Heart-thigh cuff pulse wave velocity: Aiming for the best of both worlds?

The assessment of the pulse waveform, as a tool for diagnosis, has attracted interest for many hundreds of years, because it was recognised very early that arterial elasticity is related to characteristics of the pressure pulse waveform and the velocity of its propagation through the arterial tree. With the emergence of sophisticated computers and software, novel non-invasive methods of assessing arterial stiffness have been developed, hailing the modern era of arterial pulse wave assessment. Studies conducted by many investigators around the world have now generated an impressive body of evidence demonstrating the importance of large artery stiffness in our understanding of cardiovascular disease risk. Increased aortic stiffness is associated with cardiovascular risk factors such as hypertension, hyperlipidaemia and diabetes1, underlining its role as an important biomarker of disease. However, it is also likely that aortic stiffening drives various disease processes and is an important risk factor in itself. Indeed, aortic pulse wave velocity (PWV), a robust index of aortic stiffness, independently predicts future fatal and non-fatal cardiovascular disease events and all-cause mortality2. As such, aortic PWV adds value to risk prediction beyond that provided by traditional cardiovascular risk factors and improves risk classification. But despite these data, the widespread adoption of aortic PWV into routine clinical assessment has yet to be realised.This work was funded, in part, by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NIHR. The authors appreciate the financial support provided by China Scholarship Council (CSC, Grant No. 201806260070) for S.Y