Aortic Pulse Wave Velocity: An Independent Marker of Cardiovascular Risk

Michel E. Safar, MD, Olivier Henry, MD, Sylvie Meaume, MD

Disclosures

Am J Geriatr Cardiol. 2002;11(5) 

In This Article

Aortic PWV and Heart Rate

Although resting heart rate is a potent independent CV risk factor,[13] few investigations have examined the possible pathophysiologic links between an elevated heart rate and the various CV diseases. In previous studies, the strong association between a high heart rate and sudden death had led to the consideration of three principal underlying CV mechanisms[14]: the contribution of rhythmic disorders, the development of coronary ischemic disease, and the role of atherogenic blood lipid fractions. Until recently, little had been done to show that the changes in the stiffness of peripheral or central arteries may constitute a possible link relating heart rate and CV death, although numerous experimental studies have shown that arterial stiffness is highly frequency-dependent, and therefore may be influenced by resting heart rate.[15]

In recent clinical works,[14,15,16] PWV measurements and high-resolution echo-tracking techniques were used to determine simultaneously the level of heart rate, the degree of arterial distension and the velocity of the pulse wave in a large population of normotensive and hypertensive subjects. Elevated heart rate was significantly associated with low arterial distension and high PWV, even after adjustment for age and blood pressure. The use of ambulatory blood pressure instead of casual blood pressure data amplified the significance of the association. The most significant correlations between high heart rate and high PWV were found at the site of elastic arteries such as the thoracic aorta and the carotid artery, but not muscular arteries such as the terminal aorta and those of the arm. It is well established that, in populations at large, increased heart rate and increased pulse pressure may be considered as independent predictors of CV risk.[13,17,18,19] More recently, epidemiologic studies have shown that the association of these two parameters has a synergistic effect on CV risk, particularly in subjects with a heart rate below 100 beats/min.[20]

In conclusion, aortic PWV should be considered nowadays as a marker of CV risk, independently on brachial blood pressure level, but in conjunction with heart rate. Since PWV is increased particularly in the elderly, this marker may be considered as of dominant importance in geriatric populations.[21]

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