Background: The prognostic role of aortic pulse wave velocity (aPWV) is well known. Its non-invasive determination (carotid-femoral PWV) is inconvenient, and easier yet accurate methods could be of value to facilitate the adoption by clinicians.

Methods: We recently developed the ARCSolver method to estimate aortic flow from pressure waveforms. Characteristic impedance is derived from this, and finally aPWV, using Waterhammer equation. Travel distance is estimated from body height, using a previously developed formula. In this study, we tested the prognostic value of the estimated aPWV, in comparison with invasively measured aPWV, in 620 patients (mean age 63 years, 43% women, 19% diabetes, 41% coronary artery disease) undergoing coronary angiography.

Results: Both methods for assessing aPWV showed moderate agreement (R² = 0.51, p<0.0001). After a follow-up of 3 years, 90 patients suffered from cardiovascular events (death, myocardial infarction, stroke, coronary and peripheral revascularizations). In univariate analysis, an increase in aPWV of one standard deviation was associated with a 42.1 (CI 15.7 – 74.6) % (estimated aPWV) and 36.2 (CI 17.8 – 57.5) % (measured aPWV) increased risk for cardiovascular events. In stepwise logistic regression models, including age, gender, presence of smoking, hypertension and diabetes, extent of coronary artery disease, systolic function, systolic and diastolic blood pressure, heart rate, and aPWV, both estimated (HR 1.48 per SD, p=0.001) and measured (HR 1.32 per SD, p=0.002) aPWV showed a statistically significant association with cardiovascular events.

Conclusion: Our results indicate that a simplified method to estimate aPWV can predict cardiovascular events in high-risk patients.