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Noninvasive hemodynamic indices of vascular aging: an in silico assessment
Jingyuan Hong1, Manasi Nandi2, Peter H Charlton3
1Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, United Kingdom.
Insights
This study evaluated 19 noninvasive vascular aging indices using a large virtual subject database. Cardio-ankle vascular index (CAVI) and carotid distensibility showed the best correlation with aortic stiffness and resilience to noise.
Area of Science:
- Cardiovascular Science
- Biomedical Engineering
- Physiology
Background:
- Vascular aging (VA) contributes to cardiovascular disease.
- Noninvasive pulse wave (PW) indices are used to assess arterial stiffness.
- Evaluating the accuracy and reliability of these indices is crucial for clinical application.
Purpose of the Study:
- To comprehensively investigate 19 noninvasive PW indices for assessing vascular aging.
- To compare the performance of these indices against a precise measure of aortic stiffness (aortic Young's modulus, E_Ao).
- To assess the resilience of these indices to simulated measurement errors (noise).
Main Methods:
- Utilized a database of 3,837 virtual healthy subjects (25-75 yr) with simulated PW signals.
- Calculated 19 VA indices from filtered PW signals.
- Compared calculated indices with the precise theoretical value of aortic Young's modulus (E_Ao) and assessed noise resilience.
Main Results:
- Cardio-ankle vascular index (CAVI) and pulse wave velocity (PWV) indices showed strong linear correlations with E_Ao (r > 0.95).
- Carotid distensibility demonstrated a strong negative nonlinear correlation with E_Ao (r < -0.99).
- CAVI and carotid distensibility were more resilient to noise than PWV indices; blood pressure-related and photoplethysmography (PPG)-based indices showed weaker correlations and noise sensitivity.
Conclusions:
- Carotid-femoral PWV, CAVI, and carotid distensibility are superior clinical indicators for vascular aging due to strong E_Ao correlation and noise resilience.
- PPG-based indices may be suitable for daily monitoring with minimized noise.
- The study provides freely available tools for analyzing VA indices.
Abstract:
Vascular aging (VA) involves structural and functional changes in blood vessels that contribute to cardiovascular disease. Several noninvasive pulse wave (PW) indices have been proposed to assess the arterial stiffness component of VA in the clinic and daily life. This study investigated 19 of these indices, identified in recent review articles on VA, by using a database comprising 3,837 virtual healthy subjects aged 25-75 yr, each with unique PW signals simulated under various levels of artificial noise to mimic real measurement errors. For each subject, VA indices were calculated from filtered PW signals and compared with the precise theoretical value of aortic Young's modulus (EAo). In silico PW indices showed age-related changes that align with in vivo population studies. The cardio-ankle vascular index (CAVI) and all pulse wave velocity (PWV) indices showed strong linear correlations with EAo (Pearson's rp > 0.95). Carotid distensibility showed a strong negative nonlinear correlation (Spearman's rs < -0.99). CAVI and distensibility exhibited greater resilience to noise compared with PWV indices. Blood pressure-related indices and photoplethysmography (PPG)-based indices showed weaker correlations with EAo (rp and rs < 0.89, |rp| and |rs| < 0.84, respectively). Overall, blood pressure-related indices were confounded by more cardiovascular properties (heart rate, stroke volume, duration of systole, large artery diameter, and/or peripheral vascular resistance) compared with other studied indices, and PPG-based indices were most affected by noise. In conclusion, carotid-femoral PWV, CAVI and carotid distensibility emerged as the superior clinical VA indicators, with a strong EAo correlation and noise resilience. PPG-based indices showed potential for daily VA monitoring under minimized noise disturbances.NEW & NOTEWORTHY For the first time, 19 noninvasive pulse wave indices for assessing vascular aging were examined together in a single database of nearly 4,000 subjects aged 25-75 yr. The dataset contained precise values of the aortic Young's modulus and other hemodynamic measures for each subject, which enabled us to test each index's ability to measure changes in aortic stiffness while accounting for confounding factors and measurement errors. The study provides freely available tools for analyzing these and additional indices.
