Prediction of severe aortic stenosis using peripheral arterial waveforms during brachial-ankle pulse wave velocity testing.

With the increasing use of minimally invasive catheter-based therapies, early identification of severe aortic stenosis (AS) has become essential. The slow upstroke waveform (Tardus) observed in carotid artery wave analysis is a known feature of AS, and quantitative assessments of Tardus can estimate the severity of AS. Prolongation of ejection time (ET) and upstroke time (UT) is a characteristic of Tardus. However, the clinical relevance of ET and UT measured during brachial-ankle pulse wave velocity (baPWV) assessment remained unclear. This study aimed to develop a predictive model for screening severe AS using baPWV-derived parameters. We enrolled 117 patients with mild to severe AS and 76 control subjects without cardiovascular disease. AS severity was classified based on peak aortic valve velocity (peak V) measured by echocardiography. We evaluated correlations between peak V and baPWV parameters, including ET, UT, and pre-ejection time (PEP), and developed a predictive model to identify severe AS. Peak V correlated significantly with ET, PEP, PEP/ET and mean UT (r = 0.52, - 0.28, - 0.44, 0.33; all p < 0.001). A model incorporating age, body mass index, corrected ET, corrected mean UT and mean percentage of mean arterial pressure (%MAP) showed good predictive value (area under the curve = 0.872). BaPWV-derived parameters may serve as useful noninvasive indicators for diagnosing severe AS.