Reimagining the Value of Brachial-Ankle Pulse Wave Velocity as a Biomarker of Cardiovascular Disease Risk-A Call to Action on Behalf of VascAgeNet.
Keeron Stone, Dave Veerasingam, Michelle L Meyer, Kevin S Heffernan, Simon Higgins, Rosa Maria Bruno, Celia Alvarez Bueno, Marcus Döerr, Arno Schmidt-Trucksäss, Dimitrios Terentes-Printzios, Jūlija Voicehovska, Rachel E Climie, Chloe Park, Giacomo Pucci, Martin Bahls, Lee Stoner, Network for Research in Vascular Ageing (VascAgeNet)
Author Information
Keeron Stone: Centre for Cardiovascular Health and Ageing, Cardiff Metropolitan University, Cardiff, Wales, United Kingdom (K.S.). ORCID
Dave Veerasingam: Cardiothoracic Surgery, Galway University Hospital, Ireland (D.V.). ORCID
Michelle L Meyer: Department of Emergency Medicine, University of North Carolina at Chapel Hill (M.L.M.).
Kevin S Heffernan: Department of Exercise Science, Syracuse University (K.S.H.).
Simon Higgins: Department of Exercise and Sport Science, University of North Carolina, Chapel Hill (S.H., L.S.).
Rosa Maria Bruno: Université Paris Cité, Inserm, PARCC, France (R.M.B.). ORCID
Celia Alvarez Bueno: Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain (C.A.B.).
Marcus Döerr: Department of Internal Medicine B, University Medicine Greifswald, Germany (M.D., M.B.). ORCID
Arno Schmidt-Trucksäss: Department of Sport, Exercise, and Health (A.S.-T.), University of Basel, Switzerland. ORCID
Dimitrios Terentes-Printzios: First Department of Cardiology, Athens Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Greece (D.T.-P.). ORCID
This review critiques the literature supporting clinical assessment and management of cardiovascular disease and cardiovascular disease risk stratification with brachial-ankle pulse wave velocity (baPWV). First, we outline what baPWV actually measures-arterial stiffness of both large central elastic arteries and medium-sized muscular peripheral arteries of the lower limb. Second, we argue that baPWV is not a surrogate for carotid-femoral pulse wave velocity. While both measures are dependent on the properties of the aorta, baPWV is also strongly dependent on the muscular arteries of the lower extremities. Increased lower-extremity arterial stiffness amplifies and hastens wave reflections at the level of the aorta, widens pulse pressure, increases afterload, and reduces coronary perfusion. Third, we used an established evaluation framework to identify the value of baPWV as an independent vascular biomarker. There is sufficient evidence to support (1) proof of concept; (2) prospective validation; (3) incremental value; and (4) clinical utility. However, there is limited or no evidence to support (5) clinical outcomes; (6) cost-effectiveness; (8) methodological consensus; or (9) reference values. Fourth, we address future research requirements. The majority of the evaluation criteria, (1) proof of concept, (2) prospective validation, (3) incremental value, (4) clinical utility and (9) reference values, can be supported using existing cohort datasets, whereas the (5) clinical outcomes and (6) cost-effectiveness criteria require prospective investigation. The (8) methodological consensus criteria will require an expert consensus statement. Finally, we finish this review by providing an example of a future clinical practice model.
