Arterial stiffness is an important predictor of cardiovascular events. In clinical practice, it is commonly evaluated non-invasively by central (carotid-femoral) or peripheral (femoral-ankle or brachial-ankle) foot-to-foot pulse wave velocities (PWV). Though, the efficiency of these indices as predictors of aortic stiffness in normal and pathological conditions has not been theoretically validated.

This study investigates the relation between aortic stiffness and central and peripheral PWV in normal and pathological conditions using a validated one-dimensional model of blood flow in the arterial network. The model allows us to (i) calculate the theoretical value of aortic stiffness from model parameters and (ii) investigate the effect of specific pathological changes in parameters on PWV estimates.

Our results show that in normal conditions, the central PWV over-estimates aortic stiffness by 8%. This error (e) tends to decrease with increased aortic (e=−0.5%) and global (e=2,3%) arterial stiffening (200% increase from baseline). However, in the presence of isolated lower-limb arterial stiffening, the central PWV over-estimates the aortic stiffness by up to 20%.

In normal conditions, peripheral PWV largely over-estimate aortic stiffness (42%< e<67%). Though, these errors drop to less than 3% with aortic stiffening.

Increased global arterial stiffening induces significant increases in all PWV. However, progressive increases in aortic stiffness are only detected by central PWV. Interestingly, increased peripheral vascular resistance and compliance only induce small changes in all PWV.

Our study suggests that central PWV is a good estimate of aortic stiffness, and that peripheral PWV can augment diagnosis by detecting the origin of vascular stiffening.