Vivek Rai, MD

Kim J, Song TJ, Kim EH, Lee KJ, Lee HS, Nam CM, et al. Brachial-Ankle Pulse Wave Velocity for Predicting Functional Outcome in Acute Stroke. Stroke. 2014

The elastic component of arteries decreases with age and the consequent loss of elasticity results in hemodynamic changes, which are thought to be involved in pathogenesis of vascular diseases. Brachial-ankle pulse wave velocity (baPWV) is a recently developed automated tool for measurement of arterial elasticity used as an alternative to carotid-femoral pulse wave velocity (current gold standard). Carotid-femoral pulse wave velocity (cfPWV) and baPWV have been validated to produce reliable results and a high cfPWV is related to worse functional outcomes after stroke. The authors investigated whether baPWV can also be used as prognostic marker of recovery after stroke.

Kim et al analyzed data from1091 consecutive patients with first-ever acute cerebral infarction who underwent baPWV measurements. Poor functional outcomes were defined as modified Rankin Scale score of >2 at 3 months after stroke onset. The authors report that 181 (16.59%) patients had a poor functional outcome and the patients in the highest tertile of baPWV (>22.25 m/sec) were at an increased risk for poor functional outcome (adjusted OR, 1.88) compared to those in the lowest tertile (<17.55 m/sec). No significant interaction between baPWV and stroke subtype was noted.

The authors have shown that baPWV can be used as a simple, non-invasive marker for identification of patients at risk for poor recovery after stroke, regardless of stroke subtype according to TOAST criteria. In previous studies, increased baPWV and cfPWV were found to be independent predictors of new vascular events and cardiovascular mortality. It remains to be shown whether there is any causal effect to this association. Therapeutic interventions aimed at reducing progression of arterial stiffness may reduce stroke incidence and may even help in recovery after stroke. Further studies are necessary to prove these hypothesized benefits. Till then, in my view, the clinical application of this novel tool remains limited.