Noninvasive pulse wave velocity measurement: technological progress, clinical validation, and translation challenges

Pulse wave velocity (PWV) is increasingly recognized as a vital noninvasive metric for assessing arterial stiffness and an established independent predictor of cardiovascular risk. Despite its well-recognized clinical value, the accurate and reliable measurement of PWV remains methodologically challenging due to inherent physical ambiguities, technological heterogeneity across devices, and a lack of comparability between measurements obtained by different systems. This review provides a comprehensive synthesis of the physical foundations, mainstream detection technologies, signal-processing pipelines, and current clinical standardization status for PWV assessment. Although classical frameworks such as the Moens-Korteweg and Bramwell-Hill equations theoretically link PWV to the mechanical properties of the arterial wall, the intrinsic dependence of PWV on instantaneous blood pressure complicates the precise evaluation of structural arterial stiffness in clinical settings. We categorize existing measurement modalities into four principal types: mechanical-pressure sensing, optical techniques, advanced medical imaging, and emerging contactless approaches, each demonstrating unique trade-offs among measurement fidelity, clinical applicability, and operational convenience. Presently, three major barriers hinder the clinical translation of novel technologies: insufficient operational automation, inadequate cross-population validation, and a scarcity of longitudinal prognostic evidence. Future transformative advancements will likely rely on AI-driven, fully automated continuous monitoring systems optimized for real-world daily settings, large-scale multicenter trials across diverse demographics, and extensive long-term cohort studies utilizing wearable devices. These developments will collectively extend PWV assessment from intermittent clinical evaluation toward decentralized, personalized cardiovascular risk management.