Matthew Jay Budoff, MD, FACC, FAHA
David Geffen School of Medicine at UCLA — Los Angeles, California
Matthew Jay Budoff, MD, FACC, FAHA, is a professor of medicine at David Geffen School of Medicine at UCLA and the Endowed Chair of Preventive Cardiology at Harbor-UCLA Medical Center. Dr. Budoff is a graduate of University of California at Riverside (BS) and graduated a member of Alpha Omega Alpha from George Washington University School of Medicine (MD). He completed his training in internal medicine and his cardiology fellowship at Harbor-UCLA Medical Center. Dr. Budoff is on the editorial boards of several cardiology journals, including Clinical Cardiology, Journal of Invasive Cardiology, JACC: Cardiovascular Imaging, and Cardiovascular Diabetology. Dr. Budoff has served on a number of association committees, including member of the ACC Annual Scientific Session program committee (2013–2015). He also serves on the executive committee of the ACC Center of Excellence on Cardiovascular Risk Reduction (2018-2020).
Dr. Budoff has author or coauthored more than 50 books and book chapters and more than 2000 articles and abstracts. He has received numerous research grants from the National Institutes of Health and has been invited to lecture at cardiology conferences around the world. In addition to his 2015 appointment as the Endowed Chair of Preventive Cardiology at Harbor-UCLA Medical Center, he has been recognized for his work by the Society of Cardiovascular Computed Tomography, from which he received the Gold Medal Award and recently designated as Master of the Society of Cardiovascular Computed Tomography (MSCCT), and has been inducted into the European Academy of Sciences. Dr. Budoff has been named to “America’s Top Doctors” for each of the past 9 years. In 2011, he was named a US News Top Doctor for cardiology, was awarded the Albert Nelson Marquis Lifetime Achievement Award in 2018 and named to “The world’s most influential scientific researchers” in 2018 and 2019.
Expert Consensus for the Application of Cardio-Ankle Vascular Index (CAVI)
Matthew J. Budoff1, Bruce Alpert2, Julio A. Chirinos3, Bo Fernhall4, Naomi Hamburg5, Kazuomi Kario6, Iftikhar Kullo7, Kunihiro Matsushita8, Toru Miyoshi9, Hirofumi Tanaka10, Ray Townsend3, and Paul Valensi11
1 Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA;
2 Department of Pediatrics, University of Tennessee Medical Group, Memphis, TN;
3 Department of Medicine, University of Pennsylvania, Philadelphia, PA;
4 Department of Medicine, University of Illinois at Chicago, Chicago, IL
5 Department of Medicine, Boston University School of Medicine, Boston, MA;
6 Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan;
7 Department of Medicine, Mayo Clinic, Rochester, MN;
8 Department of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
9 Department of Medicine, Okayama University, Okayama, Japan;
10 Department of Medicine, The University of Texas at Austin, Austin, TX;
11 Unit of Endocrinology-Diabetology-Nutrition, Department of Medicine, Jean Verdier hospital, AP-HP, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
Short Title - Clinical Applications Measuring Arterial Stiffness
Corresponding author: Matthew Budoff MD
Keywords: Vascular disease, Arterial stiffness, clinical, cardio-ankle vascular index, endothelial function, expert consensus
Measuring CAVI using peripheral cuffs and a chest microphone provides several logistical advantages that are beneficial for clinical use. It is primarily operator independent, does not require exposure of the groin area (which some tonometric methods use for femoral pulse reference points), is a very reliable measure, and automated for greater ease-of-use and reproducibility. In addition to including the more peripheral arteries of the legs, the entire aorta is represented in the CAVI measurement, whereas other measurements omit significant portions of the aorta.
Methods: We wrote an expert consensus document on the clinical use of CAVI.
Results: As arterial stiffness predicts cardiovascular risk independently of traditional risk factors, it has a significant impact on decision-making in various clinical scenarios. Several outcome studies demonstrate the robust risk associated with CAVI >8 and >9. Recently, the Japanese Society for Vascular Failure proposed the cut-off values for CAVI: <8 for normal, ≥8 to <9 for borderline, and ≥9 for abnormal. CAVI has been applied clinically to assess arterial stiffness in patients who were diagnosed with CAD, stroke, and those at risk. Arterial stiffness is an independent predictor of CAD, and is correlated with the severity of coronary stenosis.
Arterial stiffness, as represented by CAVI is significantly and strongly correlated with both CAC and coronary stenosis.
Conclusion: Thus, CAVI may be used as screening tool for early prediction of obstructive CAD and plays a critical role in preventive cardiology to optimize management. CAVI may also aid in the evaluation of younger individuals with a family history of isolated systolic hypertension, given that a substantial proportion of the variability in large artery stiffness is inheritable. We suggest that CAVI is a useful frontline test, appropriate for outpatient clinics, for identifying patients who might otherwise go unnoticed for coronary vessel risk. This proposed scenario is even more pertinent to patients with diabetes, hypertension, and kidney dysfunction, where cardiovascular risk is higher.