Pulse Wave Velocity In Children Research Articles

Comparative effectiveness of different types of exercise in reducing arterial stiffness in children and adolescents: a systematic review and network meta-analysis

ObjectiveArterial stiffness is an early and detectable marker of vascular changes leading to atherosclerotic cardiovascular disease (ACVD). Our objective was to compare the effectiveness of different types of exercise in...

Arterial Stiffness and Chronic Kidney Disease Progression in Children.

CKD has been linked to increased arterial stiffness in adults, but data in children with CKD remain conflicting. We aimed to investigate the longitudinal dynamics and determinants of pulse wave velocity in children with CKD and its association with CKD progression. We performed an analysis of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study, which prospectively followed children aged 6-17 years with CKD stages 3-5. Follow-up was censored at the time of KRT initiation. Two separate analyses were performed: with absolute pulse wave velocity (primary outcome) and with pulse wave velocity standardized to height (z score; restricted to participants ≤17 years) as a sensitivity analysis. In total, 667 patients with a mean baseline eGFR of 27 ml/min per 1.73 m2 were included. Pulse wave velocity above the 95th percentile was observed in 124 (20%) patients at baseline. Absolute pulse wave velocity increased gradually over the median follow-up of 2.7 (interquartile range, 0.7-4.4) years, whereas pulse wave velocity z score remained relatively stable. Absolute pulse wave velocity over time associated with time; older age; higher mean arterial pressure, LDL cholesterol, and albuminuria; and lower ferritin. Pulse wave velocity z score (n=628) was associated with the same variables and additionally, with higher diastolic BP z score, lower height z score, younger age, and girls. Of 628 patients, 369 reached the composite end point of CKD progression (50% eGFR loss, eGFR <10 ml/min per 1.73 m2, or the start of KRT) during a median follow-up of 2.4 (interquartile range, 0.9-4.6) years. Pulse wave velocity z score did not associate with CKD progression by univariable or multivariable proportional hazard analysis correcting for the established predictors eGFR, proteinuria, and BP. Pulse wave velocity is increased in children with CKD but does not associate with eGFR or CKD progression.

Pulse Wave Velocity as a Marker of Vascular Dysfunction and Its Correlation with Cardiac Disease in Children with End-Stage Renal Disease (ESRD).

One of the main markers of arterial stiffness is pulse wave velocity (PWV). This parameter is well studied as a marker for end-organ damage in the adult population, being considered a strong predictor of major cardiovascular events. This study assessed PWV in children with chronic kidney disease (CKD) as a marker of cardiovascular risk. We conducted a prospective observational single-center cohort study of 42 consecutively pediatric patients (9–18 years old) with terminal CKD and dialysis, at the Hemodialysis Department of the “M. S. Curie” Hospital, Bucharest. We measured PWV by echocardiography in the ascending aorta (AscAo) and the descending aorta (DescAo), and we correlated them with left ventricular hypertrophy (LVH). Fifteen patients (35.7%) presented vascular dysfunction defined as PWV above the 95th percentile of normal values in the AscAo and/or DescAo. Cardiac disease (LVH/LV remodeling) was discovered in 32 patients (76.2%). All patients with vascular damage also had cardiac disease. Cardiac damage was already present in all patients with vascular disease, and the DescAo is more frequently affected than the AscAo (86.6% vs. 46.9%). Elevated PWV could represent an important parameter for identifying children with CKD and high cardiovascular risk.

