New Approach to Detect Vascular Damage by Measuring Arterial Stiffness in a Hemodynamic Manner

Objective: Arterial stiffness is a risk factor for cardiovascular disease, largely attributable to vascular aging, but it can be accelerated by certain metabolic conditions, such as diabetes and kidney disease. Pulse wave velocity (PWV) is the conventional measure used to assess arterial stiffness, typically measured in the supine position with mechanical sensors placed on the carotid and on the femoral arteries. Recent advancements allow for the use of photoplethysmographic sensors to obtain finger-to-toe PWV (ftPWV), which can be performed in the sitting position, offering a new way to examine the vascular wall hemodynamically. The aim of this study is to 1) evaluate the impact of postural changes on arterial stiffness and 2) identify the determinants of PWV changes. Design and method: Cross-sectional study with a group of patients with kidney disease (eGFR < 60 ml/min) and a control group (eGFR > 60 ml/min). Blood pressure is first measured with an oscillometric device, then the finger-to-toe pulse wave velocity (ftPWV) is obtained using two photoplethysmographic sensors (pOpmetre®). Three measurements are taken in the supine position and then in the sitting position. Subsequently, paired t-test analyses and linear regressions were performed. Results: In the control group (n=37, aged 39 ± 18 years, 54% female), ftPWV increased from 6.8 ± 2.2 to 9.6 ± 2.5 m/s (P<0.001) following the postural change. Similarly, in the kidney disease group (n=73, aged 66 ± 14 years, 37% female), ftPWV significantly increased from 11.2 ± 4.7 to 17.8 ± 11.5 m/s (P<0.001). Linear regression analysis indicated that ftPWV in the supine position (ß = 0.336; P<0.001) and the presence of diabetes (ß=0.291; P<0.001) were associated with a greater increase in ftPWV. Age, sex, and cardiovascular diseases did not have a significant impact on the increase in ftPWV. Conclusions: These preliminary results show a significant increase in ftPWV following postural change, more so in patients with greater arterial stiffness and those with diabetes. This observation presents an intriguing opportunity to investigate whether a postural change can be used as a vascular stress test to identify arterial stiffness.