Objective: Carotid femoral pulse wave velocity (cfPWV) is the gold standard for measuring large artery stiffness. Automated brachial ankle pulse wave velocity (baPWV) is an alternative observer-independent method for assessing arterial stiffness at the level of both large (elastic) and small (muscular) arteries. Design and method: A systematic review and meta-analysis of PubMed and EMBASE studies was performed aiming to compare cfPWV and baPWV in terms of (i) absolute numerical difference, (ii) correlation coefficient and (iii) correlations with target organ damage (TOD). Results: Among 486 retrieved studies 44 were analyzed (n = 32.064, weighted age 59.4 ± 11.6 years, 48% hypertensives). Meta-analysis of 41 studies (n = 23.145, weighted age [SD] 60.2 ± 13.6 years, pooled cfPWV 9.4 [95% CI 8.8, 10.1] m/s) showed pooled baPWV-cfPWV difference at 4.6 m/s (95% CI 3.1, 6.1). There was considerable heterogeneity among the studies (I2 = 100%). Meta-analysis of 21 studies (n = 16.429) showed pooled correlation coefficient between baPWV and cfPWV at 0.67 (0.60, 0.74). Sensitivity analyses based on the technology used for cfPWV assessment showed baPWV minus cfPWV difference at (i) 6.5 (5.6, 7.5) m/s with the SphygmoCor (10 studies), and (ii) 3.8 (1.9, 5.6) m/s with the Omron VP1000/2000 Vascular Profiler (26 studies). Analysis of 16 high quality studies (n = 5.877) showed baPWV-cfPWV difference at 3.8 (2.9, 4.7) m/s. Three studies (n = 2,003) compared the correlation of left ventricular mass index with cfPWV (pooled r = 0.16, 95% CI 0.09, 0.23) vs. baPWV (r = 0.21, 95% CI 0.07, 0.35) (p < 0.05 for comparison). Conclusions: The current evidence indicates that baPWV gives higher values than cfPWV, which is probably due to the fact that these two indices assess the stiffness at different parts of the arterial tree. The two methods appear to be closely correlated and are associated with left ventricular mass.
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