Objectives Abnormal echogenic patterns such as the triple signal pattern can be identified in the common carotid artery (CCA) using ultrasound. These patterns have been associated not only with fibromuscular dysplasia but also with primary hypertension and cardiovascular risk factors, suggesting their potential as markers of vascular aging. Typically identified through visual inspection, their detection is time-consuming and operator-dependent. This study aimed to develop a machine learning approach to identify carotid wall patterns based on carotid-ultrasound image-derived features from a general population cohort. Methods Ultrasound data from 784 participants were analyzed, and 178 radiomic features were extracted from a standardized region of interest on the far wall of the CCA. Vascular wall patterns were visually classified by the physician as healthy or abnormal. Features were filtered based on inter-operator reproducibility, Pearson correlation and feature-relevance. Logistic regression (LR) and support vector machine models were trained using an 80/20 train-test split. Results Healthy and abnormal class represented 56% and 44% of the data, respectively. The inter-operator reproducibility increased with greater overlap in ROI placement. Logistic regression achieved accuracy: 0.70, sensitivity: 0.62, specificity: 0.76, and AUC: 0.78 on the training set, and maintained strong performance on the test set (AUC: 0.72, sensitivity: 0.71, specificity 0.59, accuracy: 0.64), based on 40 selected features. Conclusion These results demonstrate that machine learning classifier can discriminate between healthy and abnormal vascular wall patterns and in the future, this tool may be used to investigate clinical relevance of carotid wall patterns in larger cohorts.

Microcirculation is essential for maintaining tissue health and overall physiological function. Over the past few decades, various optical techniques have been developed to measure, visualize, and assess microvasculature. The skin has easily an accessible vascular bed allowing for noninvasive evaluation of microvascular function. Alterations in cutaneous microcirculation have been linked to dysfunctions in other target organs and vascular regions reinforcing the idea that cutaneous microcirculation can provide insights into systemic vascular conditions. Currently, there is no unified review focusing specifically on microcirculation-related optical techniques nor comprehensive analyses connecting these technological innovations to clinical evidence. This review aims to bridge that gap by systematically examining the wide spectrum of optical technologies used in assessing cutaneous microvascular function. We review techniques based on non-coherent light including oximetry, photoplethysmography, and microscopic methods and coherent light-based techniques, including speckle contrast imaging, diffuse correlation spectroscopy, photoacousting imaging, laser Doppler flowmetry and self-mixing interferometry. We emphasize cardiovascular research and evaluate the clinical relevance and technical maturity of the techniques. Additionally, brief explanation of skin structure and skin microvasculature while explaining light skin interaction is discussed. Lastly, we discuss these findings on wider context by including discussions and advancements in multimodal monitoring and machine learning.

Resistant hypertension (RHTN) is estimated to affect approximately 15

BACKGROUND:Cardiovascular disease is a leading cause of global mortality. Carotid-femoral pulse wave velocity (cfPWV) is the gold-standard noninvasive measure of arterial stiffness and is commonly used to assess early vascular aging, as it predicts future cardiovascular events. Although the influence of cardiovascular risk factors on cfPWV is well studied in adults, evidence in youth is limited. This study aimed to identify common cardiovascular risk factors that best explain variation in cfPWV among young people. METHODS:This study included 6763 participants aged 5 to 40 years with cfPWV measured using the SphygmoCor device, drawn from the Youth Vascular Consortium. Analyses were conducted across 5 subsets based on data completeness. Multiple linear regression models, stratified by sex and age (≤19 and >19 years), were developed to identify cardiovascular risk factors explaining cfPWV variation. Model selection was guided by Akaike information criterion and adjusted R2. RESULTS:Age and systolic blood pressure were consistent predictors, explaining <40% of cfPWV variance in cfPWV. Heart rate and waist circumference also emerged as key predictors of cfPWV, although lipids contributed modestly only in young adults. Waist circumference was the strongest anthropometric predictor in most groups. CONCLUSIONS:Age, systolic blood pressure, and heart rate were the strong contributors among traditional risk factors, yet explained <40% of variance in cfPWV in most groups. These findings highlight the role of hemodynamic load in shaping arterial stiffness even in childhood and adolescence, when structural changes are evolving. A large proportion of variance remains unexplained, suggesting that genetic, prenatal, environmental, and behavioral factors warrant investigation.

