Chest Pulse-Wave Velocity: A Novel Approach to Assess Arterial Stiffness

Pulse-wave velocity (PWV) is considered as the gold-standard method to assess arterial stiffness, an independent predictor of cardiovascular morbidity and mortality. Current available devices that measure PWV need to be operated by skilled medical staff, thus, reducing the potential use of PWV in the ambulatory setting. In this paper, we present a new technique allowing continuous, unsupervised measurements of pulse transit times (PTT) in central arteries by means of a chest sensor. This technique relies on measuring the propagation time of pressure pulses from their genesis in the left ventricle to their later arrival at the cutaneous vasculature on the sternum. Combined thoracic impedance cardiography and phonocardiography are used to detect the opening of the aortic valve, from which a pre-ejection period (PEP) value is estimated. Multichannel reflective photoplethysmography at the sternum is used to detect the distal pulse-arrival time (PAT). A PTT value is then calculated as PTT = PAT - PEP. After optimizing the parameters of the chest PTT calculation algorithm on a nine-subject cohort, a prospective validation study involving 31 normo- and hypertensive subjects was performed. 1/chest PTT correlated very well with the COMPLIOR carotid to femoral PWV (r = 0.88, <; 10^-9). Finally, an empirical method to map chest PTT values onto chest PWV values is explored.

I. Introduction

Pulse-Wave velocity (PWV) represents the velocity at which pressure pulses propagate through the arterial tree. The PWV is considered as the gold-standard measurement to assess arterial stiffness (in particular, carotid to femoral (CF) PWV), and has been identified as an independent predictor of cardiovascular morbidity and mortality [29]. In line with this data, in 2007, the European Society of Hypertension has introduced PWV as a recommended test to assess cardiovascular risk in its guidelines for the diagnosis and management of hypertension [2].