Pulse wave velocity (PWV)

Pulse wave velocity (PWV) is the speed at which the pressure wave generated by ventricular ejection travels along the arterial tree, and is the non-invasive gold-standard measure of arterial stiffness. Carotid-femoral PWV (cf-PWV), measured by applanation tonometry or oscillometric devices over the aortic segment, is the most validated modality: the European Society of Hypertension threshold of >10 m/s in the context of hypertension identifies pathological aortic stiffness. Arterial wall composition, cross-linking of structural proteins, elastin fragmentation and vascular smooth-muscle tone all contribute to stiffness, which increases progressively with age and is further accelerated by hypertension, diabetes and chronic kidney disease. Large prospective studies and meta-analyses have demonstrated that cf-PWV independently predicts cardiovascular events and all-cause mortality beyond traditional risk factors, including in populations free of established cardiovascular disease.