Cuffless blood pressure (BP) monitoring devices represent a promising innovation in hypertension management. This scientific statement provides a comprehensive update on these emerging technologies, their specific validation requirements, their potential clinical applications, and their present and future challenges. These devices generate considerable interest by enabling non-invasive BP measurement without arterial occlusion, thereby eliminating the discomfort associated with traditional cuff-based monitoring, particularly during sleep. The technologies on which these devices are based comprise a heterogeneous group, primarily utilizing pulse wave propagation time or waveform analysis through contact or non-contact sensors. They can be categorized as continuous or intermittent, automated or manual, calibration-free or requiring cuff/demographic calibration, and wearable or stationary. This technological diversity necessitates validation protocols distinct from those used for conventional cuff-based monitors, with specific requirements for each device category. Potential clinical applications include widespread out-of-office BP monitoring, unbiased assessment of circadian BP patterns and BP variability, improved detection of nocturnal hypertension, enhanced treatment adherence and long-term BP control, and continuous monitoring in hospital settings. Additionally, their lower cost compared with conventional technologies could enhance the early detection of hypertension in resource-limited settings. However, due to insufficient accuracy validation, this scientific statement does not recommend their use in clinical decisions in spite of their potential interest, in line with international guidelines not recommending their use in hypertension management. Key challenges ahead include developing standardized validation protocols, establishing normative BP data, managing the resulting burden on clinicians in handling huge volumes of data, exploring additional haemodynamic parameters, and advancing sensor technology, mathematical models, and algorithms.

Cuffless blood pressure (BP) monitoring devices represent a promising innovation in hypertension management. This scientific statement provides a comprehensive update on these emerging technologies, their specific validation requirements, their potential clinical applications, and their present and future challenges. These devices generate considerable interest by enabling noninvasive BP measurement without arterial occlusion, thereby eliminating the discomfort associated with traditional cuff-based monitoring, particularly during sleep. The technologies on which these devices are based comprise a heterogeneous group, primarily utilizing pulse wave propagation time or waveform analysis through contact or noncontact sensors. They can be categorized as continuous or intermittent, automated or manual, calibration-free or requiring cuff/demographic calibration, and wearable or stationary. This technological diversity necessitates validation protocols distinct from those used for conventional cuff-based monitors, with specific requirements for each device category. Potential clinical applications include widespread out-of-office BP monitoring, unbiased assessment of circadian BP patterns and BP variability, improved detection of nocturnal hypertension, enhanced treatment adherence and long-term BP control, and continuous monitoring in hospital settings. Additionally, their lower cost compared with conventional technologies could enhance the early detection of hypertension in resource-limited settings. However, due to insufficient accuracy validation, this scientific statement does not still recommend their use in clinical decisions, in line with international guidelines not recommending their use in hypertension management. Key challenges ahead include developing standardized validation protocols, establishing normative BP data, manage the resulting burden on clinicians in handling huge volumes of data, exploring additional hemodynamic parameters, and advancing sensor technology, mathematical models, and algorithms.

Vascular cells continuously remodel the arterial wall (micro)structure in response to changes in their biomechanical/biochemical environment. Although the functional effects of arterial remodelling can be easily measured, assessing the underlying microstructural mechanisms is complex in vivo. Constitutive modelling is a computational technique that allows for linking whole-organ function to tissue constituent-level mechanics. However, the need for comprehensive biomechanical data for model parametrisation hampers its clinical applicability. In the present study, we propose a novel constitutive modelling framework that addresses this limitation by leveraging longitudinal acquisitions of pressure-diameter relationships at different arterial beds to aid model parametrisation. We applied our constitutive framework to data from a study on the effect of 60 days head-down bed rest (HDBR) on arterial function, where pressure-diameter relationships of three arteries (carotid, femoral and popliteal) were measured at baseline, during HDBR (two time points) and during a 30-day recovery (two time points). We modelled the arterial wall as a constrained mixture of elastin, collagen and vascular smooth muscle cells (VSMCs). The dimensionality of the parameterisation problem was reduced through assumptions on (i) the time evolution of the behaviour of individual constituents and (ii) consistency in intrinsic constituent mechanical properties across different arterial beds. Overall, the proposed framework captured well the in vivo data (R2 = 0.89 ± 0.05). We identified increased VSMC contraction and microstructural re-arrangement of collagen fibres as key adaptations to haemodynamic changes during HDBR, also resulting in reversible de-stiffening of peripheral arteries. The proposed approach appears promising for disentangling microstructural mechanisms of arterial remodelling in clinical settings. KEY POINTS: Constitutive modelling is a computational technique that links the macroscopic behaviour of arteries to the microstructure and mechanics of the constituents of their wall. Although constitutive modelling is used extensively on ex vivo data, the sparsity of biomechanical data that can be acquired in vivo hinders its applicability in clinical settings, where it could be instrumental in disentangling remodelling processes in ageing and disease. We propose a novel framework that leverages longitudinal acquisition of arterial waveforms at different arterial sites to aid in the parametrisation of comprehensive constitutive models. We exemplify the utility of our approach by teasing out the pivotal adaptation roles of vascular smooth muscle cell contraction and collagen microstructural remodelling in response to haemodynamic alterations resulting from prolonged head-down bed rest. Our approach shows promise for the quantitative characterisation of arterial remodelling from non-invasive in vivo data that can be easily measured in clinical settings.

