Central aortic blood pressure estimation in children and adolescents: results of the KidCoreBP study

Abstract

Background: Central aortic SBP (cSBP) may have superior prognostic value compared with peripheral SBP (pSBP), but noninvasive cSBP measurement techniques have not been formally validated in children and adolescents. Method: This study assessed the accuracy of two automated devices and the radial tonometry/transfer function method (RT-TF) for estimating central pressures and pulse pressure amplification (PPA) in this population, with adherence to validation guidelines for central pressure devices. In 69 children/adolescents aged 3–18 years undergoing clinically indicated aortic catheterization, high fidelity ascending aortic cSBP was measured with a micromanometer-tipped wire and compared with values from SphygmoCor XCEL, Mobil-O-Graph (systolic/diastolic calibration, MoG-C1, or mean/diastolic calibration, MoG-C2) and RT-TF. Reference intra-arterial pSBP was derived from the tonometry pulse calibrated to central mean/diastolic pressures. Results: XCEL, MoG-C1 and MoG-C2 overestimated cSBP by 7.9 ± 6.8 mmHg (mean ± SD), 5.7 ± 10.3 mmHg, and 19.1 ± 14.9 mmHg, exceeding the validation cut-off (5 ± 8 mmHg). Brachial pSBP was also overestimated by XCEL (10.9 ± 8.4 mmHg) and Mobil-O-Graph (11.5 ± 12.3 mmHg). By contrast, central and brachial diastolic pressures were underestimated by the automated devices, albeit mostly within acceptable limits; pulse pressures were, therefore, substantially overestimated. Central-brachial PPA (4.5 ± 4.4 mmHg) was overestimated by XCEL (8.7 ± 3.2 mmHg) and MoG-C1 (11.1 ± 6.4 mmHg), but underestimated by MoG-C2 (−3.0 ± 6.6 mmHg). Given accurate pulse calibration, RT-TF achieved acceptable accuracy for cSBP (−0.2 ± 4.6 mmHg) and central-radial PPA (1.9 ± 5.1 mmHg). Conclusion: In conclusion, XCEL and Mobil-O-Graph overestimated pSBP and cSBP in children and adolescents. cSBP can be obtained via the same transfer function used in adults, but accurate pressure pulse calibration is critical. Video Abstracts: http://links.lww.com/HJH/B222

Insight into the 24‐hour ambulatory central blood pressure in adolescents and young adults

“…C2 is known to provide a more accurate estimation of central aortic BP, as shown by invasive validation studies in adults 16 . On the other hand, a study in children and adolescents showed greater overestimation of aortic SBP with the calibration method C2 instead of C1 17 . In addition, pSBP is known to be underestimated by the oscillometric device in adults, 12,18 whereas relevant data in children are unclear 17,19 .…”

“…On the other hand, a study in children and adolescents showed greater overestimation of aortic SBP with the calibration method C2 instead of C1 17 . In addition, pSBP is known to be underestimated by the oscillometric device in adults, 12,18 whereas relevant data in children are unclear 17,19 . A single study reported that the Mobil‐O‐Graph overestimated pSBP in children, yet intra‐arterial pSBP was indirectly measured 17 .…”

“…In addition, pSBP is known to be underestimated by the oscillometric device in adults, 12,18 whereas relevant data in children are unclear 17,19 . A single study reported that the Mobil‐O‐Graph overestimated pSBP in children, yet intra‐arterial pSBP was indirectly measured 17 . These findings might be supported by a recent study in older adults highlighting the age effect on the difference between cuff BP and invasive BP measurements, which showed that cuff SBP overestimated aortic SBP in those aged 40‐49 years, but with each older age decade, there was a progressive shift toward increasing underestimation 20 .…”

“…More specifically, considering multiple physiological differences between adults and children (body size, vascular wall properties, heart rate, and BP levels), transfer functions developed for non‐invasive ceBP estimation in adult population might not be accurate in young individuals 38 . Furthermore, such concerns may also arise for the accuracy of brachial waveform recording via the cuffs and of the estimation of brachial BP and MAP through the oscillometric curve that can affect the validity of calibration methods 16,17 . More research is needed to ascertain and elucidate such findings.…”

Pulsatile and steady‐state 24‐hour hemodynamics in adolescents and young adults: The next steps ahead

“…However, in children, two recent studies showed C1SBP to be overestimated compared with the invasive gold standard (by 2.0 mm Hg 18 and 5.7 mm Hg 19 ). Of note, whereas in adults the C2 calibration is more accurate than C1 calibration, 4,20 in children C2 calibration may lead to sizeable overestimation of central systolic BP (mean 19.1 mm Hg) 19 . Moreover, a contributory source of error in central systolic BP estimation is inaccuracies of the cuff brachial BP used for waveform calibration.…”