Findings from 4C-T Study demonstrate an increased cardiovascular burden in girls with end stage kidney disease and kidney transplantation

Mortality in children with kidney failure is higher in girls than boys with cardiovascular complications representing the most common causes of death. Pulse wave velocity (PWV), a measure of vascular stiffness, predicts cardiovascular mortality in adults. Here, PWV in children with kidney failure undergoing kidney replacement therapy was investigated to determine sex differences and potential contributing factors. Two-hundred thirty-five children (80 girls; 34%) undergoing transplantation (150 pre-emptive, 85 with prior dialysis) having at least one PWV measurement pre- and/or post-transplantation from a prospective cohort were analyzed. Longitudinal analyses (median/maximum follow-up time of 6/9 years) were performed for PWV z-scores (PWVz) using linear mixed regression models and further stratified by the categories of time: pre-kidney replacement therapy and post-transplantation. PWVz significantly increased by 0.094 per year and was significantly higher in girls (PWVz+0.295) compared to boys, independent of the underlying kidney disease. During pre-kidney replacement therapy, an average estimated GFR decline of 4 ml/min/1.73 m2 per year was associated with a PWVz increase of 0.16 in girls only. Higher diastolic blood pressure and low density lipoprotein were independently associated with higher PWVz during pre-kidney replacement therapy in both sexes. In girls post-transplantation, an estimated GFR decline of 4ml/min/1.73m2 per year pre-kidney replacement therapy and a longer time (over 12 months) to transplantation were significantly associated with higher PWVz of 0.22 and of 0.57, respectively. PWVz increased further after transplantation and was positively associated with time on dialysis and diastolic blood pressure in both sexes. Thus, our findings demonstrate that girls with advanced chronic kidney disease are more susceptible to develop vascular stiffening compared to boys, this difference persist after transplantation and might contribute to higher mortality rates seen in girls with kidney failure.

Pulse Wave Velocity, Central Haemodynamic Parameters, and Markers of Kidney Function in Children

Objectives: Chronic kidney disease (CKD) is a well-established risk factor for cardiovascular diseases. Studies in adults have demonstrated the association between mildly decreased kidney function or even normal values of markers of kidney function to pulse wave velocity (PWV), a measure of arterial stiffness and a predictor of cardiovascular events. Our study aimed to evaluate associations between markers of CKD, PWV, and central haemodynamic parameters in children and adolescents at risk of subclinical kidney damage. Methods: 182 children and adolescents with hypertension, obesity, or hypercholesterolaemia (risk factors for subclinical kidney damage) were included in the study. The subjects were subdivided into 4 groups comprising children and adolescents with hypertension (group 1), obesity (group 2), hypercholesterolaemia (group 3), and a group with a combination of risk factors, such as obesity-related hypertension and metabolic syndrome (group 4). The study groups were compared to a group of healthy controls (group 5). PWV was measured by applanation tonometry (SphygmoCor, SCOR-Vx, Sydney, NSW, Australia) and laboratory parameters (serum creatinine, serum cystatin C, and microalbuminuria) were collected. Results: Pearson’s correlation coefficient demonstrated a statistically significant correlation between PWV and serum creatinine in group of all subjects (r = 0.220, p = 0.002). Further subdivision showed the correlation was significant in group 4 (r = 0.370, p = 0.002). In group 2 a correlation between PWV and cystatin C was found (r = −0.535, p = 0.009). In multiple regression analysis of all subjects with PWV as the dependent variable, age and diastolic blood pressure were statistically significant. Correlations between markers of kidney function and central haemodynamic parameters also showed significant correlations between serum creatinine and heart rate (HR) (r = −0.476, p < 0.001) as well as associated parameters (augmentation index, standardized at HR 75/min, ejection duration, and subendocardial viability ratio). Conclusions: Our study demonstrated a correlation between serum creatinine and PWV in children with combined risk factors for atherosclerosis and probable subclinical kidney damage. Further prospective research is needed to confirm the findings, and thus the preventive role of PWV determination in paediatric nephrology.

Association of Parental Socioeconomic Status and Physical Activity with Development of Arterial Stiffness in Prepubertal Children.

