Functional Markers of Vascular Aging: Subendocardial Viability Ratio, Augmentation Pressure, and Augmentation Index as Links to Atherosclerotic Cardiovascular Disease Risk.
Yang L, Wang L, et al. • Journal of clinical hypertension (Greenwich, Conn.) • 2026
SEVR, AP, and Aix@75 are independent correlates of estimated 10-year ASCVD risk and together provide a functional hemodynamic profile that independently correlates with estimated risk beyond traditional factors, suggesting their potential role as supplementary tools for cardiovascular risk stratification.
Key Findings
Results
10-year ASCVD risk was inversely correlated with subendocardial viability ratio (SEVR) and positively correlated with augmentation pressure (AP) and heart-rate-corrected augmentation index (Aix@75).
SEVR showed an inverse correlation with 10Y-ASCVDR (r = -0.171, p < 0.001)
AP showed a positive correlation with 10Y-ASCVDR (r = 0.452, p < 0.001)
Aix@75 showed a positive correlation with 10Y-ASCVDR (r = 0.236, p < 0.001)
AP demonstrated the strongest correlation among the three functional hemodynamic parameters
Results
Stepwise multivariable linear regression identified SEVR, AP, and Aix@75 as independent correlates of estimated 10-year ASCVD risk.
All three parameters remained statistically significant after multivariable adjustment (p < 0.001)
Multivariable logistic regression was also used to identify independent correlates of elevated estimated 10Y-ASCVDR
The associations were independent of traditional cardiovascular risk factors
These parameters together provide a functional hemodynamic profile that independently correlates with estimated risk beyond traditional factors
Methods
The study enrolled 3,354 Chinese participants aged 18–80 years and assessed functional hemodynamic parameters using pulse wave analysis.
This was a cross-sectional study design
Inclusion criterion required left ventricular ejection fraction >55%
Functional hemodynamic parameters (SEVR, AP, Aix@75) were assessed by pulse wave analysis
The 10-year ASCVD risk (10Y-ASCVDR) was estimated using the China-PAR model, a China-specific risk prediction tool
Conclusions
SEVR, AP, and Aix@75 were identified as functional markers of vascular aging with potential utility as supplementary tools for cardiovascular risk stratification.
The authors describe these parameters as constituting a 'functional hemodynamic profile'
Their associations with ASCVD risk were independent of traditional risk factors
The findings suggest these markers offer 'a valuable supplemental approach for improving cardiovascular risk assessment in clinical practice'
The parameters were correlated with age as well as ASCVD risk, consistent with their characterization as markers of vascular aging
What This Means
This research suggests that three measurements of how blood flows through the heart and arteries — the subendocardial viability ratio (SEVR), augmentation pressure (AP), and a corrected augmentation index (Aix@75) — are meaningfully linked to a person's calculated risk of developing atherosclerotic cardiovascular disease (ASCVD, such as heart attack or stroke) over the next 10 years. The study examined over 3,300 adults in China ranging from 18 to 80 years old, measuring these parameters non-invasively using pulse wave analysis and calculating cardiovascular risk using a validated Chinese risk model. People with higher cardiovascular risk tended to have lower SEVR and higher AP and Aix@75 values, and these associations held up even after accounting for traditional risk factors like blood pressure, cholesterol, and diabetes.
These three parameters reflect how stiff or compliant the arteries are and how efficiently the heart receives blood supply relative to its workload — features that tend to worsen with aging and cardiovascular disease. This research suggests that measuring these functional hemodynamic parameters could add useful information beyond what standard risk calculators already capture, potentially helping clinicians identify people at elevated cardiovascular risk who might otherwise appear lower-risk based on traditional measures alone.
The practical implication is that pulse wave analysis, a relatively simple and non-invasive test, might serve as a supplemental screening tool in cardiovascular risk assessment. However, since this was a cross-sectional study (a single snapshot in time), it cannot prove that these parameters cause cardiovascular disease or predict future events — only that they are associated with estimated risk. Future longitudinal studies would be needed to confirm whether incorporating these measurements actually improves clinical outcomes.
Yang L, Wang L, Ma J, Wang N, Yu R, Wu T, et al.. (2026). Functional Markers of Vascular Aging: Subendocardial Viability Ratio, Augmentation Pressure, and Augmentation Index as Links to Atherosclerotic Cardiovascular Disease Risk.. Journal of clinical hypertension (Greenwich, Conn.). https://doi.org/10.1111/jch.70364