New Comprehensive Reference Values for Arterial Vascular Parameters in Children

J Am Soc Echocardiogr. 2020 Aug;33(8):1014-1022.e4. doi: 10.1016/j.echo.2020.03.001. Epub 2020 May 19.


Background: Noninvasive measurements of vascular parameters can be used for the detection and risk stratification of cardiovascular diseases. Most vascular parameters are influenced by age and body size, but pediatric reference values are scarce and limited to a few parameters. The aim of this study was to develop pediatric reference values and Z score equations for a comprehensive set of vascular parameters.

Methods: A total of 292 healthy subjects aged 0 to 18 years were prospectively recruited. Stiffness index β, pressure-strain elastic modulus, common carotid intima-media thickness, brachial flow-mediated dilation, radial augmentation index, central and right arm peripheral artery pulse-wave velocities, and pulse-wave velocity ratio were assessed. Normalization for age and anthropometric variables was performed using parametric multivariate regression modeling. Z scores were assessed for heteroscedasticity, residual association with age and body size, and distribution.

Results: Multivariate regression models with various combinations of height, weight, and age were used to obtain Z scores that were independent of age and body size. There was no residual association between Z scores and body size, age, or body mass index. There was no significant departure from the normal distribution.

Conclusions: The authors present reference values and Z score equations for a comprehensive set of vascular parameters during childhood. Further studies are necessary to assess their usefulness in detecting the vascular signs of subclinical atherosclerosis and chronic diseases, including congenital heart disease.

Keywords: Arterial stiffness; Children; Endothelial function; Intima-media thickness; Normal data.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brachial Artery
  • Cardiovascular Diseases* / diagnostic imaging
  • Carotid Intima-Media Thickness
  • Child
  • Humans
  • Pulse Wave Analysis
  • Reference Values
  • Vascular Stiffness*