The present study examined the prospective association of parental household income, education level, migration background, and physical activity (PA) behavior with the development of pulse wave velocity (PWV) in prepubertal children. A total of 223 children (initial age 6–8 years) were included in this prospective school-based cohort study from 2014 to 2018. Parental socioeconomic status, migration background, and PA behavior were assessed by the use of questionnaires at both times points. PWV was measured by an oscillometric device at follow-up (2018). No significant association of household income, education level, and parental migration background with PWV in children after four years was found. However, a high level of maternal PA was related to a lower childhood PWV at follow-up (mean (95% CI) 4.6 (4.54–4.66) m/s) compared to children of mothers with a low PA behavior (mean (95% CI) 4.7 (4.64–4.77) m/s) (p = 0.049). Children of mothers with a high PA level revealed a beneficial arterial stiffness after four years. Little evidence for an association of socioeconomic status and migration background with childhood arterial stiffness was found. Increased parental PA seems to support the development of childhood vascular health and should be considered in the generation of future primary prevention strategies of childhood cardiovascular health.

Change in the aortic pulse wave velocity in children with familial hypercholesterolemia

Background.Familial hypercholesterolemia (FH) is the genetic disease characterized by an increase in the levels of total cholesterol and low density lipoproteins since childhood.The aim of the studywas to assess arterial stiffness in children with heterozygous FH by measuring pulse wave velocity (PWV) in the aorta.Designand methods.The study involved 118 children. Of these, 60 healthy children were in the control group and 58 children with the diagnosis of heterozygous FH were included in the main group. Both groups were divided into 3 age subgroups: from 5 to 7 years old, from 8 to 12 years old and from 13 to 17 years old. The diagnosis of FH was made according to the British criteria by Simon Broome. The lipid profile was determined for all children, blood pressure was monitored daily with the estimate of the minimum, average and maximum PWV (PWVmin, PWVav, PWVmax) in aorta using oscillometric method.Results.In the younger age subgroup (5–7 years), there were no significant differences in PWV between main and control groups. In children aged 8–12 years, the main group was characterized by significantly higher values of maximum PWV compared to healthy peers — 5,1 [4,7–5,8] and 4,6 [4,45–5,05] m/s, respectively (p = 0,041). In group of children with FH aged 13–17 years, compared to the control group, a significant increase in the minimum PWV was observed — 4,7 [4,1–5,1] and 3,9 [3,5–4,1] m/s, respectively (p = 0,009), average PWV — 5,5 [4,8–6,4] and 4,5 [4,2–4,9] m/s, respectively (p = 0,009), and maximum PWV — 6,2 [5,7–7,55] and 5,4 [5,05–5,6] m/s, respectively (p = 0,007). Correlation analysis in patients with FH showed direct correlation between PWVmin, PWVav and PWVmax with total cholesterol (r = 0,46, r = 0,46 and r = 0,464, respectively, p &lt; 0,001).Conclusions.Our study demonstrates an increase in the PWV in the aorta in children with FH compared with healthy peers from 8–12 years of age. There is a further progression of arterial stiffness with an increase in the minimum, average and maximum PWV most significant in the group of 13–17 years.

Ambulatory hemodynamic patterns, obesity, and pulse wave velocity in children and adolescents

In recent years, pulse wave velocity (PWV) has emerged as a surrogate marker of cardiovascular disease in children with cardiovascular risk factors. The aims of the present study were to identify determinants of PWV in children according to their weight status and to investigate the role of peripheral blood pressure and central hemodynamic parameters in the association between PWV and obesity. We included in the study healthy children and adolescents randomly selected from a school-based blood pressure screening study. All participants underwent ambulatory blood pressure monitoring and 24-h pulse wave analysis. Overweight and obese children had higher 24-h PWV, 24-h peripheral and central systolic blood pressure (SBP), and cardiac output than normal weight ones. Children with both overweight and hypertension presented the highest 24-h PWV values (p < 0.001). Peripheral and central SBP, body mass index (BMI), and hemodynamic parameters, including stroke volume, cardiac output, total peripheral resistance, and cardiac index, were all associated with 24-h PWV. However, in stepwise regression analysis, 24-h peripheral and central SBP and cardiac index, but not BMI, were independent predictors of 24-h PWV. There were statistically significant differences in 24-h blood pressure and hemodynamic parameters among those on the lower and highest 24-h PWV quartile, but there were no significant differences in BMI among 24-h PWV quartile groups. Arterial stiffness is higher in overweight and obese children in the co-presence of hypertension. Peripheral and central SBP are the main determinants of 24-h PWV independent of weight status. Graphical abstract.

