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Background <p>Carotid peak velocity variation (ΔVpeak<sub>Car</sub>) is an alternative to aortic peak velocity variation (ΔVpeak<sub>Ao</sub>) and has been used in the pediatric population. Children’s physiology and anatomy are heterogeneous throughout their growth. For this reason, the predictive value of ΔVpeakCar as a surrogate of ΔVpeakAo can vary at different ages. We hypothesize that the ability of ΔVpeak<sub>Car</sub> as a surrogate of ΔVpeak<sub>Ao</sub> changes throughout childhood.</p> Aim <p>Analyze the concordance and the tracking ability of ΔVpeak<sub>Car</sub> and the ΔVpeak<sub>Ao</sub> at different stages of development.</p> Methods <p>Patients from 0 to 12 years were included. Three groups were defined: under 12 months (G1), between 12 and 60 months (G2), and over 60 months (G3). After anesthesia induction and mechanical ventilation, maximal and minimal aortic and carotid peak flow were measured. ΔVpeak<sub>Ao</sub> and ΔVpeak<sub>Car</sub> were calculated. Pearson test and simple linear regression were performed. Bland-Altman analysis was performed to determine concordance. 4-quadrant analysis was used, followed by polar analysis of the vectors, to complement the concordance analysis and determine the tracking ability of ΔVpeak<sub>Car</sub> to surrogate ΔVpeak<sub>Ao</sub>.</p> Results <p>Sixty-seven patients were enrolled. 22 (32.4%) patients in G1, 21 (31.3%) in G2 and 24 (35.8%) in G3. The determination coefficient (r) between ΔVpeak<sub>Ao</sub> and ΔVpeak<sub>Car</sub> in G1 was 0.44 (<i>p</i> &lt; 0.001) with a slope value of 0.61 (SE = 0.11; 95% CI:0.3–0.91). In G2, r<sup>2</sup> = 0.56 (<i>p</i> &lt; 0.001) with a slope value of 0.59 (SE = 0.14; 95% CI:0.35–0.82); and in G3, r<sup>2</sup> = 0.85 (<i>p</i> &lt; 0.001) with a slope value of 1.11 (SE = 0.10; 95% CI:0.91–1.31). Bland-Altman analysis showed to G1 a mean bias of -0.37 (LOA − 7.87 to 7.53), to G2 -0.07 (LOA − 7.37 to 7.23) and G3 0.55 (-3.81 to 4.91). Concordance rates were 100% in G3, 95% in G2, and 93% in G1.</p> Conclusions <p>ΔVpeak<sub>Car</sub> showed good correlation and tracking ability with ΔVpeak<sub>Ao</sub> in schoolchildren. In younger children, it was not reliable enough.</p>

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Carotid peak flow velocity variation as a surrogate of aortic peak flow velocity variation in a pediatric population

  • 期刊论文

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  • 发表日期：

    2025年3月25日

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  • Federico Cristiani,
  • Juan Pablo Bouchacourt,
  • Juan Riva,
  • Pablo Motta

摘要

Background

Carotid peak velocity variation (ΔVpeakCar) is an alternative to aortic peak velocity variation (ΔVpeakAo) and has been used in the pediatric population. Children’s physiology and anatomy are heterogeneous throughout their growth. For this reason, the predictive value of ΔVpeakCar as a surrogate of ΔVpeakAo can vary at different ages. We hypothesize that the ability of ΔVpeakCar as a surrogate of ΔVpeakAo changes throughout childhood.

Aim

Analyze the concordance and the tracking ability of ΔVpeakCar and the ΔVpeakAo at different stages of development.

Methods

Patients from 0 to 12 years were included. Three groups were defined: under 12 months (G1), between 12 and 60 months (G2), and over 60 months (G3). After anesthesia induction and mechanical ventilation, maximal and minimal aortic and carotid peak flow were measured. ΔVpeakAo and ΔVpeakCar were calculated. Pearson test and simple linear regression were performed. Bland-Altman analysis was performed to determine concordance. 4-quadrant analysis was used, followed by polar analysis of the vectors, to complement the concordance analysis and determine the tracking ability of ΔVpeakCar to surrogate ΔVpeakAo.

Results

Sixty-seven patients were enrolled. 22 (32.4%) patients in G1, 21 (31.3%) in G2 and 24 (35.8%) in G3. The determination coefficient (r) between ΔVpeakAo and ΔVpeakCar in G1 was 0.44 (p < 0.001) with a slope value of 0.61 (SE = 0.11; 95% CI:0.3–0.91). In G2, r2 = 0.56 (p < 0.001) with a slope value of 0.59 (SE = 0.14; 95% CI:0.35–0.82); and in G3, r2 = 0.85 (p < 0.001) with a slope value of 1.11 (SE = 0.10; 95% CI:0.91–1.31). Bland-Altman analysis showed to G1 a mean bias of -0.37 (LOA − 7.87 to 7.53), to G2 -0.07 (LOA − 7.37 to 7.23) and G3 0.55 (-3.81 to 4.91). Concordance rates were 100% in G3, 95% in G2, and 93% in G1.

Conclusions

ΔVpeakCar showed good correlation and tracking ability with ΔVpeakAo in schoolchildren. In younger children, it was not reliable enough.