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Safronova T, Kravtsova A, Vavilov S, Leon C, Bragina A, Milyagin V, Makiev R, Sumin A, Peskov K, Sokolov V, Podzolkov V. Model-Based Assessment of the Reference Values of CAVI in Healthy Russian Population and Benchmarking With CAVI0. Am J Hypertens 2024; 37:77-84. [PMID: 37696678 DOI: 10.1093/ajh/hpad082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/17/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Cardio-ankle vascular index (CAVI) and its modified version (CAVI0) are promising non-invasive markers of arterial stiffness, extensively evaluated primarily in the Japanese population. In this work, we performed a model-based analysis of the association between different population characteristics and CAVI or CAVI0 values in healthy Russian subjects and propose a tool for calculating the range of reference values for both types of indices. METHODS The analysis was based on the data from 742 healthy volunteers (mean age 30.4 years; 73.45% men) collected from a multicenter observational study. Basic statistical analysis [analysis of variance, Pearson's correlation (r), significance tests] and multivariable linear regression were performed in R software (version 4.0.2). Tested covariates included age, sex, BMI, blood pressure, and heart rate (HR). RESULTS No statistically significant difference between healthy men and women were observed for CAVI and CAVI0. In contrast, both indices were positively associated with age (r = 0.49 and r = 0.43, P < 0.001), however, with no clear distinction between subjects of 20-30 and 30-40 years old. Heart rate and blood pressure were also identified as statistically significant predictors following multiple linear regression modeling, but with marginal clinical significance. Finally, the algorithm for the calculation of the expected ranges of CAVI in healthy population was proposed, for a given age category, HR and pulse pressure (PP) values. CONCLUSIONS We have evaluated the quantitative association between various population characteristics, CAVI, and CAVI0 values and established a method for estimating the subject-level reference CAVI and CAVI0 measurements.
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Affiliation(s)
- Tatiana Safronova
- 2nd Internal Medicine Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Anna Kravtsova
- Modeling and Simulation Decisions LLC, Dubai, UAE
- Lomonosov Moscow State University, Moscow, Russia
| | | | | | - Anna Bragina
- 2nd Internal Medicine Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Victor Milyagin
- Department of Therapy, Ultrasound and Functional Diagnostics, Smolensk State Medical University, Smolensk, Russia
| | - Ruslan Makiev
- S. M. Kirov Military Medical Academy, Saint Petersburg, Russia
| | - Alexei Sumin
- Laboratory of Comorbidity in Cardiovascular Diseases, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Kirill Peskov
- Modeling and Simulation Decisions LLC, Dubai, UAE
- Scientific Center of Information Technologies and Artificial Intelligence, Sirius University of Science and Technology, Sochi, Russia
- Center for Mathematical Modeling in Drug Development, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Victor Sokolov
- Modeling and Simulation Decisions LLC, Dubai, UAE
- Scientific Center of Information Technologies and Artificial Intelligence, Sirius University of Science and Technology, Sochi, Russia
| | - Valery Podzolkov
- 2nd Internal Medicine Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Takahashi K, Yamamoto T, Tsuda S, Maruyama M, Shirai K. The Background of Calculating CAVI: Lesson from the Discrepancy Between CAVI and CAVI 0. Vasc Health Risk Manag 2020; 16:193-201. [PMID: 32547046 PMCID: PMC7251085 DOI: 10.2147/vhrm.s223330] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/09/2020] [Indexed: 12/18/2022] Open
Abstract
Arterial stiffness is a good predictor of cardiovascular events. As a substitute for elastic modulus representing stiffness, pulse wave velocity (PWV) has been used for over a century as it is easy to measure; however, PWV is known to essentially depend on blood pressure at the time of measurement. The cardio-ankle vascular index (CAVI) is a relatively new index of global arterial stiffness of the origin of the aorta to the ankle arteries. The characteristic feature is its independency from blood pressure at the measuring time. Recently, a variant index CAVI0 was proposed, which was claimed to be a more accurate arterial stiffness index than CAVI, considering independency from blood pressure. The purpose of this review is to evaluate the properties of CAVI more precisely by comparing with CAVI0, and to confirm the true meaning of CAVI as an index of arterial stiffness. First, the properties of PWV depending on the blood pressure and the variation of PWV values in the cardiac cycle were analyzed. Then, we attempted to clarify the point at which the PWV, adopted in CAVI or in CAVI0, was measured in cardiac cycle. A comprehensive comparison of the clinical data of CAVI and CAVI0 showed that CAVI is more appropriate than CAVI0. In conclusion, CAVI is reconfirmed to be a reliable and useful index of blood pressure-independent arterial stiffness composed of both organic and functional stiffness.
