Name: measuring the carotid to femoral pulse wave velocity (cf-pwv) to evaluate arterial stiffness
Uploaded: 2018-05-03T13:30:00
Description: Watch this Scientific Journal Video about Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness at JoVE.com

This work is under the financial support from National key research and development program of China (Grant No. 2017YFC0111800) and the Shanghai municipal government (Grant ID. 2013ZYJB0902 and 15GWZK1002). Dr. Yi Zhang was supported by the National Nature Science Foundation of China (Grant ID. 81300239 and 81670377).

This protocol was approved by the Ethics Committee of Shanghai Tenth People&#39;s Hospital.
1. Recruitment of Participants
<ol>
	<li>Include Adults with a moderate heart rate (40 &#60; HR &#60; 160).</li>
	<li>Use the following exclusion criteria.
	<ol>
		<li>Exclude those without internal arteriovenous fistula for renal dialysis or any other peripheral arteriovenous fistula like that.</li>
		<li>Exclude those without peripheral arterial spasm, for example the Raynaud disease.</li>
		<li>Exc...

<ol>
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H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hypertensive+Target+Organ+Damage+and+Longitudinal+Changes+in+Brain+Structure+and+Function:+The+Second+Manifestations+of+Arterial+Disease-Magnetic+Resonance+Study.">Hypertensive Target Organ Damage and Longitudinal Changes in Brain Structure and Function: The Second Manifestations of Arterial Disease-Magnetic Resonance Study.</a> Hypertension. 66 (6), 1152-1158 (2015).</li><li>Ji, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Shanghai+Study:+cardiovascular+risk+and+its+associated+factors+in+the+Chinese+elderly-a+study+protocol+of+a+prospective+study+design.">Shanghai Study: cardiovascular risk and its associated factors in the Chinese elderly-a study protocol of a prospective study design.</a> BMJ Open. 7 (3), (2017).</li><li>O'Brien, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Practice+guidelines+of+the+European+Society+of+Hypertension+for+clinic,+ambulatory+and+self+blood+pressure+measurement.">Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement.</a> J Hypertens. 23 (4), 697-701 (2005).</li><li>Agnoletti, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulse+wave+analysis+with+two+tonometric+devices:+a+comparison+study.">Pulse wave analysis with two tonometric devices: a comparison study.</a> Physiol Meas. 35 (9), 1837-1848 (2014).</li><li>Ji, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Shanghai+Study:+cardiovascular+risk+and+its+associated+factors+in+the+Chinese+elderly-a+study+protocol+of+a+prospective+study+design.">Shanghai Study: cardiovascular risk and its associated factors in the Chinese elderly-a study protocol of a prospective study design.</a> BMJ Open. 7 (3), e013880 (2017).</li><li>Zhang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+study+of+central+blood+pressure+and+wave+reflection+obtained+from+tonometry-based+devices.">Comparison study of central blood pressure and wave reflection obtained from tonometry-based devices.</a> Am J Hypertens. 26 (1), 34-41 (2013).</li><li>Sharman, J. 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Here, we demonstrate a widely accessible methodology to assess the participants&#39; novel preclinical vascular TOD, arterial stiffness, evaluated by cf-PWV. In order to compare PWs with minimal hemodynamic differences between measurements done prior to devices, only accept data when the brachial systolic and diastolic BP varied by less than 3 mmHg. This reduces the deviation caused by human manipulation. In this protocol, the critical steps are to have standardized patient conditions using 80% of the direct straight dis...

