Derivation of Pulse Wave Velocity from Arterial Waveforms in Children

Q: What are the key findings of this study?

Deriving pulse wave velocity from pediatric arterial waveforms using a new effective reflecting distance equation significantly correlated with tonometry-measured PWV (R² = 0.30, ICC 0.53, p = 0.0002).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Critically ill hospitalized infants and children requiring invasive arterial blood pressure monitoring (n=60). Intervention: Pulse wave velocity (PWV) derived from arterial line waveforms using a newly derived pediatric effective reflecting distance (EfRD) equation vs. Gold-standard applanation tonometry-measured brachio-femoral or carotid-femoral PWV (b/cfPWV) and adult EfRD equation. Primary outcome: Correlation and agreement between tonometry-measured brachio/carotid-femoral PWV and arterial waveform-calculated PWV using the new pediatric EfRD equation (R² = 0.30, ICC 0.53, 95% CI 0.26-0.73, p=0.0002).

Q: What does this research mean for the field?

Aortic pulse wave velocity can be reliably estimated from arterial waveforms in pediatric patients using an effective reflecting distance equation based on body length, heart rate, and blood pressure rather than adult models. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ramya Deepthi Billa; John M. Dagle; Mendi L. Schmelzel; Karen Johnson; Patrick Joseph McNamara; Aditya V. Badheka; Michael H. Tomasson; Madhuradhar Chegondi; Sarah E. Haskell; Anastasiia Vasileva; Harald Martin Stauss; Melissa Lowe Bates

doi:10.1152/ajpheart.00597.2026

October 30, 2026AJP Heart and Circulatory PhysiologyOpen Access

Derivation of Pulse Wave Velocity from Arterial Waveforms in Children

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Key result

Novel pediatric reflecting-distance equation derives pulse wave velocity from arterial waveforms with moderate tonometry agreement.

R² = 0.30, ICC 0.53
95% CI 0.26-0.73
P=0.0002
n=60

Why the study?

Calculating aortic pulse wave velocity (PWV) from peripheral arterial waveforms had not been validated in children. The study sought to determine whether PWV could be feasibly measured by tonometry and accurately derived from arterial waveforms in critically ill infants and children.

Can aortic pulse wave velocity be accurately estimated from indwelling arterial waveforms using a newly derived effective reflecting distance equation compared with applanation tonometry in critically ill infants and children?

Key Points

To determine whether pulse wave velocity can be reliably measured by tonometry and accurately derived from arterial catheter waveforms in critically ill infants and children.
Evaluated 60 patients with indwelling arterial catheters (median age 4.2 years, range 0–11.8 years) in intensive care units.
Measured brachio-femoral or carotid-femoral pulse wave velocity (b/cfPWV) using applanation tonometry in 55 patients, analyzing 39 artifact-free patient recordings.
Transformed peripheral arterial waveforms into central aortic waveforms using a model transfer function and derived a pediatric-specific effective reflecting distance (EfRD) equation via best-subsets regression.
The adult EfRD equation poorly estimated pediatric values and overestimated b/cfPWV (mean difference 4.9 ± 3.6 m/s; R² = 0.05, p = 0.09; interclass correlation -0.67, 95% CI -0.81 to -0.45, p > 0.99).
The new pediatric EfRD equation incorporated patient length, heart rate, and blood pressure, producing a strong correlation with true EfRD (Pearson's R² = 0.47, p < 0.0001; mean difference 0.08 ± 6.2 cm).
Calculated b/cfPWV using the new equation correlated well with measured b/cfPWV (Pearson's R² = 0.30, p = 0.0002; mean difference 0.19 ± 2.3 m/s; interclass correlation 0.53, 95% CI 0.26 to 0.73, p = 0.0002).

Study Design

Type

Cross-Sectional (n=60)

Multicenter

No

Structured PICO

Can aortic pulse wave velocity be accurately estimated from indwelling arterial waveforms using a newly derived effective reflecting distance equation compared with applanation tonometry in critically ill infants and children?

P

Population

60 clinically stable infants and children (mean age 4.17 years, 47% female) in a single-center NICU and PICU with indwelling arterial catheters undergoing 5-minute waveform and tonometry recordings.