Updated and revised normal values of aortic pulse wave velocity in children and adolescents aged 3-18 years.

Measurement of aortic pulse wave velocity (PWVao) is recommended for stratifying individual cardiovascular (CV) risk in adults. Diseases in children and adolescents might influence aortic stiffness. It is necessary to exclude overweight (OW), obese (O) subjects, and individuals with increased systolic (SBP) and/or diastolic blood pressure (DBP) from the population, when creating normal values of PWVao in children and adolescents. Body mass index (BMI), SBP/DBP cut-off values have remarkably changed in this population during the last decade. Aims of our study were to expand our previously published PWVao database and to revise it by using the recently determined normal values. PWVao was measured by an occlusive-oscillometric device (Arteriograph, TensioMed Ltd, Budapest, Hungary) in a healthy population aged 3-18 years. 7940 (4374 boys) participants were recruited, 1912 OW/O subjects and 1368 individuals with high SBP/DBP were excluded. Finally, n = 4690 (2599 boys) participants were enrolled. Mean PWVao values increased from 5.4 ± 0.6 to 6.4 ± 0.5 m/s (p < 0.05) in boys and from 5.5 ± 0.6 to 6.4 ± 0.5 m/s (p < 0.05) in girls. Mean PWVao values were significantly lower in our new study, in boys in age groups of 9-16, in girls in age groups of 11-17. This is the largest and widest age-ranged database of PWVao published to date. Due to the change of BMI and SBP/DBP reference values during the last decade, the "old" database of PWVao needed to be revised. As a result of this, normal values of PWVao decreased significantly in both sexes.

Cardiometabolic Health and Carotid-Femoral Pulse Wave Velocity in Children: A Systematic Review and Meta-Regression

To identify, in children the normal rate of carotid-femoral pulse wave velocity (cfPWV) progression, and whether presence of cardiometabolic risk factors is associated with cfPWV. Electronic databases (PubMed, Google Scholar) were searched from inception to May 2018, for all studies which reported cfPWV in children (<19years of age). Random effects meta-regression quantified the association between time (years) and cfPWV, and a systematic review was performed to determine whether cardiometabolic risk factors are associated with cfPWV. Data from 28 articles were eligible for inclusion, including 9 reference value (n=13 100), 5 cardiovascular risk (n=5257), 10 metabolic risk (n=2999), and 8 obesity-focused (n=8760) studies. Meta-regression findings (9 studies) showed that the increase in cfPWV per year (age) was 0.12m/second (95% CI, 0.07-0.16m/second) per year, and when stratified by sex the CIs overlapped. Systematic review findings showed that cardiometabolic risk factors were positively associated with cfPWV, including positive associations with blood pressure, impaired glucose metabolism, and metabolic syndrome. However, obesity was not consistently associated with cfPWV. Arterial stiffness in children progresses with age and is associated with cardiometabolic risk factors. Although further longitudinal studies are warranted, the presented reference data will be valuable to epidemiologists tracking children, and to scientists and clinicians prescribing therapies to mitigate risk in a population that is increasingly more vulnerable to cardiovascular disease.

P74 Validation of Surface Distance Measurement by MRI for Pulse Wave Velocity in Children

