Breakthrough in Clinical Cardiology : In - Office Assessment with Pulse Wave Velocity ( PWV ) and Digital Pulse

TOWNSEND LETTER – MAY 2010 This article explores an exciting, noninvasive, easy-to-use, and economical method of assessing patients’ cardiovascular physiologic status that is backed by more than 25 years of advanced research in medical physics. A 2007 Clinical Medicine article points the way to better clinical treatment of CVD, stating: “Arterial stiffness measured by pulse wave velocity (PWV) is an accepted strong, independent predictor of cardiovascular events and mortality.”1 Anesthesiologists are well aware of this technology, used for monitoring purposes. While pulse oximetry became standard in the operating room and in other critical care areas as a detector of hypoxemia – all pulse oximeters are fundamental photoelectric plethysmographs – PWV has been largely ignored. This is unfortunate, as PWV (plethysmographic) information itself may provide important clues regarding the CV condition of the patient.2,3 With this advanced technology, cardiovascular science has moved forward, but many physicians have yet to appreciate these advances. As stated in the 1993 issue of the Journal of Hypertension, “Wave reflection is not a subject with which most physicians are familiar and only given mention in undergraduate physiology courses.” Little has changed. As this article was going to press, however, “Arterial Stiffness and Cardiovascular Events: The Framingham Heart Study,” by Gary F. Mitchell, MD, et al. (Circulation. 2010;121:505–511) was published and featured on Medscape, stating: “In this study, we assessed the incremental value of adding pulse wave velocity [PWV] ... to a risk model that includes standard risk factors for a first cardiovascular event. ... Adding pulse wave velocity led to significant reclassification of risk and improvement in global risk prediction. ... [W]e need to focus our efforts on identifying and implementing interventions that can prevent or reverse abnormal aortic stiffness in order to prevent a marked increase in the burden of disease potentially attributable to aortic stiffness.” The specific intervention/ solution will be given later in this article.