Enhanced accuracy of NIRS-vascular occlusion testing through incorporation of conduit artery diameter

Near-infrared spectroscopy with vascular occlusion testing (NIRS-VOT) offers a non-invasive approach for real-time assessment of tissue oxygenation and vascular function. However, its clinical application remains limited, in part due to substantial inter-individual variability in anatomical and physiological characteristics. To identify potential sources of variability, we explored whether incorporating conduit artery size-specifically baseline brachial artery diameter (BrAD)-into the NIRS-VOT data analysis could enhance physiological interpretation and reduce measurement error. We analyzed NIRS-VOT responses from 16 healthy participants recruited to the NIH Clinical Center (NCT06552767 and NCT03538639), incorporating individual BrAD measurements as a covariate. Strong to moderate Spearman's rank-order correlations were observed between BrAD and dynamic perfusion parameters, including the desaturation rate ( $\rho$ = 0.77, p = 0.0005) and resaturation rate ( $\rho$ = 0.79, p = 0.0003). These findings suggest that larger brachial arteries are associated with greater oxygen extraction during occlusion and faster reoxygenation during reperfusion. Across parameters, BrAD explained a substantial proportion of the variance in NIRS-VOT outcomes. When BrAD was included as a covariate, the unexplained variability in the desaturation and resaturation rates was reduced to 28% and 34% of the total variance, respectively, indicating that accounting for conduit artery size substantially decreases residual variability and enhances the interpretability of these dynamic responses. Visual comparison also indicated that incorporating BrAD helped clarify response patterns and reclassify outliers. By reducing inter-individual variability and explaining a greater share of the physiological response, the BrAD-informed analysis enhances the interpretability and consistency of NIRS-VOT measurements. Integrating vascular anatomy into NIRS-VOT analysis may improve the detection of subtle vascular dysfunction and strengthen its diagnostic utility. Future research involving larger and more diverse cohorts, and additional vascular territories are needed to validate and expand these findings.