Due to the nature of the pump (the heart), blood pressure and blood flow in humans are pulsatile. The simplest measure of pulsatile hemodynamics is brachial pulse pressure, but to explore the effect of pulsatile hemodynamics further, more accurate measures are needed. These can be derived from the analysis of arterial waveforms (mainly measures to quantify wave reflections, such as Augmentation Index (Aix) or amplitude of backward waves (Pb) or from measurement of the speed of travelling waves (carotid-femoral or brachial-ankle pulse wave velocity (cfPWV, baPWV)).

It seems obvious that pulsatile stress on the arterial wall may cause damage, and indeed several studies have proven that higher wave reflections (AIx, Pb) and higher aortic stiffness (PWV) are associated with the presence and extent of coronary artery disease.
Furthermore, impaired pulsatile hemodynamics may deteriorate coronary perfusion, and indeed an inverse relationship between AIx/Pb/PWV and time to ischemia as well as invasively measured coronary blood flow have been documented.

These facts likely explain the association between higher measures of pulsatile hemodynamics and worse clinical outcomes in population-based studies and in patients with established coronary artery disease. Of note, this association is independent of and additional to traditional cardiovascular risk factors, the extent of atherosclerosis and left ventricular function and may offer novel possibilities for risk stratification and, ultimately, for treatment.

In summary, pulsatile hemodynamics are closely associated with coronary atherosclerosis, coronary blood flow and ischemia, and with prognosis in population-based studies and in patients with established coronary artery disease.