INTEGRATED NON-INVASIVE VASCULAR PHENOTYPING USING ANKLE-BRACHIAL INDEX (ABI) AND PULSE WAVE VELOCITY (PWV) FOR EARLY DETECTION OF SUBCLINICAL ATHEROSCLEROSIS. BRIDGING EVIDENCE FROM COMPREHENSIVE LITERATURE REVIEW AND CASE-BASED CLINICAL EVALUATION

Abstract

Cardiovascular disease remains the leading global cause of morbidity and mortality, often preceded by a prolonged subclinical phase characterized by early vascular alterations. This study aims to evaluate the clinical utility of integrated non-invasive vascular phenotyping using ankle–brachial index (ABI) and pulse wave velocity (PWV) for the early detection of subclinical atherosclerosis, combining a comprehensive literature review with a case- based clinical evaluation. A 36-year-old male with cardiometabolic risk factors, including smoking, physical inactivity, and dyslipidemia, underwent detailed vascular assessment using a four-limb oscillometric system (BPlab® with Vasotens®). Despite normal findings on conventional cardiovascular testing—including ECG, echocardiography, and exercise stress testing—advanced vascular evaluation revealed subtle abnormalities. ABI values were within the upper- normal range on the right (1.28) but elevated on the left (1.44), suggesting increased arterial stiffness rather than overt peripheral arterial disease. PWV analysis demonstrated mildly increased brachial–ankle and aortic PWV, while carotid–femoral PWV remained within normal limits, indicating early peripheral arterial stiffening. Central hemodynamic parameters were preserved, although wave reflection indices suggested early vascular functional changes. These findings highlight the discordance between standard diagnostic approaches and advanced vascular biomarkers, emphasizing the added value of combined structural (ABI) and functional (PWV) assessment. The observed vascular phenotype is consistent with early vascular aging associated with cardiometabolic dysregulation. In conclusion, integrated vascular phenotyping enhances early detection of subclinical vascular disease, improves cardiovascular risk stratification, and may guide timely preventive interventions, particularly in younger individuals with modifiable risk factors.