Evaluating carotid femoral pulse wave velocity measured by cuff-based approach against the tonometry-based reference standard in a paediatric population

Background: Carotid femoral pulse wave velocity (cfPWV) is directly associated with arterial stiffness in major elastic arteries and predicts future cardiovascular events (1). Little is known of cfPWV as a marker of vascular health in children. Semi-automated cuff-based devices for assessing cfPWV are increasingly popular, although these utilize an algorithm developed and validated in adults (2). Physiological differences between adults and children may thus reduce the accuracy of cuff-based.

Methods: We sought to determine the accuracy of a cuff-based cfPWV device in healthy children and determine whether an age-appropriate algorithm increases accuracy. Methods we prospectively recruited 29 healthy children (mean age = 11.5 ± 5.2 years old). cfPWV was measured using a tonometer on the carotid artery and an inflated cuff on the thigh (Sphygmocor XCEL; AtCor Medical, Australia), and using a tonometer on both the carotid artery and femoral artery (SphygmoCor CvMS; AtCor Medical, Australia) as a reference method. We assessed the accuracy of the cuff-based device with its standard algorithm that was developed in adults, and an adjusted algorithm corrected for physiological differences in leg (femoral to thigh cuff) PWV between adult and children (3).

Results: Cuff-based device estimates of cfPWV in children had excellent agreement to the reference standard (r = 0.85; Δ = −0.26 ms−1 [SD 0.44]). The adjusted algorithm improved the accuracy of the cuff-based method (r = 0.84; Δ=0.02 ms−1 [SD 0.44]) (Figure 1).

Conclusions: Although the cuff-based semi-automatic approach estimates cfPWV with excellent agreement to the reference standard, adjusting the algorithm for known differences in leg PWV improves the accuracy of cuff-based measurement in children.