BACKGROUND:The extensive assessment of vascular health requires the integration of both structural and functional (hemodynamic) parameters. These are usually obtained by fragmented technologies and different signals (e.g., imaging, tonometry). In this study, we aimed to (i) develop a novel software platform that enables a combined ultrasound-based analysis of longitudinal scans of the carotid; (ii) provide an initial evaluation of its technical performance and usability. METHODS:The development of the new platform was based on two validated software medical devices, the ARCSolver and the Carotid Studio, with novel components and integration efforts. The integration was achieved through the design of a unified processing pipeline and a shared data architecture, allowing seamless interoperability between the two systems. Moreover, besides the structural ultrasound-based analysis derived by Carotid Studio (i.e., Intima-Media-Thickness and diameter), a new generalized transfer function (newGTF) was developed in order to obtain ultrasound-based aortic waveforms and the ARCSolver-based algorithms were applied to obtain hemodynamic parameters (i.e., Pulse Wave Analysis). A study was conducted to evaluate the performance of the integrated system, and of the new GTF, with repeated acquisitions on 14 healthy volunteers with pairwise ultrasound and reference tonometric acquisitions at the right common carotid artery. Accuracy of the new GTF was assessed against central pulse waveforms measured by the tonometric reference method, and precision was evaluated through the repeatability of central hemodynamic parameters. Finally, a small group of medical operators tested usability of the integrated solution. RESULTS:According to the identified aims: (i) The resulting software provides an intuitive graphical user interface that enables comprehensive carotid analysis from a single acquisition. It processes longitudinal ultrasound scans to derive local structural parameters, including diameter, and applies mathematical models combined with a machine-learning-based approach to transform diameter waveforms into aortic pressure curves; (ii) the findings demonstrated good repeatability of the functional derived parameters, correlation with the reference approach and excellent usability, confirming the system's potential for clinical and research applications. CONCLUSION:The developed integrated solution may facilitate more comprehensive vascular assessment by enabling multiple measurements to be obtained within a single software environment.

BACKGROUND AND OBJECTIVE:Arterial pulse wave analysis (PWA), a tool capable of reflecting regional hemodynamics and wave propagation characteristics, has been primarily based on tonometric measurements, while ultrasound has been used for evaluating local arterial wall mechanics. This study investigates the accuracy of aortic PWA, derived from ultrasound measurements of carotid diameter, in comparison to standard tonometry. METHODS:A sub-dataset of the FUCHSIA study (i.e., patients with fibromuscular dysplasia, matched hypertensives and matched healthy controls) with pairs of carotid ultrasound (MyLab, ESAOTE, Genoa, Italy) and tonometric (SphygmoCor CvMS, Atcor Medical) recordings were used for analyses. Ultrasound longitudinal scans were processed as follows: extraction of diameter curves (Carotid Studio, Quipu); discarding low-quality curves; transformation of diameter to local pressure curves by mathematical models; machine-learning-based transformation from carotid to aortic pulse waves; and finally, calibration of aortic pressure curves. ARCSolver algorithms (AIT) were applied to these ultrasound-based aortic pressure waveforms and the tonometry-based aortic waveforms as reference method to derive PWA parameters (e.g., heart rate (HR), central systolic pressure (cSBP) and augmentation index (AIx)) for pairwise comparison. RESULTS:In total, 74 recordings from 49 patients (51 (SD 15) years; 15 men) were used in this comparative study. Tonometry- and ultrasound-derived HR correlated well (r = 0.88) with no significant bias (mean difference 0.58 (SD 4.9) bpm). Comparable results were obtained for cSBP (r = 0.97, mean difference -3.6 (SD 4.2) mmHg) and AIx (r = 0.77, mean difference -4.2 (SD 9.1) %). CONCLUSIONS:Central PWA parameters obtained from carotid ultrasound-derived aortic pressure curves showed agreement with tonometry-based measurements and results are in line with literature.

