstrated that the increased CAVI was significantly associated with LV diastolic dysfunction in patients with preserved LVEF. CAVI, a new parameter of aortic stiffness, was independently associated with LV systolic and diastolic function as well as coronary artery disease in IHD patients.

Establishment of the Cardio-Ankle Vascular Index in Patients With Obstructive Sleep Apnea

An arterial stiffness parameter, the cardio-ankle vascular index (CAVI), has been developed. CAVI is adjusted for BP and can be used to measure arterial stiffness with little influence of BP. The purpose of this study was to evaluate the reproducibility, validity, and clinical usefulness of CAVI among patients with obstructive sleep apnea (OSA), who often have elevated BP during measurement. Overall, 543 consecutive patients with OSA were studied. CAVI was automatically calculated from the pulse volume record, BP, and the vascular length from the heart to the ankle. First, CAVI was measured three times on different days in 25 patients to evaluate its reproducibility. Second, the correlation between CAVI and BP was assessed. Third, patients were classified into two groups (mild OSA or moderate-to-severe OSA), and the CAVIs of these groups were compared. Fourth, the correlation between CAVI and carotid intima-media thickness (IMT) was also assessed in 74 patients. The mean coefficient of variation was 2.8. CAVI demonstrated weak or no correlations with BP (with systolic BP, r = 0.184; with diastolic BP, r = 0.223). Patients with moderate-to-severe OSA (n = 469) had a significantly greater CAVI than patients with mild OSA (p = 0.034). CAVI was positively correlated with IMT (r = 0.487). The measurement of CAVI demonstrated good reproducibility and was not affected by the BP during measurement. Additionally, CAVI was positively correlated with another arteriosclerosis indicator. CAVI was higher in patients with more severe OSA and is regarded as a clinically useful index for the progression of vascular damage.

Postchallenge hyperglycaemic spike associate with arterial stiffness

Several large-scale epidemiological and intervention studies strongly indicate that postchallenge hyperglycaemia is the main factor associated with increasing the risk of morbidity and mortality in type 2 diabetes. However, the mechanisms that increase the risk of cardiovascular disease remain unclear. We aimed to study the relationship between postchallenge hyperglycaemia and arterial stiffness. We recruited 40 healthy subjects from a physical examination in 2005. Cardio-ankle vascular index (CAVI) was automatically calculated by VaSera VS-1000. For the reliability study, we performed the baseline study in the first 20 subjects who were returned to receive repeated measurements of CAVI 2 weeks later. The determinants of mean CAVI at different timings of oral glucose tolerance test (OGTT) study were analysed by constructing multivariate linear regression models. In reliability test, the inter-observer correlation coefficient was 0.82 for right CAVI, 0.87 for left CAVI and 0.85 for mean CAVI. Age, systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose levels at 60 min (Glu60) and glucose area under the curve of OGTT (GluAUC) are found to be significantly and positively correlated to right CAVI, left CAVI and mean CAVI (p < 0.05). After adjustment for age, gender and SBP, Glu60 and GluAUC are still independent determinants of CAVI. In subjects without clinical diagnosis of type 2 diabetes, postchallenge hyperglycaemic spike is highly associated with CAVI, a good parameter of aortic stiffness, independent of age, gender and blood pressure.

Cardio-Ankle Vascular Index is a New Noninvasive Parameter of Arterial Stiffness

Beta is an index of arterial stiffness independent of blood pressure. Beta of the thoracic descending aorta (TDA) has been obtained by transesophageal echocardiography (TEE) and the cardio-ankle vascular index (CAVI) is a new noninvasive estimation of beta. The purpose of this study was to evaluate the accuracy and usefulness of CAVI and to compare it with other parameters of arteriosclerosis by carotid ultrasound (CU). The instantaneous dimensional change of the TDA on TEE was measured simultaneously with systemic pressure of the brachial artery in 70 patients in sinus rhythm. There were significant correlations between CAVI and age (r=0.65, p<0.01), and CAVI and the beta from TEE (Aobeta) (r=0.67, p<0.01). Next, 110 patients with chest pain syndrome underwent CU and measurement of CAVI, intima - media thickness (IMT), plaque score and beta. There were significant relationships between CAVI and IMT (r=0.42, p<0.01), and between CAVI and beta (r=0.39, p<0.01). CAVI of the group diagnosed with plaque was significant higher than that of the normal group (9.872+/-1.464 vs 9.038+/-1.377, p=0.0039). CAVI is measured easily and noninvasively and is a new index of arterial stiffness that is independent of blood pressure.

