Potential sources of error in carotid-femoral pulse wave velocity measurements: a lack in clinical uptake

James Cox; Isabella Tan; Alberto Avolio; Mark Butlin

Abstract

Background: Arterial stiffness is a strong predictor of cardiovascular events and can be measured through carotid-femoral pulse wave velocity (cfPWV). Despite the clinical relevance of this measurement, integration of cfPWV in routine clinical assessments has been limited. Potential error in the measurement of cfPWV may be a determining factor of this. Aim: To investigate the potential sources of error in cfPWV measurement. Methods: Sources of error were investigated in healthy participants (n=15, age 30±15 years, 12 female) by repeated supine cfPWV measurements with respect to 1) operator experience; 2) poor carotid waveform acquisition; and 3) lower femoral pulse acquisition site. `True’ cfPWV was obtained by averaging twenty cfPWV measurements (regression to the mean). Data analysis was performed using regression analysis and Bland-Altman plots. Results: All cfPWV measurements fell within ±0.5 m/s (based on an increase of PWV of 1m/s equivalent to a 14% increase in cardiovascular events) of the true cfPWV following an average of three measurements for both operators, irrespective of experience (mean difference±SD: -0.03±0.35 m/s, p=0.25). Measurements made with a poor carotid waveform signal (mean difference±SD: -0.28±0.54 m/s, p=0.06) and a lower femoral pulse acquisition site (mean difference±SD: -0.18±0.37 m/s, p=0.08) did not significantly differ from the true cfPWV. However, there were some physiologically significant differences, as represented as a difference in cfPWV>±0.5 m/s. Conclusions: Irrespective of operator experience, with a reasonable waveform an accurate measurement of cfPWV can be obtained within the average of three measurements. These results suggest that cfPWV measurement error should not necessarily be a contributing factor to the limited clinical uptake of cfPWV. The true limiting factor may instead be a consequence of the absence of treatment options available for individuals with abnormal arterial stiffnesses.

Original language	English
Publication status	Published - 2020
Event	Annual Scientific Meeting of the High Blood Pressure Research Council of Australia 2020 - Virtual, Australia Duration: 1 Dec 2020 → 4 Dec 2020 https://www.xcdsystem.com/hbprca/program/NRpjEW0/index.cfm

Conference

Conference	Annual Scientific Meeting of the High Blood Pressure Research Council of Australia 2020
Country/Territory	Australia
Period	1/12/20 → 4/12/20
Internet address	https://www.xcdsystem.com/hbprca/program/NRpjEW0/index.cfm

Cite this

@conference{3e93f5f6fd154ed592b07e55e0121564,

title = "Potential sources of error in carotid-femoral pulse wave velocity measurements: a lack in clinical uptake",

abstract = "Background: Arterial stiffness is a strong predictor of cardiovascular events and can be measured through carotid-femoral pulse wave velocity (cfPWV). Despite the clinical relevance of this measurement, integration of cfPWV in routine clinical assessments has been limited. Potential error in the measurement of cfPWV may be a determining factor of this. Aim: To investigate the potential sources of error in cfPWV measurement. Methods: Sources of error were investigated in healthy participants (n=15, age 30±15 years, 12 female) by repeated supine cfPWV measurements with respect to 1) operator experience; 2) poor carotid waveform acquisition; and 3) lower femoral pulse acquisition site. `True{\textquoteright} cfPWV was obtained by averaging twenty cfPWV measurements (regression to the mean). Data analysis was performed using regression analysis and Bland-Altman plots. Results: All cfPWV measurements fell within ±0.5 m/s (based on an increase of PWV of 1m/s equivalent to a 14% increase in cardiovascular events) of the true cfPWV following an average of three measurements for both operators, irrespective of experience (mean difference±SD: -0.03±0.35 m/s, p=0.25). Measurements made with a poor carotid waveform signal (mean difference±SD: -0.28±0.54 m/s, p=0.06) and a lower femoral pulse acquisition site (mean difference±SD: -0.18±0.37 m/s, p=0.08) did not significantly differ from the true cfPWV. However, there were some physiologically significant differences, as represented as a difference in cfPWV>±0.5 m/s. Conclusions: Irrespective of operator experience, with a reasonable waveform an accurate measurement of cfPWV can be obtained within the average of three measurements. These results suggest that cfPWV measurement error should not necessarily be a contributing factor to the limited clinical uptake of cfPWV. The true limiting factor may instead be a consequence of the absence of treatment options available for individuals with abnormal arterial stiffnesses.",

author = "James Cox and Isabella Tan and Alberto Avolio and Mark Butlin",

year = "2020",

language = "English",

note = "Annual Scientific Meeting of the High Blood Pressure Research Council of Australia 2020 ; Conference date: 01-12-2020 Through 04-12-2020",

url = "https://www.xcdsystem.com/hbprca/program/NRpjEW0/index.cfm",

}

TY - CONF

T1 - Potential sources of error in carotid-femoral pulse wave velocity measurements

