Clinical Potential of Arterial Stiffness Measured from the Aortic Valve to the Brachial Artery in a Seated Position

BACKGROUND: The cardio-ankle vascular index (CAVI) is a widely used noninvasive marker of arterial stiffness that is independent of blood pressure at the time of measurement. However, its requirement for supine positioning limits practicality in certain settings. This study aimed to evaluate the feasibility and clinical utility of a novel seated-position stiffness index, termed the innovative CAVI (iCAVI), measured from the aortic valve to the brachial artery in assessing arterial stiffness. METHODS: We enrolled 121 outpatients with cardiovascular risk factors. Participants were divided into groups with and without coronary artery disease (CAD). All CAD participants had previously undergone percutaneous coronary intervention at our department at least 3 months before enrollment and were in stable outpatient follow-up. Reproducibility, correlations with clinical parameters, and diagnostic performance for CAD were assessed. RESULTS: The cohort included 63 CAD-positive and 58 CAD-negative patients. Both CAVI and iCAVI showed high intraobserver reproducibility (ρ = 0.937 and 0.895; P < .001). iCAVI correlated with CAVI (ρ = 0.481; P < .001). Diagnostic discrimination for CAD was modest and similar between indices: area under the curve 0.630 for iCAVI and 0.591 for CAVI. Optimal cutoffs were 2.95 (iCAVI) and 10.40 (CAVI). In sensitivity analyses, iCAVI showed no significant association with measurement-time SBP or DBP, in contrast to heart-brachial pulse wave velocity. CONCLUSIONS: In this single-center cohort, iCAVI showed modest discrimination for CAD, similar to conventional CAVI, while enabling seated measurement. The development of a dedicated device-akin to a home blood pressure monitor-could facilitate clinical implementation and support day-to-day health management.