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Spronck B, Jurko A, Mestanik M, Avolio AP, Tonhajzerova I. Reply to Comments: Using the Cardio-Ankle Vascular Index (CAVI) or the Mathematical Correction Form (CAVI 0) in Clinical Practice. Int J Mol Sci 2020; 21:ijms21072647. [PMID: 32290313 PMCID: PMC7178141 DOI: 10.3390/ijms21072647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/09/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Bart Spronck
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, 6229ER Maastricht, The Netherlands;
- Department of Biomedical Engineering, School of Engineering & Applied Science, Yale University, New Haven, CT 06511, USA
| | - Alexander Jurko
- Pediatric Cardiology Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia;
| | - Michal Mestanik
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia;
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Alberto P. Avolio
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2019, Australia;
| | - Ingrid Tonhajzerova
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia;
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
- Correspondence: or ; Tel.: +421-43-2633-425
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Ato D. Evaluation of the calculation formulas of the cardio-ankle vascular index used in the Japanese apparatus. Vasc Health Risk Manag 2019; 15:395-398. [PMID: 31686831 PMCID: PMC6752165 DOI: 10.2147/vhrm.s215709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/01/2019] [Indexed: 12/14/2022] Open
Abstract
Background Recently, coefficients in the equation of cardio-ankle vascular index (CAVI) used in VaSera® device were disclosed. This study aimed to simulate the influence of adjusting the coefficients in the equation of CAVI and also aimed to validate the equation. Methods The CAVI displayed by VaSera (CAVIvs) and the CAVI estimated (CAVIes) with fixing the coefficients of the middle range of the heart-ankle stiffness parameter β (haβ) in the equation were compared. Moreover, the heart-ankle pulse wave velocity (haPWV) which corresponds to the low cutoff haβ of 7.348 was estimated in various blood pressure patterns to validate the formula. Results The CAVIvs was clearly lower than CAVIes in the low and the high range of CAVIvs. Moreover, it was virtually impossible to obtain the low cutoff haβ of 7.348 by using typical values of haPWV. Conclusion The CAVIvs in the high-range of VaSera underestimates the original property of stiffness parameter β. Moreover, there will be also a missing information in the equations introduced in the corresponding article, especially in the calculation formula of CAVIvs from haβ. Therefore, in order to make the best use of the nature of the stiffness parameter β to be used in VaSera, fixing the coefficients or termination of its use should be considered.
