Volumetric sphygmography with assessment of arterial stiffness as an alternative to ultrasound examination of the carotid arteries in the cardiovascular risk stratification

Aim. To study the potential of volume sphygmography (VS) with assessment of arterial stiffness (AS) as an alternative to carotid ultrasound in cardiovascular risk (CVR) stratification in a Tomsk adult population sample.

Material and methods. The results of a survey of a Tomsk population sample aged 40 to 64 years (n=971) were analyzed. They underwent carotid ultrasound and VS with cardio-ankle vascular index (CAVI) assessment as part of the ESSE-RF study. During a 5-year follow-up, cardiovascular events (CVEs) (cardiovascular death, non-fatal myocardial infarction (MI) or stroke) were registered in 34 people. Individuals with high and very high CVR were identified according to traditional CVR stratification based on clinical, anamnestic, and carotid ultrasound data. Alternative options for CVR stratification using the criterion of increased AS (CAVI ≥8) were considered. The effectiveness of CVR stratification was assessed by identifying CVR over a 5-year follow-up period.

Results. Based on clinical, anamnestic and carotid ultrasound (plaques in 40% (n=386)) data, 605 (62%) individuals were classified as high and very high risk, accounting for 88% (30 out of 34) of CVEs over the follow-up period (CVE rate over 5 years — 5%). CAVI ≥8 was detected in 45% (n=432) of those examined. When using the CAVI ≥8 indicator instead of the plaque criterion, a group of 633 people was formed, which also accounted for 88% (30 out of 34) of the CVEs (CVE rate over follow-up period — 4,7%), i.e. the results are comparable with the traditional approach.

Conclusion. When stratifying the CVR in the Tomsk population sample, consideration of the criterion of increased AS (CAVI ≥8) in addition to clinical and anamnestic data forms a group of people with a comparable CVE rate over a 5-year follow-up period, as when taking into account the plaque criterion according to carotid ultrasound, which account for the same number (88%) of the CVEs. This suggests the use of VS with AS assessment in the CVR stratification.

1. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42:3227-337. doi:10.1093/eurheartj/ehab484.

2. Boytsov SA, Pogosova NV, Ansheles AA, et al. Cardiovascular prevention 2022. Russian national guidelines. Russian Journal of Cardiology. 2023;28(5):5452. (In Russ.. doi:10.15829/1560-4071-2023-5452.

3. Laurent S, Cockcroft J, van Bortel L, et al. European Network for Non-invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588-605. doi:10.1093/eurheartj/ehl254.

4. Vasyuk YA, Ivanova SV, Shkolnik EL, et al. Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice. Cardiovascular Therapy and Prevention. 2016;15(2):4-19. (In Russ.). doi:10.15829/1728-8800-2016-2-4-19.

5. 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) Society. Atherosclerosis. 2015;241:507e532. doi:10.1016/j.atherosclerosis.2015.05.007.

6. Kobalava ZhD, Konradi AO, Nedogoda SV, et al. 2024 Clinical practice guidelines for Hypertension in adults. Russian Journal of Cardiology. 2024;29(9):6117. (In Russ.). doi:10.15829/1560-4071-2024-6117.

7. Zairova AR, Rogoza AN. Volume sphygmography today. Medical alphabet. 2018;4(36):8-18. (In Russ.)

8. Asmar R. Principles and usefulness of the cardio-ankle vascular index (CAVI): a new global arterial stiffness index. Eur Heart J Suppl. 2017;19(suppl B):4-10. doi:10.1093/eurheartj/suw058.

9. Boitsov SA, Chazova IE, Shlyahto EV, et al. Scientific and organizing committee of the project ESSE-RF. Epidemiology of cardiovascular diseases in different regions of Russia (ESSE-RF). The rationale for and design of the study. Russian Journal of Preventive Medicine. 2013;16(6):25-34. (In Russ.).

10. Zairova AR, Rogoza AN, Oshchepkova EV, et al. Contribution of cardio-ankle vascular index to prediction of cardiovascular events in the adult urban population: data from the ESSE-RF study (Tomsk). Cardiovascular Therapy and Prevention. 2021;20(5):2967. (In Russ.). doi:10.15829/1728-8800-2021-2967.

11. Zairova AR, Rogoza AN, Oshchepkova EV, et al. Cardiovascular risk stratification using the SCORE2 scale in the population sample of urban adults and assessment of its effectiveness based on the results of a 5-year follow-up. Cardiovascular Therapy and Prevention. 2025;24(1):4184. (In Russ.. doi:10.15829/1728-8800-2024-4184.

12. Park JB, Sharman JE, Li Y, et al. Expert Consensus on the Clinical Use of Pulse Wave Velocity in Asia. Jeong Bae Park James E. Sharman Yan Li Masanori Munakata Kohji Shira Pulse. 2022;10(1-4):1-18. doi:10.1159/000528208.

13. Matsushita K, Ding N, Kim ED, et al. Cardio-ankle vascular index and cardiovascular disease: systematic review and meta-analysisof prospective and cross-sectional studies. J Clin Hypertens (Greenwich). 2019;21:16-24. doi:10.1111/jch.13425.

14. Budoff MJ, Alpert B, Chirinos JA, et al. Clinical Applications Measuring Arterial Stiffness: An Expert Consensus for the Application of Cardio-Ankle Vascular Index. Am J Hypertens. 2022;35(5):441-53. doi:10.1093/ajh/hpab178.

15. Zairova AR, Rogoza AN, Oshchepkova EV, et al. Prognostic markers of early vascular aging according to volumetric sphygmography in adult urban population sample (based on the ESSE-RF study in Tomsk). Russian Cardiology Bulletin. 2023;18(1):55-64. (In Russ.) . doi:10.17116/Cardiobulletin20231801155.

16. Bäck M, Topouchian J, Labat C, et al. Cardio-ankle vascular index for predicting cardiovascular morbimortality and determinants for its progression in the prospective advanced approach to arterial stiffness (TRIPLE-A-Stiffness) study. eBioMedicine. 2024;105107. doi:10.1016/j.ebiom.2024.105107.

17. Kaveshnikov VS, Trubacheva IA, Kuzmichkina MA, et al. Factors associated with carotid artery calcification in the general working-age population. Cardiovascular Therapy and Prevention. 2024;23(9):4062. (In Russ.). EDN KLQATB.

18. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-88. doi:10.1093/eurheartj/ehz455.

19. Ezhov MV, Kukharchuk VV, Sergienko IV, et al. Disorders of lipid metabolism. Clinical Guidelines 2023. Russian Journal of Cardiology. 2023;28(5):5471. (In Russ.). doi:10.15829/1560-4071-2023-5471. EDN YVZOWJ.