BackgroundAortic pulse wave velocity (PWV) is the gold standard measurement for arterial stiffness. Normative values exist for PWV in children using the subtracted method (LSM) for the estimation of the distance, however no imaging validation studies in the growing pediatric population. The formula of 0.8 × surface distance (L0.8) based on MRI validation is only used in adults. Our aim was to compare the different techniques of surface measurement and distances determined by MRI in pediatric subjects.Methods21 patients were included (3.2–17.8 years) in the study. Pulse wave travel distance was assessed by surface tape measurements. Carotid-femoral path length was also measured by MRI. To calculate the reference distance (LREF) for the real aortic path length, centerpoints were placed manually in each slice and a centerline was reconstructed. Bland-Altman plots (BA) were used to assess the difference between the distances measured on surface or intraarterial.ResultsThere was a high correlation (r > 0.86, p < 0.001) between surface and MRI distance measurements. According to L0.8 and LREF values the average difference was 35.9 cm and BA plots showed significant difference. The difference between LSM and LREF was 2 cm and in the BA analysis LSM and LREF were in good accordance. There was a proportional error in the BA plots in patients over 13 years.ConclusionIn our study group the path length assessed by the subtracted method showed excellent correlation with intra-arterial MRI measurements. The small number of cases does not allow to conclude the difference in postpubertal patients, which needs further evaluation.

Comparison of Two Measurement Devices for Pulse Wave Velocity in Children: Which Tool Is Useful to Detect Vascular Alterations Caused by Overweight?

Vascular alterations may lead to manifest cardiovascular disease in future life. There is a tremendous time delay between the onset and obvious clinical appearance of vascular alterations. Pulse wave velocity (PWV) is one subclinical parameter to detect vascular alterations at a very early stage. Different techniques exist to measure PWV non-invasively as a vascular parameter—all with their own technique-inherent advantages, challenges, and pitfalls. The aim of this study was to compare two techniques to measure PWV, to assess their agreement, and interchangeability. In 780 (♀ = 49.4%) healthy children and adolescents (mean age: 11.61 ± 2.11 years), PWV was obtained with two different techniques. Ultrasound-measured local PWV (PWVβ) at the carotid artery was graphically compared by a Bland–Altman plot with aortic PWV (aPWV), measured oscillometrically on the brachial artery. Reproducibility was assessed with the concordance correlation coefficient by Lin (ρc). Furthermore, participants were categorized by BMI as normal weight (N) or overweight/obese (O) to identify differences in PWVβ and aPWV caused by an increased BMI. Mean PWVβ was lower (4.01 ± 0.44 m/s) than mean aPWV (4.67 ± 0.34 m/s). The two methods differ by mean Δ0.66 ± 0.47 m/s (95% CI: 0.62 to 0.69 m/s; p < 0.001). Bland–Altman analysis indicated the 95% limits of agreement (−0.26 to 1.57) without any evidence of systemic difference. Lin's ρc represented a weak concordance between PWVβ and aPWV (ρc = 0.122; 95% CI: 0.093–0.150). There was no difference in PWVβ between N and O, whereas aPWV was higher in O: 4.81 ± 0.42 m/s than in N: 4.65 ± 0.32 m/s (p < 0.001). The difference, Δ0.16 m/s, 95% CI [−0.25; −0.08], was significant, t(121) = −3.76, p < 0.001, with a medium-sized effect. PWVβ (ultrasound) and aPWV (oscillometry) show a level of disagreement that includes clinically important discrepancies. A discrimination between normal and altered vascular function was possible with aPWV but not with PWVβ.

Arterial stiffness in children and adolescents with and without continuous insulin infusion.

Background Arterial stiffness is a consequence of aging, but there are several diseases that contribute to this process. The evaluation of pulse wave velocity (PWV) allows a dynamic evaluation of vascular distensibility and the detection of atherosclerosis at an early stage. It was intended to evaluate the PWV in children and adolescents with type 1 diabetes mellitus (T1DM) and to compare their outcome according to the type of treatment used. Methods Forty-eight patients were randomly selected. Inclusion criteria: T1DM, under intensive insulin therapy (multiple daily insulin administrations [MDI] or continuous insulin infusion system [CIIS]). Exclusion criteria: existence of another chronic pathology or microvascular complications. Echocardiography was performed and three measurements of PWV were done, with their mean calculated. Results Most of the children and adolescents presented a PWV ≥ the 75th centile. There was a statistically significant difference for hemoglobin A1c (HbA1c) (7.8 in CIIS vs. 9 in MDI, p < 0.05). There were not statistically significant differences in the PWV between the two groups. This can be attributed to the fact that children with CIIS are those who previously presented greater glycemic instability. There was a significant correlation between PWV and disease duration (Pearson's correlation coefficient [r] = 0.314, p = 0.036). Conclusions This study showed that in children and adolescents with T1DM, there is an important prevalence of arterial stiffness, translated by an increase in PWV. This increase in PWV appears to exist even in very young children with little disease evolution time.