Clinical Significance and Reproducibility of New Arterial Distensibility Index

The brachial-ankle pulse wave velocity (baPWV) is used to evaluate the degree of atherosclerosis and arterial distensibility, but its major limitation is that it is affected by changes in blood pressure (BP) during measurement. Recently, a new atherosclerotic index, the cardio-ankle vascular index (CAVI), has been developed by measuring PWV and BP. CAVI is adjusted for BP based on the stiffness parameter beta and should measure arterial stiffness independent of BP. The purpose of this study was to evaluate the validity of CAVI compared with baPWV, the reproducibility of the measurement of CAVI, and the effect of BP changes on CAVI and baPWV. One thousand and thirty-three consecutive subjects undergoing health checkups were studied. CAVI was automatically calculated from the pulse volume record, BP, and the vascular length from heart to ankle. In this general population, both baPWV and CAVI demonstrated a positive correlation with age and systolic BP (SBP). CAVI showed a weaker correlation with SBP than baPWV. The measurement of CAVI demonstrated good reproducibility and was not affected by the increase in BP during measurement. CAVI is a useful index of arterial distensibility and is not influenced by BP changes during measurement.

Chronoecological health watch of arterial stiffness and neuro-cardio-pulmonary function in elderly community at high altitude (3524 m), compared with Japanese town

Effects of high altitude on arterial stiffness and neuro-cardio-pulmonary function were studied. Blood pressure (BP) and heart rate (HR) were measured in a sitting position on resting Ladakhis, living at an altitude of 3250–4647 m (Phey village, 3250 m: 17 men and 55 women; Chumathang village, 4193 m: 29 men and 47 women; Sumdo village, 4540 m: 38 men and 57 women; and Korzok village, 4647 m: 84 men and 70 women). The neuro-cardio-pulmonary function, including the Kohs block design test, the Up and Go, the Functional Reach and the Button tests, was examined in 40 elderly subjects (19 men and 21 women, mean age: 74.7 ± 3.3 years) in Leh, Ladakh (altitude: 3524 m), for comparison with 324 elderly citizens (97 men and 227 women, mean age: 80.7 ± 4.7 years) of Tosa, Japan (altitude: 250 m). Cardio-Ankle Vascular Index (CAVI) was measured as the heart-ankle pulse wave velocity (PWV) in these subjects using a VaSera CAVI instrument (Fukuda Denshi, Tokyo). SpO 2 decreased while Hb and diastolic BP increased with increasing altitude. At higher altitude, residents were younger and leaner. Women in Leh vs. Tosa had a poorer cognitive function, estimated by the Kohs block design test (3.7 ± 3.6 vs. 16.4 ± 9.6 points, P < 0.0001) and poorer ADL functions (Functional Reach: 13.7 ± 7.0 cm vs. 25.3 ± 8.7 cm, P < 0.0001; Button test: 22.5 ± 4.8 vs. 14.8 ± 5.7 s, P < 0.0001). Time estimation was shorter at high altitude (60-s estimation with counting: 41.1% shorter in men and 23.0% shorter in women). A higher voltage of the QRS complex was observed in the ECG of Leh residents, but two times measurement of CAVI showed no statistically significant differences between Leh and Tosa (two times of CAVI measures; 9.49 vs. 10.01 m/s and 9.41 vs. 10.05 m/s, respectively), suggesting that most residents succeed to adapt sufficiently to the high-altitude environment. However, correlation of CAVI with age shows several cases who show an extreme increase in CAVI. Thus, for the prevention of stroke and other adverse cardiovascular outcomes, including dementia, CAVI may be very useful, especially at high altitude. In conclusion, elderly people living at high altitude have a higher risk of cardiovascular disease than low-latitude peers. To determine how these indices are associated with maintained cognitive function deserves further study by the longitudinal follow-up of these communities in terms of longevity and aging in relation to their neuro-cardio-pulmonary function.