Jornal Vascular Brasileiro
Jornal Vascular Brasileiro
Review Article

Aplicabilidade dos marcadores de rigidez arterial na doença arterial periférica

Applications of arterial stiffness markers in peripheral arterial disease

Daniel Mendes-Pinto; Maria da Glória Rodrigues-Machado

Downloads: 0
Views: 78


Resumo: A análise de rigidez arterial tem sido feita em vários grupos populacionais com o objetivo de identificar precocemente o risco cardiovascular e realizar medidas terapêuticas específicas. O aumento da rigidez arterial leva à perda de capacidade de adaptação da aorta e das artérias elásticas às variações de pressão durante o ciclo cardíaco. Os principais marcadores de rigidez arterial são a velocidade de onda de pulso (VOP), o índice de aumentação (AIx) e a pressão aórtica central. Esses índices podem ser obtidos de maneira não invasiva. Ocorre aumento da mortalidade em pacientes com doença coronariana ou em hemodiálise que apresentam aumento da VOP ou do AIx. A associação com a doença arterial periférica é pouco estudada. O objetivo desta revisão é mostrar a aplicabilidade e a utilidade de realizar medidas de rigidez arterial em pacientes com doença arterial periférica.


rigidez arterial, doença arterial periférica, velocidade da onda de pulso


Abstract: Arterial stiffness has been analyzed in many different population groups with the objective of identifying cardiovascular risk early and performing specific therapeutic interventions. Increased arterial stiffness affects the capacity of the aorta and elastic arteries to adapt to pressure variations during the cardiac cycle. The main markers of arterial stiffness are pulse wave velocity (PWV), augmentation index (AIx) and central aortic pressure. They can be measured noninvasively. Patients with coronary disease or on hemodialysis who have elevated PWV or AIx have increased mortality. The association with peripheral arterial disease has been studied little. The objective of this review is to demonstrate the applicability and utility of assessing measures of arterial stiffness in patients with peripheral arterial disease.


arterial stiffness, peripheral arterial disease, pulse wave velocity


Townsend RR, Wilkinson IB, Schiffrin EL, et al. Recommendations for improving and standardizing vascular research on arterial stiffness: A scientific statement from the American Heart Association. Hypertension. 2015;66(3):698-722. PMid:26160955.

Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588-605. PMid:17000623.

Fan X, Zhu M, Chi C, et al. Association of arteriosclerosis and/or atherosclerosis with hypertensive target organ damage in the community-dwelling elderly Chinese: the Northern Shanghai Study. Clin Interv Aging. 2017;12:929-36. PMid:28652715.

Fowkes FGR, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: A systematic review and analysis. Lancet. 2013;382(9901):1329-40. PMid:23915883.

Makdisse M, Pereira AC, Brasil DP, et al. Prevalence and risk factors associated with peripheral arterial disease in the Hearts of Brazil Project. Arq Bras Cardiol. 2008;91(6):370-82. PMid:19142364.

Mozos I, Malainer C, Horbańczuk J, et al. Inflammatory Markers for Arterial Stiffness in Cardiovascular Diseases. Front Immunol. 2017;8:1058. PMid:28912780.

Avolio A. Arterial Stiffness. Pulse. 2013;1(1):14-28. PMid:26587425.

Lusis AJ. Atherosclerosis. Nature. 2000;407(6801):233-41. PMid:11001066.

Brozovich FV, Nicholson CJ, Degen CV, Gao YZ, Aggarwal M, Morgan KG. Mechanisms of Vascular Smooth Muscle Contraction and the Basis for Pharmacologic Treatment of Smooth Muscle Disorders. Pharmacol Rev. 2016;68(2):476-532. PMid:27037223.

Maksuti E, Westerhof N, Westerhof BE, Broome M, Stergiopulos N. Contribution of the Arterial System and the Heart to Blood Pressure during Normal Aging - A Simulation Study. PLoS One. 2016;11(6):e0157493. PMid:27341106.

Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation. 2003;107(22):2864-9. PMid:12796414.

Yannoutsos A, Ahouah M, Tubiana CD, et al. Hemodynamic parameters in hypertensive diabetic patients. J Hypertens. 2016;34(6):1123-31. PMid:26999754.

Safar ME, Plante GE, Mimran A. Arterial stiffness, pulse pressure, and the kidney. Am J Hypertens. 2015;28(5):561-9. PMid:25480804.

García-Espinosa V, Curcio S, Marotta M, et al. Changes in central aortic pressure levels, wave components and determinants associated with high peripheral blood pressure states in childhood: Analysis of hypertensive phenotype. Pediatr Cardiol. 2016;37(7):1340-50. PMid:27388527.

Chirinos JA, Kips JG, Jacobs DR Jr, et al. Arterial wave reflections and incident cardiovascular events and heart failure: MESA (Multiethnic Study of Atherosclerosis). J Am Coll Cardiol. 2012;60(21):2170-7. PMid:23103044.

Husmann M, Jacomella V, Thalhammer C, Amann-Vesti BR. Markers of arterial stiffness in peripheral arterial disease. Vasa. 2015;44(5):341-8.

Manisty CH, Hughes AD. Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index. Br J Clin Pharmacol. 2013;75(1):79-92. PMid:22625662.

Nunan D, Wassertheurer S, Lasserson D, et al. Assessment of central haemomodynamics from a brachial cuff in a community setting. BMC Cardiovasc Disord. 2012;12(48):1-9. PMid:22734820.

Gajdova J, Karasek D, Goldmannova D, et al. Pulse wave analysis and diabetes mellitus. A systematic review. Biomed Pap. 2017;161(3):223-33. PMid:28627523.