Arterial stiffening is a good marker for vascular aging evaluation1,2. The measurement of arterial stiffening is traditionally conducted using a pulse wave velocity (PWV) methodology that is an important and reliable measure of arterial stiffness1,3,4,5. Specifically, PWV represents the stiffness of a specific arterial segment. The pulse wave is transmitted through the arterial vessels in a specific segment, and its speed is inversely related to the viscoelastic properties of the wall itself6. PWV value increases with arterial stiffening.
Carotid-femoral PWV (cf-PWV) and brachial-ankle PWV (ba-PWV) are the 2 most frequently applied PWV measurements. They are widely used in clinical practice, where cf-PWV is popular in western countries and ba-PWV is popular in Asian countries.7,8. In fact, cf-PWV has been considered as the &#39;gold-standard&#39; measurement of arterial stiffness1. For cf-PWV, it is taken as representative of the PWV for the entire aorta. Besides, for ba- PWV, there is no true arterial pathway linking the measurement sites (brachial to ankle). The estimated ba-PWV represents the PWV for the entirety of the central and peripheral arterial system9. A previous study has reported that cf-PWV is superior to ba-PWV in associations with asymptomatic hypertensive target organ damage (TOD)10 (Figure 1).
Non-invasive devices for regional stiffness equipped with a specific tonometer are increasingly being used to measure the stiffness of the carotid to femoral segment1. In cf-PWV measurements, this device and a handheld tonometer create a steady waveform on the computer that can record high resolution digital waveform images and the specific PWV values (Figure 2). All these measurements need to be standardized. Here, we show how to record a good quality cf-PWV with this non-invasive tonometry-based device in a real-world setting.
Some established cardiovascular risk prediction models such as the Framingham risk score and the SCORE Risk Charts are mainly calculated and sorted by conventional risk factors11,12. However, some novel biomarkers should be added into the risk assessment model to improve the risk stratification13. In literature, arterial stiffening is considered as an intermediate state between conventional risk factors and clinical cardiovascular events14. Thus, adding cf-PWV into the risk assessment model may be a tool for risk stratification15,16.
Here, we generate a methodology plan to assess participants&#39; cf-PWV, together with PWA, to establish a standard protocol for arterial stiffening assessment.

<table>
	<tbody>
		<tr>
			<td>SphygmoCor tonometry-based device</td>
			<td>AtCor Medical, Australia</td>
			<td></td>
			<td>For central blood pressures and cf-PWV</td>
		</tr>
		<tr>
			<td>Electrodes</td>
			<td>AtCor Medical, Australia</td>
			<td></td>
			<td>To record the ECG</td>
		</tr>
		<tr>
			<td>Semiautomatic Oscillometric device</td>
			<td>OMRON Healthcare, kyoto, Japan</td>
			<td></td>
			<td>To measure brachial BP</td>
		</tr>
	</tbody>
</table>

measuring the carotid to femoral pulse wave velocity (cf-pwv) to evaluate arterial stiffness

For the elderly, arterial stiffening is a good marker for aging evaluation and it is recommended that the arterial stiffness be determined noninvasively by the measurement of carotid to femoral pulse wave velocity (cf-PWV) (Class I; Level of Evidence A). In literature, numerous community-based or disease-specific studies have reported that higher cf-PWV is associated with increased cardiovascular risk. Here, we discuss strategies to evaluate arterial stiffness with cf-PWV. Following the well-defined steps detailed here, e.g., proper position operator, distance measurement, and tonometer position, we will obtain a standard cf-PWV value to evaluate arterial stiffness. In this paper, a detailed stepwise method to record a good quality PWV and pulse wave analysis (PWA) using a non-invasive tonometry-based device will be discussed.

Cf-PWV (with this method) and ba-PWV (with other method10) were conducted in all of the 2098 participants from Northern Shanghai Study19. Both cf-PWV and ba-PWV were used in the same logistic regression model. In this model, age and gender were adjusted. The results showed that only cf-PWV, but not ba-PWV, was significantly associated with increased IMT and arterial plaque, which indicates the superiority of cf-PWV over ba-PWV in the associa...

Watch this Scientific Journal Video about Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness at JoVE.com

Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness

This protocol describes a method to standardize the measurements of carotid-femoral pulse wave velocity to evaluate arterial stiffness.

Measuring the Carotid to Femoral Pulse Wave Velocity (Cf-PWV) to Evaluate Arterial Stiffness

For the elderly, arterial stiffening is a good marker for aging evaluation and it is recommended that the arterial stiffness be determined noninvasively ...

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