Utility of arterial stiffness assessment in children

Abstract

Atherosclerotic cardiovascular disease is a leading cause of death and disability worldwide, and the atherosclerotic process begins in childhood. Prevention or containment of risk factors that accelerate atherosclerosis can delay the development of atherosclerotic cardiovascular disease. Although current recommendations are to periodically screen for commonly prevailing risk factors for atherosclerosis in children, a single test that could quantify the cumulative effect of all risk factors on the vasculature, thus assessing arterial health, would be helpful in further stratifying risk. Measurement of pulse wave velocity and assessment of augmentation index - measures of arterial stiffness - are easy-to-use, non-invasive methods of examining arterial health. Various studies have assessed pulse wave velocity and augmentation index in children with commonly occurring conditions including obesity, hypertension, insulin resistance, diabetes mellitus, dyslipidaemia, physical inactivity, chronic kidney disease, CHD and acquired heart diseases, and in children who were born premature or small for gestational age. This article summarises pulse wave velocity and augmentation index assessments and the effects of commonly prevailing chronic conditions on arterial health in children. In addition, currently available reference values for pulse wave velocity and augmentation index in healthy children are included. Further research to establish widely applicable normative values and the effect of lifestyle and pharmacological interventions on arterial health in children is needed.

Cognitive dysfunction is associated with abnormal responses in cerebral blood flow in patients with single ventricular physiology: Novel insights from transcranial Doppler ultrasound

“…Patients with complex congenital heart disease are noted to be prone to ischemic cerebral injury, with progressive risk complicating the development of traditional cardiovascular risk factors with aging, resulting in ongoing risks to cognitive performance . The development of atherosclerotic disease is now recognized to progress from childhood, with ultrasound measures to assess vascular function identified as an important modality . Abnormal carotid artery resistance is associated with increased stroke risk; transcranial Doppler techniques have identified abnormal resistance in cerebral arteries in patients with diabetes, a group prone to adverse cerebral vascular events, as well as in adult patients with a background of aortic coarctation repair, similarly documented to be at risk of adverse cerebral events .…”

Increased Arterial Stiffness in Adolescents With Obesity

“…For this measurement, pressure is applied to applanate (flatten) the artery using a special probe creating a signal that approximates arterial pressure. 10,24 For the PWV, waveforms of the right carotid artery and the right femoral artery were obtained. The waveforms of the carotid and femoral arteries were recorded sequentially gated by the R-wave on a simultaneously recorded electrocardiogram.…”

“…8 In addition, other factors such as hypertension and dyslipidemia may accelerate this process. 10 It has also been suggested that AS is influenced by gender and puberty, caused by differences in sex steroids. 11 Estrogens are assumed to decrease AS while androgens are proposed to promote it, causing higher AS in boys compared with girls.…”

“…12 Moreover, weight and insulin resistance (IR) are suggested to have an influence on AS, although literature shows conflicting results. 10,13…”

“…14,15 Applanation tonometry is considered to be the gold standard for measuring PWV and AIx. 10 PWV can be determined at multiple sites of the arterial system. However, central measurements from carotid to femoral artery are preferred, since this has the strongest correlation with cardiovascular morbidity and mortality.…”