T2 - Annual Scientific Meeting of the High Blood Pressure Research Council of Australia 2020

AU - Cox, James

AU - Tan, Isabella

AU - Avolio, Alberto

AU - Butlin, Mark

PY - 2020

Y1 - 2020

N2 - Background: Arterial stiffness is a strong predictor of cardiovascular events and can be measured through carotid-femoral pulse wave velocity (cfPWV). Despite the clinical relevance of this measurement, integration of cfPWV in routine clinical assessments has been limited. Potential error in the measurement of cfPWV may be a determining factor of this. Aim: To investigate the potential sources of error in cfPWV measurement. Methods: Sources of error were investigated in healthy participants (n=15, age 30±15 years, 12 female) by repeated supine cfPWV measurements with respect to 1) operator experience; 2) poor carotid waveform acquisition; and 3) lower femoral pulse acquisition site. `True’ cfPWV was obtained by averaging twenty cfPWV measurements (regression to the mean). Data analysis was performed using regression analysis and Bland-Altman plots. Results: All cfPWV measurements fell within ±0.5 m/s (based on an increase of PWV of 1m/s equivalent to a 14% increase in cardiovascular events) of the true cfPWV following an average of three measurements for both operators, irrespective of experience (mean difference±SD: -0.03±0.35 m/s, p=0.25). Measurements made with a poor carotid waveform signal (mean difference±SD: -0.28±0.54 m/s, p=0.06) and a lower femoral pulse acquisition site (mean difference±SD: -0.18±0.37 m/s, p=0.08) did not significantly differ from the true cfPWV. However, there were some physiologically significant differences, as represented as a difference in cfPWV>±0.5 m/s. Conclusions: Irrespective of operator experience, with a reasonable waveform an accurate measurement of cfPWV can be obtained within the average of three measurements. These results suggest that cfPWV measurement error should not necessarily be a contributing factor to the limited clinical uptake of cfPWV. The true limiting factor may instead be a consequence of the absence of treatment options available for individuals with abnormal arterial stiffnesses.

AB - Background: Arterial stiffness is a strong predictor of cardiovascular events and can be measured through carotid-femoral pulse wave velocity (cfPWV). Despite the clinical relevance of this measurement, integration of cfPWV in routine clinical assessments has been limited. Potential error in the measurement of cfPWV may be a determining factor of this. Aim: To investigate the potential sources of error in cfPWV measurement. Methods: Sources of error were investigated in healthy participants (n=15, age 30±15 years, 12 female) by repeated supine cfPWV measurements with respect to 1) operator experience; 2) poor carotid waveform acquisition; and 3) lower femoral pulse acquisition site. `True’ cfPWV was obtained by averaging twenty cfPWV measurements (regression to the mean). Data analysis was performed using regression analysis and Bland-Altman plots. Results: All cfPWV measurements fell within ±0.5 m/s (based on an increase of PWV of 1m/s equivalent to a 14% increase in cardiovascular events) of the true cfPWV following an average of three measurements for both operators, irrespective of experience (mean difference±SD: -0.03±0.35 m/s, p=0.25). Measurements made with a poor carotid waveform signal (mean difference±SD: -0.28±0.54 m/s, p=0.06) and a lower femoral pulse acquisition site (mean difference±SD: -0.18±0.37 m/s, p=0.08) did not significantly differ from the true cfPWV. However, there were some physiologically significant differences, as represented as a difference in cfPWV>±0.5 m/s. Conclusions: Irrespective of operator experience, with a reasonable waveform an accurate measurement of cfPWV can be obtained within the average of three measurements. These results suggest that cfPWV measurement error should not necessarily be a contributing factor to the limited clinical uptake of cfPWV. The true limiting factor may instead be a consequence of the absence of treatment options available for individuals with abnormal arterial stiffnesses.

UR - https://www.xcdsystem.com/hbprca/program/NRpjEW0/index.cfm?pgid=1989

M3 - Abstract

Y2 - 1 December 2020 through 4 December 2020

ER -

Potential sources of error in carotid-femoral pulse wave velocity measurements: a lack in clinical uptake

Abstract

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