Measurement of pulse
wave velocity (XII.)
DEP. OF PHYSIOLOGY, FAC. OF MEDICINE, MU, 2015 © JANA HRUŠKOVÁ
Definition of pulse wave
• Pulse wave arises during heart revolution, when blood is ejected.
• Single pulse is propagated in arterial wall through whole arterial system
Pulse wave curve
Pulse wave is composed of two waves: forward
traveling wave and backward traveling wave.
Forward wave travels from the heart to periphery.
Backward wave is rebounded from bifurcations of
arteries in periphery. It travels to the heart,
interferes with forward wave and both together
form shape of the pulse wave curve.
Amplitude of pulse wave increases in periphery
due to increased pulse wave velocity.
The shape of the curve is depend on the place
where it is measured. The smallest amplitude is
common in radial artery, greatest one in dorsal
pedis artery.
Backward traveling wave
Forward traveling wave
Pulse wave in aorta
Pulse wave in periphery
Heart
Periphery
Pulse wave velocity (PWV)
• Velocity of pulse wave propagation varies from 6 m/s (in aorta) to 20 m/s (in periphery)
• It is much greater than velocity of blood flow (0.8 – 1.0 m/s)
Factors affected the pulse wave velocity
◦ Age
◦ Sex
◦ Genetic load
◦ Smoking
◦ Obesity
◦ Diabetes
◦ Dyslipidaemia
Changes of pulse wave in elderly people
Increased PWV and vanishing of typical characteristics of shape of the pulse
wave due to:
1. Increased arterial stiffness
2. Increased blood pressure
Forward wave
Backward wave
Total waveYoung man:
High arterial compliance → lower pulse wave velocity
→ backward wave meets forward wave during the
beginning of diastole → lower pulse amplitude
ŠPÁC, Jiří. Hypertenze a vlastnosti arteriální stěny. Kardiofórum, 2006, roč. 4, č. 4, s. 9-13. ISSN 1214-2255.
Elder man:
decreased arterial compliance → increased pulse
wave velocity → backward wave meets forward wave
during the end of systole → increased pulse amplitude
Changes of pulse wave in children
Increased PVW and vanishing of typical characteristics of shape of the pulse
wave due to:
1. Smaller length of arterial system
2. Longer ejection time
• Relatively long ejection time to small body and higher heart rate
leads to changes of summation of consecutive pulse waves
Normal values of PWV
Reference intervals for carotid-femoral index (PWV)
If the measured value is higher than 90. percentile for the age, it is the sign of cardiovascular pathology
(such as atherosclerosis) and such person has significant higher risk for cardiovascular diseases.
Measurement of PWV
1. Direct method
◦ Catheterisation
2. Indirect methods
◦ Ultrasonography
◦ Sphygmography
◦ Bioimpedance analysis
Sphygmography
•Carotid-femoral PWV („gold standard“) measured
from pulse on a. carotis, a. femoralis and ECG.
•Well reproducible method (differences between
two measurement are < 5 %),
• Arterial segment is analysed as complexly
• In clinical practise, it is important to take in
consideration the actual blood pressure. Arterial
compliance is a function of blood pressure and
arterial hypertension increases rigidity of the
arterial wall.
•Aortal PWV is the most important parameter,
because it reflects dampening function of the
central arterial system.
A B
T1 T2
d
PWV= d/ (T2-T1)
A B