Validation of a cuff-based device for measuring carotid-femoral pulse wave velocity in children and adolescents.

Carotid-femoral pulse wave velocity is associated with arterial stiffness in major elastic arteries, and predicts future cardiovascular events. However, little is known about carotid-femoral pulse wave velocity as a marker of vascular health in children. Semi-automated cuff-based devices for assessing pulse wave velocity are increasingly popular, although these utilize an algorithm developed and validated in adults. Physiological differences between adults and children may, however, reduce the accuracy of cuff-based methods. We sought to determine the accuracy of a cuff-based pulse wave velocity device in healthy children, and determine whether a novel age-appropriate algorithm increases accuracy. We recruited 29 healthy children between the ages of 2 and 20 years. Pulse wave velocity was measured both by using a tonometer on the carotid artery and an inflated cuff on the thigh, and using a tonometer on both the carotid artery and femoral artery as a reference standard. Accuracy of the cuff-based device with its standard algorithm developed in adults, and a novel age-appropriate algorithm corrected for physiological differences in leg pulse wave velocity was assessed with Regression analysis and Bland-Altman plots. Cuff-based device estimates of pulse wave velocity had excellent agreement to the reference standard (Δ = -0.26 ms-1 [SD 0.44]). The novel age-appropriate algorithm improved the accuracy of the cuff-based method (Δ = 0.02 ms-1 [SD 0.44]). The cuff-based semi-automatic approach estimates carotid-femoral pulse wave velocity with excellent agreement to the reference standard. However, adjusting the algorithm for known differences in leg pulse wave velocity further improves the accuracy of cuff-based measurement in children and adolescents.

Aortic pulse wave velocity in children with Cushing syndrome: A window into a marker of early cardiovascular disease.

SummaryObjectiveTo investigate early signs of cardiovascular arterial remodelling in paediatric patients with Cushing syndrome (CS) in comparison with normative values from healthy children.Study DesignThe metrics used to assess cardiac health were from thoracic aorta and carotid MRI. Scans were performed on 18 children with CS (mean: 12.5 ± 3.1 years, range: 6.0‐16.8 years, 10 female). Pulse wave velocity (PWV), aortic distensibility (AD) and carotid intima‐media thickness (cIMT), well‐validated measurements of cardiac compromise, were measured from the images and compared to normative age‐matched values where available.ResultsPatients with CS had significantly higher PWV compared to age‐adjusted normal median control values (4.0 ± 0.7 m/s vs. 3.4 ± 0.2 m/s, respectively, P = 0.0115). PWV was positively correlated with midnight plasma cortisol (r = 0.56, P = 0.02). Internal and common cIMT were negatively correlated with ascending AD (r = −0.75, P = 0.0022, r = −0.69, P = 0.0068, respectively).ConclusionPulse wave velocity data indicate that paediatric patients with CS have early evidence of cardiovascular remodelling. The results suggest the opportunity for monitoring as these changes begin in childhood.

