Key result
Invasively calibrated radial adult transfer functions accurately estimate intra-aortic cSBP in children, unlike noninvasive waveforms.
Why the study?
Despite increasing interest in central hemodynamic indices in children, the accuracy of current noninvasive techniques against invasive intra-aortic measurements had not been assessed.
Do noninvasive transfer functions accurately estimate central arterial hemodynamics compared to invasive intra-aortic measurements in children undergoing cardiac catheterization?
Observational (n=29)
Do noninvasive transfer functions accurately estimate central arterial hemodynamics compared to invasive intra-aortic measurements in children undergoing cardiac catheterization?
Effect estimate: ICC 0.91
Adult radial transfer functions can accurately estimate central systolic blood pressure in children when calibrated invasively, but noninvasive calibration and augmentation index estimations remain inaccurate.
Invasively calibrated adult transfer functions may estimate pediatric cSBP; leaves open whether noninvasive calibration can be refined for clinical use.
BACKGROUND: In adults, central systolic blood pressure (cSBP) and augmentation index (cAIx) are independently associated with cardiovascular events and mortality. There is increasing interest in central hemodynamic indices in children. We aimed to assess the accuracy of current techniques against invasive intra-aortic measurements in children. METHODS: Intra-aortic pressure waveforms were recorded with simultaneous brachial, radial, and carotid waveforms in 29 children (6.7 ± 3.9 years old) undergoing cardiac catheterization. Adult and age-appropriate transfer functions (TFs) (brachial adult: b-aTF; radial adult: r-aTF; radial for 8-year-old children: TF8; and radial for 14-year-old children: TF14) were used to synthesize central aortic waveforms from peripheral waveforms calibrated either to invasively or noninvasively recorded BP. Central hemodynamic indices were measured by pulse wave analysis. RESULTS: cSBP measured from invasively calibrated r-aTF (β = 0.84; intraclass correlation coefficient = 0.91; mean error ± SDD = -1.0 ± 5.0 mm Hg), TF8 (β = 0.78; intraclass correlation coefficient = 0.84; mean error ± SDD = 4.4 ± 5.6 mm Hg), and TF14 (β = 0.82; intraclass correlation coefficient = 0.90; mean error ± SDD = 2.0 ± 4.7 mm Hg)-synthesized central waveforms correlated with and accurately estimated intra-aortic cSBP measurements, while noninvasively calibrated waveforms did not. cAIx derived from TF-synthesized central waveforms did not correlate with intra-aortic cAIx values, and degree of error was TF-dependent. CONCLUSIONS: The currently available r-aTF accurately estimates cSBP with invasive pulse pressure calibration, while. Age-appropriate TFs do not appear to provide additional benefit. Accuracy of cAIx estimation appears to be TF dependent.
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Cai et al. (2020) conducted an observational in Children undergoing cardiac catheterization (n=29). Noninvasive central arterial hemodynamic measurements using transfer functions vs. Invasive intra-aortic measurements was evaluated on Accuracy of central systolic blood pressure (cSBP) estimation using invasively calibrated radial adult transfer function (r-aTF) (ICC 0.91). Invasively calibrated radial adult transfer functions accurately estimated intra-aortic central systolic blood pressure in children (ICC = 0.91), while noninvasively calibrated waveforms did not.
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