Turkiye Klinikleri Journal of Medical Sciences

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Assessment of Arterial Stiffness with Pulse Wave Velocity or Augmentation Index: Which Method is the Best?: Scientific Letter
Arteriyel Sertliğin Nabız Dalga Hızı veya Artırma Göstergesi ile Değerlendirilmesi: En İyi Yöntem Hangisi?
Mustafa YILDIZa, Ahmet Çağrı AYKANa, Hakan HASDEMİRb
aDepartment of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul
bDepartment of Cardiology, Antalya Memorial Hospital, Antalya
Turkiye Klinikleri J Med Sci. 2012;32(1):214-7
doi: 10.5336/medsci.2010-22276
Article Language: EN
Full Text
ABSTRACT
Assesment of large arterial stiffness is increasingly used in clinal settings. Although there are several invasive and non-invasive methods such as carotid-femoral pulse wave velocity (PWV) and augmentation index (AI), researchers and clinicians still face problems in selecting the best methodology for their specific use. PWV, which is defined as the velocity of the arterial pulse for moving along the vessel wall, plays an important clinical role in defining patients under high cardiovascular risk and it is inversely correlated with arterial elasticity and relative arterial compliance. PWV along the aorta can be measured by using two ultrasound or pressure sensitive transducers fixed transcutaneously over the course of a pair of arteries separated by a known distance: the femoral and right common carotid arteries. PWV is calculated from measurements of pulse transit time and the distance, according to the following formula: PWV (m/s)= distance (m)/transit time (s). AI is defined as Dp/pp (where Dp is the difference between the late systolic peak and the mid-systolic peak and pp is the amplitude of the pulse pressure wave). Central blood pressure and pulse pressure, the AI and PWV, which are often used incorrectly as interchangeable indexes of arterial stiffness, increase with age, hypertension, diabetes mellitus and hyperlipidemia, and are associated with target organ damage such as left ventricular hypertrophy, microalbuminuria, carotid intima-media thickness and endothelial dysfunction. Althouhg the carotid-femoral (aortic) PWV is the gold standard test for assessing central arterial stiffness, the AI reflects stiffness of the systemic arterial tree. This paper summaries the advantages and disadvantages of PWV and AI in the assessment of arterial stiffness.

Keywords: Pulse; arteries; atherosclerosis; inflammation
ÖZET
Büyük arterlerin sertliğinin değerlendirilmesi klinikte giderek artan sıklıkta kullanılmaktadır. Arteriyel sertliğin değerlendirilmesinde karotid-femoral nabız dalga hızı ve artırma göstergesi gibi invaziv ve non-invaziv yöntemler olmakla birlikte, araştırmacılar ve klinisyenler, bunların özgül kullanımları için en uygun yöntemi seçmede halen sorun yaşamaktadırlar. Nabız dalga hızı, arteriyel nabzın damar duvarı boyunca hareketinin hızı olarak tanımlanır ve arteriyel sertliğin bir göstergesi olarak yüksek kardiyovasküler risk altındaki hastaları tanımlamada önemli rol oynar. Arteryel elastisite ve rölatif arteriyel kompliyans ile ters ilişkilidir. Nabız dalga hızı aorta boyunca belli bir aralıkla ayrılmış bir çift arter boyunca (femoral ve sağ ana karotid arterler) transkütanöz yerleştirilmiş iki ultrason veya basınca duyarlı iletme sistemleri kullanılarak nabız transit zamanı ve uzaklık ölçümlerinden şu formüle göre hesaplanır: Nabız dalga hızı (m/s)=uzaklık (m)/ transit zamanı (s). Artırma göstergesi Dp/pp olarak tanımlanır (Dp: Geç sistolik zirve ve orta sistolik zirve arasındaki fark; pp: Nabız basınç dalgasının amplitüdü). Sıklıkla yanlış şekilde birbirinin yerine kullanılan arteriyel sertlik göstergeleri olan santral kan basıncı ve nabız basıncı, artırma göstergesi ve nabız dalga hızı yaş, hipertansiyon, diabet ve hiperlipidemi ile artar ve sol ventrikül hipertrofisi, mikroalbüminüri, karotid intima-media kalınlığı ve endotel disfonksiyonu ile ilişkilidir. Karotis-femoral (aortik) nabız dalga hızı merkezi arterial sertliğin değerlendirilmesinde altın standartken, artırma göstergesi sistemik arterial ağacın sertliğini yansıtır. Bu yazıda arteriyel sertliğin değerlendirilmesinde nabız dalga hızı ve artırma indeksinin avantajları ve dezavantajları özetlenmiştir.

Anahtar Kelimeler: Nabız; arterler; ateroskleroz; enflamasyon

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