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Affiliation(s)
- Dai Ato
- Gakujutsu Shien Co., Ltd., Tokyo, Japan
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Shirai K, Suzuki K, Tsuda S, Shimizu K, Takata M, Yamamoto T, Maruyama M, Takahashi K. Comparison of Cardio-Ankle Vascular Index (CAVI) and CAVI 0 in Large Healthy and Hypertensive Populations. J Atheroscler Thromb 2019; 26:603-615. [PMID: 31068504 PMCID: PMC6629744 DOI: 10.5551/jat.48314] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: The cardio-ankle vascular index (CAVI) represents the blood pressure-independent arterial stiffness from the origin of the aorta to the ankle. CAVI0 has been proposed as a variant index. We aimed to clarify the difference between CAVI and CAVI0 among large populations, and to explore reasons of the difference. Methods: The subjects were 5,293 Japanese healthy and 3,338 hypertensive people. Simple and multiple regression analyses were performed using age, sex, body mass index, systolic, and diastolic blood pressure (Pd) as variables. Sub-group analysis was performed by sex and age. The CAVI values with and without adjustment by reference pressure were also compared. Results: CAVI had a positive correlation with Pd, while CAVI0 had a negative correlation with Pd in the healthy population. The CAVI values of the hypertensive group were higher than those of healthy group in both men and women, but the CAVI0 values in women of the hypertensive group in the 30–39 age group was significantly lower than that of the corresponding healthy group. Differences of CAVI values with or without modification using the reference pressure were 1.09% ± 1.38% for the healthy group and 3.68% ± 1.66% for the hypertensive group. Conclusion: CAVI showed the expected values, but CAVI0 showed inexplicable results in the healthy and hypertensive populations. The differences were due to the strong dependency of CAVI0 on Pd. Differences of CAVI values with or without reference pressure were negligible. These results indicate that CAVI obtained by the VaSera system is appropriate, but CAVI0 is not.
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Affiliation(s)
| | | | | | - Kazuhiro Shimizu
- Department of Internal Medicine, Toho University Sakura Medical Center
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Medical science is based on evidence (answer to Spronck et al.'s refutation: physics cannot be disputed). J Hypertens 2018; 36:958-960. [PMID: 29489619 DOI: 10.1097/hjh.0000000000001661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spronck B, Delhaas T, Butlin M, Reesink KD, Avolio AP. Options for Dealing with Pressure Dependence of Pulse Wave Velocity as a Measure of Arterial Stiffness: An Update of Cardio-Ankle Vascular Index (CAVI) and CAVI0. Pulse (Basel) 2017; 5:106-114. [PMID: 29761084 DOI: 10.1159/000479322] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/06/2017] [Indexed: 12/20/2022] Open
Abstract
Pulse wave velocity (PWV), a marker of arterial stiffness, is known to change instantaneously with changes in blood pressure. In this mini-review, we discuss two main approaches for handling the blood pressure dependence of PWV: (1) converting PWV into a pressure-independent index, and (2) correcting PWV per se for the pressure dependence. Under option 1, we focus on cardio-ankle vascular index (CAVI). CAVI is essentially a form of stiffness index β - CAVI is estimated for a (heart-to-ankle) trajectory, whereas β is estimated for a single artery from pressure and diameter measurements. Stiffness index β, and therefore also CAVI, have been shown to theoretically exhibit a slight residual blood pressure dependence due to the use of diastolic blood pressure instead of a fixed reference blood pressure. Additionally, CAVI exhibits pressure dependence due to the use of an estimated derivative of the pressure-diameter relationship. In this mini-review, we will address CAVI's blood pressure dependence theoretically, but also statistically. Furthermore, we review corrected indices (CAVI0 and β0) that theoretically do not show a residual blood pressure dependence. Under option 2, three ways of correcting PWV are reviewed: (1) using an exponential relationship between pressure and cross-sectional area, (2) by statistical model adjustment, and (3) through reference values or rule of thumb. Method 2 requires a population to be studied to characterise the statistical model, and method 3 requires a representative reference study. Given these limitations, method 1 seems preferable for correcting PWV per se for its blood pressure dependence. In summary, several options are available to handle the blood pressure dependence of PWV. If a blood pressure-independent index is sought, CAVI0 is theoretically preferable over CAVI. If correcting PWV per se is required, using an exponential pressure-area relationship provides the user with a method to correct PWV on an individual basis.
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Affiliation(s)
- Bart Spronck
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Koen D Reesink
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Alberto P Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
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Spronck B. Stiff vessels approached in a flexible way: Advancing quantification and interpretation of arterial stiffness☆. Artery Res 2017. [DOI: 10.1016/j.artres.2017.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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