A Mismatch Between Aortic Pulse Pressure and Pulse Wave Velocity Predicts Advanced Peripheral Arterial Disease

ObjectivesTo determine whether increases in central aortic pulse pressure (PPc), but decreases in carotid–femoral pulse wave velocity (PWV) predict the presence of advanced peripheral arterial disease (PAD).MethodsApplanation tonometry and vascular ultrasound were employed to assess carotid–femoral PWV, PPc, and carotid intima media thickness (IMT) in 136 patients of African ancestry with chronic critical lower limb ischaemia (CLI) and in 1,030 randomly selected healthy adults of African ancestry, 194 of whom were age- and sex matched (controls).ResultsWith adjustments for confounders, compared with age- and sex-matched controls, participants with CLI had an increased carotid IMT (p = .0001) and PPc (p < .0001), but a markedly reduced PWV (m/second) (CLI = 5.7 ± 3.7, controls = 8.6 ± 3.4, p < .0001). PWV was correlated with PPc in controls (r = .52, p < .0001), but not in CLI (r = −.06). A PPc/PWV mismatch index showed increased values in participants with CLI over the full adult age range assessed. With carotid IMT, PPc, or aortic augmentation index in the same regression model, an increase in the PPc/PWV mismatch index was independently associated with CLI (p < .0001) and a PPc/PWV value upper 95% confidence interval in the community sample predicted CLI (odds ratio = 32 [6–169], p < .0001). PPc/PWV predicted CLI with a similar level of performance and accuracy and a greater specificity (98%) than that of IMT (82%).ConclusionIn CLI, while PPc increases, carotid–femoral PWV is markedly reduced. A PPc/PWV mismatch may be a new risk marker for advanced PAD.