Are All “Arterial Stiffening” Parameters Equal or Are Some More Equal Than Others?

From theoretical point of view, arterial stiffness can be viewed as the slope of the relationship between the distending pressure and the cross-sectional area or volume of an artery under study.¹ Carotid-femoral pulse wave velocity (cf-PWV) is generally considered as the gold standard for estimation of regional arterial stiffness in the field of clinical medicine. PWV is proportional to the square root of the incremental elastic modulus of the vessel wall given constant ratio of wall thickness to vessel radius and given blood density and assuming that the artery wall is isotropic and experiences iso-volumetric change with pulse pressure. cf-PWV independently predicts established clinical endpoints in models that include classical risk indicators and is instrumental in reclassifying patients into higher and lower risk categories.² However, one should realize that cf-PWV in its own right does not perfectly describe important nonlinear dynamic components of arterial mechanics. It initiated a "quest for the holy grail" in order to develop meaningful alternatives accounting for the intrinsic weaknesses of the concept of PWV.

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