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Central blood pressure in children and adolescents: non-invasive development and testing of novel transfer functions
T Y Cai1,2,3, A Qasem4, J G Ayer1,5
1Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Insights
New age-specific transfer functions (TF) accurately estimate central systolic pressure in children. These non-invasive methods outperform adult TFs for pediatric cardiovascular assessment.
Area of Science:
- Cardiovascular physiology
- Pediatric cardiology
- Biomedical engineering
Background:
- Central blood pressure estimation in adults commonly uses generalized transfer functions (TF).
- Non-invasive methods for assessing pediatric central blood pressure are crucial for cardiovascular health monitoring.
- Existing adult TFs may not accurately reflect hemodynamic changes in children.
Purpose of the Study:
- To develop and validate age-specific, non-invasively derived transfer functions (TF) for estimating central systolic pressure in children.
- To compare the accuracy of these pediatric TFs against a pre-existing adult TF.
- To assess the performance of TFs at different pediatric age groups (8 and 14 years).
Main Methods:
- Healthy children (n=272) aged 8 and 14 years participated from two study sites.
- Radial and carotid pressure waveforms were acquired using applanation tonometry.
- Central systolic pressure was calculated from carotid waveforms, calibrated with brachial mean and diastolic pressures.
- Age-specific TFs were developed in one group and tested in a separate validation group.
Main Results:
- At 8 years, the age-specific TF estimated central systolic pressure within 5, 10, and 15 mmHg for 82%, 99%, and 100% of participants, respectively.
- At 14 years, the age-specific TF achieved similar accuracy, estimating values within 5, 10, and 15 mmHg for 60%, 87%, and 95% of participants.
- The pediatric TF showed significantly better agreement with measured central systolic pressure compared to the adult TF in both age groups.
Conclusions:
- Age-specific transfer functions provide a more accurate non-invasive estimation of central systolic pressure in children compared to adult TFs.
- These findings support the use of tailored TFs for improved pediatric cardiovascular assessment.
- Development of age-specific TFs is essential for accurate non-invasive central blood pressure monitoring in pediatric populations.
Abstract:
Central blood pressure can be estimated from peripheral pulses in adults using generalised transfer functions (TF). We sought to create and test age-specific non-invasively developed TFs in children, with comparison to a pre-existing adult TF. We studied healthy children from two sites at two time points, 8 and 14 years of age, split by site into development and validation groups. Radial and carotid pressure waveforms were obtained by applanation tonometry. Central systolic pressure was derived from carotid waveforms calibrated to brachial mean and diastolic pressures. Age-specific TFs created in the development groups (n=50) were tested in the validation groups aged 8 (n=137) and 14 years (n=85). At 8 years of age, the age-specific TF estimated 82, 99 and 100% of central systolic pressure values within 5, 10 and 15 mm Hg of their measured values, respectively. This TF overestimated central systolic pressure by 2.2 (s.d. 3.7) mm Hg, compared to being underestimated by 5.6 (s.d. 3.9) mm Hg with the adult TF. At 14 years of age, the age-specific TF estimated 60, 87 and 95% of values within 5, 10 and 15 mm Hg of their measured values, respectively. This TF underestimated central systolic pressure by 0.5 (s.d. 6.7) mm Hg, while the adult TF underestimated it by 6.8 (s.d. 6.0) mm Hg. In conclusion, age-specific TFs more accurately predict central systolic pressure measured at the carotid artery in children than an existing adult TF.
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