Arq. Bras. Cardiol. 2020; 115(6): 1133-1134
Parameters of Central Hemodynamics as New Biomarkers of Cardiovascular Risk
This Short Editorial is referred by the Research article "Relationship between Pulse Wave Velocity and Cardiovascular Biomarkers in Patients with Risk Factors".
Historically, the importance of the arterial pulse wave was already observed by the Egyptians and the Chinese, before Christ. The knowledge of peripheral hemodynamics showed great progress after the introduction of non-invasive blood pressure (BP) measurement using the sphygmomanometer about 120 years ago and, to date, brachial BP represents an excellent predictor of cardiovascular morbidity and mortality. However, changes in macro and microcirculation cannot be completely observed only by peripheral BP measurement. Thus, structural and functional vascular changes can be better assessed by central hemodynamic parameters, represented by central BP, augmentation index and pulse wave velocity (PWV), , with OPV being the gold standard in the assessment of arterial stiffness.The reference prognostic value of central hemodynamics was clinically demonstrated by the CAFE study (Conduit Artery Function Evaluation Study), which showed that a greater reduction in central BP compared to peripheral BP resulted in a greater reduction in cardiovascular events.
In turn, other studies associated the role of PWV with the presence of cardiovascular and cerebrovascular lesions, so this topic was included in the European guidelines for hypertension in 2007. PWV was first used as a clinical index of arterial elasticity in 1922, but its determination too long to be applied to clinical practice because its registration and calculation were difficult to obtain. Aortic stiffness, measured by carotid-femoral PWV, has been the most used in epidemiological studies. Obtaining PWV in the carotid-femoral segment is simple, non-invasive, reproducible, widely accepted and clinically relevant, as it includes the aorta, an important segment in relation to the pathophysiological effects of arterial stiffness. Currently, PWV can be considered a biomarker of cardiovascular risk and is a predictor of cardiovascular events and mortality. ,
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