Determinants of Pulse Wave Velocity in children

BackgroundArterial stiffening measured by Pulse Wave Velocity (PWV) predicts cardiovascular events and mortality in adults. It advances with age and seems accelerated in children with certain disease conditions such as chronic kidney disease or diabetes. The aim of this study was to determine factors that influence PWV in children.MethodsPWV was captured in 285 children aged 10–14 years attending a Portuguese school. The effects of sex, age, height, weight, body mass index, waist circumference, blood pressure, heart rate and sodium excretion in 24-h urinary samples in PWV were tested.ResultsPWV correlated positively with age, height, systolic blood pressure, diastolic blood pressure and heart rate in males and females (p < 0.05) and with weight in males (p < 0.05). Major predictors for PWV in a multivariate regression analysis were gender, height, weight, diastolic blood pressure, heart rate and body mass index.ConclusionOur study found several determinants of PWV in children, some of them modifiable and interfering with cardiovascular outcomes. Future research may provide clarity to the association between PWV in children and cardiovascular events in adulthood.

A6210 Reference values for carotid-femoral pulse wave velocity in children and adolescents – data from the Portuguese Vascular Phenotype in Children and Adolescents (PORT-VASPh) Cohort

Objectives: To propose reference values in Portuguese children and adolescents, based on a statistical definition that considers the fundamental physiological role of aging in arterial stiffness. Methods: The PORT-VASPh cohort has 953 children and adolescents enrolled (age: 5 to 17 years). The overall health profile for each participant was defined based on three clinical evaluations, in which blood pressure (BP) was measured under standard conditions over the brachial artery. Gender-specific percentiles were used for the definition of the individual BP phenotype. For the proposal of reference values for PWV, data were collected from 758 healthy and normotensive participants included in the cohort, 60% males and 40% females, with a mean age of 11.95 ± 2.87 years (ranging from 5 to 17 years) and a body mass index (BMI) of 18.56 ± 2.98 kg/m2. Carotid-femoral PWV was measured to all participants with the Complior SP device, complying with the methodological recommendations. All participants were evaluated by the same clinician. Results: Gender-specific percentile tables, accounting for age, were obtained, as depicted in Figure 1. Mean PWV was 6.08 ± 0.90 m/s, and was higher in boys as compared with girls (6.19 ± 0.90 m/s versus 5.91 ± 0.86 m/s, respectively; p < 0.0001). A significant correlation of PWV with age, BMI, systolic and diastolic BP and family history of hypertension was identified. The availability of reference tables for PWV in children and adolescents is necessary, as it would allow the incorporation of the arterial stiffness concept into pediatric clinical decision, thus contributing for a better definition of the adequate preventive strategies for these particular populations. Conclusion: The availability of reference tables for PWV in children and adolescents is necessary, as it would allow the incorporation of the arterial stiffness concept into pediatric clinical decision, thus contributing for a better definition of the adequate preventive strategies for these particular populations.

REFERENCE VALUES FOR AORTIC PULSE WAVE VELOCITY IN PORTUGUESE CHILDREN AND ADOLESCENTS – AN UPDATE FROM THE PORTUGUESE VASCULAR PHENOTYPE IN CHILDREN AND ADOLESCENTS COHORT

Objective: Carotid-femoral pulse wave velocity (PWV) is the gold-standard method to estimate aortic stiffness, and has been clearly associated with cardiovascular risk in different clinical subsets. Still, its use in clinical practice is still limited in some specific groups, particularly in pediatrics, due to the absence of reference values for this population. This subanalysis of the PORT-VASPh Cohort aimed to propose reference values in Portuguese children and adolescents, based on a statistical definition that considers the fundamental physiological role of aging in arterial stiffness.Design and method: The PORT-VASPh cohort has 953 children and adolescents enrolled, age ranging from 5 to 17 years. The overall health profile for each participant was defined based on three clinical evaluations, in which blood pressure (BP) was measured under standard conditions over the brachial artery with a clinically validated automatic sphygmomanometer (OMRON 705IT) and an appropriately sized cuff. Gender-specific percentiles were used for the definition of the individual BP phenotype. For the proposal of reference values for PWV, data were collected from 758 healthy and normotensive participants included in the cohort, 60% males and 40% females, with a mean age of 11.95 ± 2.87 years (ranging from 5 to 17 years) and a body mass index (BMI) of 18.56 ± 2.98 kg/m2. Carotid-femoral PWV was measured to all participants with the Complior SP device, complying with the methodological recommendations. All participants were evaluated by the same clinician. Results: Gender-specific percentile tables, accounting for age, were obtained, as depicted in Figure 1. Mean PWV was 6.08 ± 0.90 m/s, and was higher in boys as compared with girls (6.19 ± 0.90 m/s versus 5.91 ± 0.86 m/s, respectively; p < 0.0001). A significant correlation of PWV with age, BMI, systolic and diastolic BP and family history of hypertension was identified. Conclusions: The availability of reference tables for PWV in children and adolescents is necessary, as it would allow the incorporation of the arterial stiffness concept into pediatric clinical decision, thus contributing for a better definition of the adequate preventive strategies for these particular populations.