Tamminen MK, Westerbacka J, Vehkavaara S, Yki-Jarvinen H. Insulin therapy improves insulin actions on glucose metabolism and aortic wave reflection in type 2 diabetic patients. Eur J Clin Invest. 2003;33(10):855-60. PMid:14511356.

Weber T, Wassertheurer S, Rammer M, Haiden A, Hametner B, Eber B. Wave reflections, assessed with a novel method for pulse wave separation, are associated with end-organ damage and clinical outcomes. Hypertens. 2012;60(2):534-41.

Zettervall SL, Buck DB, Darling JD, Lee V, Schermerhorn ML, Guzman RJ. Increased preoperative pulse pressure predicts procedural complications and mortality in patients who undergo tibial interventions for critical limb ischemia. J Vasc Surg. 2016;63(3):673-7. PMid:26577658.

Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318-27. PMid:20338492.

Ben-Shlomo Y, Spears M, Boustred C, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014;63(7):636-46. PMid:24239664.

Kaess BM, Rong J, Larson MG, et al. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA. 2012;308(9):875-81. PMid:22948697.

Mitchell GF, Hwang S-J, Vasan RS, et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation. 2010;121(4):505-11. PMid:20083680.

Mitchell GF, Tardif JC, Arnold JM, et al. Pulsatile hemodynamics in congestive heart failure. Hypertens. 2001;38(6):1433-439.

Hashimoto J, Ito S. Central pulse pressure and aortic stiffness determine renal hemodynamics: pathophysiological implication for microalbuminuria in hypertension. Hypertens. 2011;58(5):839-46.

Williams B, Lacy PS, Thom SM, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006;113(9):1213-25. PMid:16476843.

Baumann M, Wassertheurer S, Suttmann Y, Burkhardt K, Heemann U. Aortic pulse wave velocity predicts mortality in chronic kidney disease stages 2-4. J Hypertens. 2014;32(4):899-903. PMid:24609217.

Mitchell GF, van Buchem MA, Sigurdsson S, et al. Arterial stiffness, pressure and flow pulsatility and brain structure and function: the Age, Gene/Environment Susceptibility-Reykjavik study. Brain. 2011;134(Pt 11):3398-407. PMid:22075523.

Kinjo Y, Ishida A, Kinjo K, Ohya Y. A high normal ankle-brachial index combined with a high pulse wave velocity is associated with cerebral microbleeds. J Hypertens. 2016;34(8):1586-93. PMid:27254311.

Vlachopoulos C, Xaplanteris P, Aboyans V, et al. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation. Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY). Atherosclerosis. 2015;241(2):507-32. PMid:26117398.

Weiss W, Gohlisch C, Harsch-Gladisch C, Tölle M, Zidek W, Van Der Giet M. Oscillometric estimation of central blood pressure: Validation of the Mobil-O-Graph in comparison with the SphygmoCor device. Blood Press Monit. 2012;17(3):128-31. PMid:22561735.

Papaioannou TG, Argyris A, Protogerou AD, et al. Non-invasive 24 hour ambulatory monitoring of aortic wave reflection and arterial stiffness by a novel oscillometric device: the first feasibility and reproducibility study. Int J Cardiol. 2013;169(1):57-61. PMid:24063914.

Mosimann K, Jacomella V, Thalhammer C, et al. Severity of peripheral arterial disease is associated with aortic pressure augmentation and subendocardial viability ratio. J Clin Hypertens. 2012;14(12):855-60. PMid:23205752.

Brewer LC, Chai H-S, Bailey KR, Kullo IJ. Measures of arterial stiffness and wave reflection are associated with walking distance in patients with peripheral arterial disease. Atherosclerosis. 2007;191(2):384-90. PMid:16730015.

Catalano M, Scandale G, Carzaniga G, et al. Increased aortic stiffness and related factors in patients with peripheral arterial disease. J Clin Hypertens. 2013;15(10):712-6. PMid:24088278.

Catalano M, Scandale G, Carzaniga G, et al. Aortic augmentation index in patients with peripheral arterial disease. J Clin Hypertens. 2014;16(11):782-7. PMid:25228305.

Zahner GJ, Gruendl MA, Spaulding KA, et al. Association between arterial stiffness and peripheral artery disease as measured by radial artery tonometry. J Vasc Surg. 2017;66(5):1518-26. PMid:28756044.

Zahner GJ, Spaulding KA, Ramirez JL, et al. Characterizing the relationship between flow-mediated vasodilation and radial artery tonometry in peripheral artery disease. J Surg Res. 2018;224:121-31. PMid:29506827.

Jacomella V, Shenoy A, Mosimann K, Kohler MK, Amann-Vesti B, Husmann M. The impact of endovascular lower-limb revascularisation on the aortic augmentation index in patients with peripheral arterial disease. Eur J Vasc Endovasc Surg. 2013;45(5):497-501. PMid:23453515.

Brand M, Woodiwiss AJ, Michel F, Booysen HL, Veller MG, Norton GR. A mismatch between aortic pulse pressure and pulse wave velocity predicts advanced peripheral arterial disease. Eur J Vasc Endovasc Surg. 2013;46(3):338-46. PMid:23835110.

Khaleghi M, Kullo IJ. Aortic augmentation index is associated with the ankle-brachial index: A community-based study. Atherosclerosis. 2007;195(2):248-53. PMid:17254587.

Eldrup N, Sillesen H, Prescott E, Nordestgaard BG. Ankle brachial index, C-reactive protein, and central augmentation index to identify individuals with severe atherosclerosis. Eur Heart J. 2006;27(3):316-22. PMid:16278227.

5c87b7a40e88259c48db04aa jvb Articles

J Vasc Bras

Share this page
Page Sections