E

Exposure

Estimation of aortic pulse wave velocity (PWV) and effective reflecting distance (EfRD) derived from 5-minute continuous invasive arterial catheter waveforms (recorded at 1000 Hz, converted to ascending aortic waveforms via a model transfer function in Hemolab software) using a newly derived pediatric best-subsets regression EfRD equation incorporating sex, body length, heart rate, systolic BP, diastolic BP, mean arterial pressure, SBP percentile, and pulse transit distances

C

Comparator

Gold-standard noninvasive arterial applanation tonometry (SPT-301 probe) measuring brachio-femoral or carotid-femoral PWV (b/cfPWV), as well as PWV estimated using a previously published adult EfRD equation by Pierce et al. (EfRD = 0.173*age + 0.661*BMI + 34.548)

O

Outcome

Correlation (Pearson R²), intraclass correlation (ICC), and Bland-Altman agreement between tonometry-measured b/cfPWV (and true EfRD) and arterial waveform-calculated PWV (and estimated EfRD) during a 5-minute recording sessionsurrogate

Main Result

Effect estimate: R² = 0.30, ICC 0.53 (95% CI 0.26-0.73)

Absolute Event Rate: 4.39% vs 4.19%

p-value: p=0.0002

This study provides a novel, validated pediatric equation to estimate effective reflecting distance and aortic pulse wave velocity directly from standard arterial line waveforms, eliminating the need for specialized tonometry in critically ill children.

Limitations

Small sample size within individual prepubertal developmental age groups (n=60 total, n=39 in final regression analysis)
Brachio-femoral PWV was sometimes used instead of gold-standard carotid-femoral PWV due to neck length and mechanical ventilation artifacts
Conducted in a critical care setting where cardiac output, shunts, mechanical ventilation, sedatives, and vasoactive medications may affect absolute PWV values
Peripheral arterial catheters were placed at different anatomical sites (radial, femoral, and umbilical arteries)
Not enough patients in each prepubertal age group to definitively quantify the impact of development on estimated PWV (60 enrolled, 39 with sufficient artifact-free data quality for final regression)
Brachio-femoral PWV was sometimes used instead of gold-standard carotid-femoral PWV due to artifacts from mechanical ventilation, cervical collars, pacifier swallows, or short neck length
Measurements were performed in a critical care setting where cardiac output, shunt status, hypertension, discomfort, mechanical ventilation, sedatives, and vasoactive/antihypertensive medications may affect absolute PWV values, limiting generalizability as normal values for healthy conscious children
Arterial catheters were placed at different anatomical sites (radial, femoral, and 3-4 umbilical lines whose waveforms were used directly without transfer function conversion)

Implication

May facilitate arterial line PWV estimation in children; leaves open prospective validation before clinical adoption.

Abstract

Aortic stiffness can be measured using aortic pulse wave velocity (PWV), calculated from peripheral arterial waveforms. However, this method has not been validated in children. We sought to determine whether PWV could be feasibly measured by tonometry and accurately derived from the arterial waveforms available in critically ill infants and children. Applanation tonometry was used to measure brachio-femoral or carotid-femoral PWV (b/cfPWV) in hospitalized hemodynamically stable, pre-pubertal children with an indwelling arterial catheter. Peripheral arterial line waveforms were converted into ascending aortic waveforms by a model transfer function. We found that the effective reflecting distance (EfRD) calculation used in adults overestimated b/cfPWV in children. We derived a new EfRD equation that yielded a better agreement between measured and estimated PWV (R² = 0.30, p < 0.05). Estimating PWV from arterial waveforms data eliminates the need for tonometry, allowing larger sample sizes of infants and children to be included in future cardiovascular disease and development studies. NEW AND NOTEWORTHY Our study provides a method for non-invasively measuring PWV in children using arterial waveforms. We used gold-standard tonometry to measure brachio/carotid-femoral PWV and derived an equation to estimate effective reflecting distance (EfRD) and PWV from the arterial waveforms in a pediatric critical care setting. We determined that PWV can be accurately estimated from arterial waveforms, providing a new tool for studying aortic stiffness in pediatric patients at risk for cardiovascular disease.

Discussion

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Cite This Study

Billa et al. (2026) conducted a cross-sectional in Critically ill hospitalized infants and children requiring invasive arterial blood pressure monitoring (n=60). Pulse wave velocity (PWV) derived from arterial line waveforms using a newly derived pediatric effective reflecting distance (EfRD) equation vs. Gold-standard applanation tonometry-measured brachio-femoral or carotid-femoral PWV (b/cfPWV) and adult EfRD equation was evaluated on Correlation and agreement between tonometry-measured brachio/carotid-femoral PWV and arterial waveform-calculated PWV using the new pediatric EfRD equation (R² = 0.30, ICC 0.53, 95% CI 0.26-0.73, p=0.0002). Deriving pulse wave velocity from pediatric arterial waveforms using a new effective reflecting distance equation significantly correlated with tonometry-measured PWV (R² = 0.30, ICC 0.53, p = 0.0002).

synapsesocial.com/papers/6ae682a3e432e7a5c4ef35ba https://doi.org/10.1152/ajpheart.00597.2026

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Derivation of Pulse Wave Velocity from Arterial Waveforms in Children

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Derivation of Pulse Wave Velocity from Arterial Waveforms in Children

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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