OP.7C.07] REFERENCE VALUES FOR AORTIC PULSE WAVE VELOCITY IN PORTUGUESE CHILDREN AND ADOLESCENTS - THE PORTUGUESE VASCULAR PHENOTYPE IN CHILDREN AND ADOLESCENTS (PORT-VASPH) COHORT

Objective: Carotid-femoral pulse wave velocity (PWV) is the gold-standard method to estimate aortic stiffness, and has been clearly associated with cardiovascular risk in different clinical subsets. Still, its use in clinical practice is still limited in some specific groups, particularly in pediatrics, due to the absence of reference values for this population. This subanalysis of the PORT-VASPh Cohort aimed to propose preliminary reference values in Portuguese children and adolescents, based on a statistical definition that considers the fundamental physiological role of aging in arterial stiffness. Design and method: The PORT-VASPh cohort has 402 children and adolescents enrolled so far, age ranging from 5 to 17 years. The overall health profile for each participant was defined based on three clinical evaluations, in which blood pressure (BP) was measured under standard conditions over the brachial artery with a clinically validated automatic sphygmomanometer (OMRON 705IT) and an appropriately sized cuff. Gender-specific percentiles were used for the definition of the individual BP phenotype. For the proposal of reference values for PWV, data were collected from 295 healthy and normotensive participants included in the cohort, 59.3% males and 40.7% females, with a mean age of 11.84 ± 2.86 years (ranging from 5 to 17 years) and a body mass index (BMI) of 18.75 ± 3.07 kg/m2. Carotid-femoral PWV was measured to all participants with the Complior SP device, complying with the methodological recommendations. All participants were evaluated by the same clinician. Results: Gender-specific percentile tables, accounting for age, were obtained, as depicted in Figure 1. Mean PWV was 6.14 ± 0.99 m/s, and was higher in boys as compared with girls (6.29 ± 1.00 m/s versus 5.92 ± 0.93 m/s, respectively; p = 0.002). A significant correlation of PWV with age, BMI, systolic and diastolic BP and family history of hypertension was identified Figure 1. Gender-specific percentiles for carotid-femoral pulse wave velocity.Conclusions: The availability of reference tables for PWV in children and adolescents is necessary, as it would allow the incorporation of the arterial stiffness concept into pediatric clinical decision, thus contributing for a better definition of the adequate preventive strategies for these particular populations.

Effects of Obesity and Hypertension on Pulse Wave Velocity in Children.

Pulse wave velocity (PWV) is a biomarker of arterial stiffness. Findings from prior studies are conflicting regarding the impact of obesity on PWV in children. The authors measured carotid-femoral PWV in 159 children aged 4 to 18 years, of whom 95 were healthy, 25 were obese, 15 had hypertension (HTN), and 24 were both obese and hypertensive. Mean PWV increased with age but did not differ by race or sex. In adjusted analyses in children 10 years and older (n=102), PWV was significantly higher in children with hypertension (PWV±standard deviation, 4.9±0.7 m/s), obesity (5.0±0.9 m/s), and combined obesity-hypertension (5.2±0.6 m/s) vs healthy children (4.3±0.7 m/s) (each group, P<.001 vs control). In our study, obesity and HTN both significantly and independently increased PWV, while African American children did not have a higher PWV than Caucasian children.