IntroductionArterial stiffness, measured by Pulse Wave Velocity (PWV), is a critical marker of cardiovascular risk. However, current reference values are often derived from limited clinical cohorts. This study aims to establish large-scale normative trajectories for PWV using real-world data.MethodsWe analyzed anonymized data from 38,648,329 measurements collected via Withings smart scales in 1 196 712 unique users (681719 men and 514993 women) between 2023 and 2024, across Japan, North America, and Europe. PWV was estimated using ballistocardiography coupled with impedancemetry. We applied multivariate quantile regression to assess the impact of age, sex, and BMI on PWV.ResultsThere was a significant interaction between age and sex (p < 0.001). Men exhibited higher PWV values in early adulthood after adolescence compared to women. However, a distinct crossover was observed around the fifth decade of life, after which women displayed a steeper rate of arterial stiffening, eventually surpassing men. Age, sex and BMI were independently associated with PWV.DiscussionThis observational study provides the largest real-world dataset on PWV to date. The results illustrate in an observational way the sex dependent “vascular aging crossover” likely associated with hormonal change at adolescence and later menopause. This finding demonstrates the utility of connected devices in large-scale cardiovascular epidemiology.

OBJECTIVES:Vascular aging (VA) is a prognostically relevant aspect of biological aging. We investigated its prevalence and determinants in Austria. METHODS:The LEAD (Lung, Heart, Social, Body) study is an ongoing, longitudinal, population-based observational study, which started in 2011 in Vienna and six villages from Lower Austria. Within the study, carotid-femoral pulse wave velocity (cfPWV) was measured using applanation tonometry. Based on a reference population (no history of overt cardiovascular disease, no diabetes, no pharmacological treatment for hypertension or dyslipidemia), sex-, and age-specific Z -scores for cfPWV were calculated. Healthy (HVA), normal (NVA), and early (EVA) vascular aging were defined as cfPWV Z -score <10th, 10th-90th, and >90th percentile, respectively. RESULTS:In the overall population ( n = 7926, 54.2% women, age 18-82 years), the prevalence of HVA/NVA/EVA was 9.1/78.6/12.2%, respectively, with EVA prevalence increasing in older age. The risk of EVA, as compared to HVA, was independently and directly associated with female sex (odds ratio, OR 2.8), systolic (OR 1.04) and diastolic (OR 1.02) blood pressure, heart rate (OR 1.06), body height (OR 1.03), and diabetes mellitus (OR 3.0), and inversely related to appendicular lean mass index (OR 0.82), postbronchodilation FEV1 (OR 0.81), and healthy nutrition (OR 0.69). The results were similar for the comparison of EVA and NVA, adding an independently increased risk for EVA with regular alcohol intake (OR 1.37) and low income (OR 1.21). CONCLUSIONS:We observed a high percentage of EVA in Austria, determined by classical and nonclassical risk factors. The latter may offer novel targets for prevention.

AIMS:Susceptibility to hypertension-mediated organ damage (HMOD) is influenced by genetics, age, gender, and additional cardiovascular risk factors and comorbidities in the individual patient. All major hypertension guidelines recommend assessment of HMOD to identify high cardiovascular risk. However, in clinical practice, it may be difficult to choose the optimal strategy and diagnostic tools for the individual patient. METHODS AND RESULTS:We reviewed recommendations on HMOD assessment in the 2024 European Society of Cardiology, the 2023 European Society of Hypertension, the 2025 American Heart Association/American College of Cardiology, and the 2020 International Society of Hypertension guidelines to provide an expert opinion on how to optimize the diagnosis of HMOD in clinical practice. Basic assessment of cardiac and renal HMOD is recommended in all patients using electrocardiography, serum creatinine, and estimated glomerular filtration rate, and albumin-creatinine ratio in a morning spot-urine. Advanced tests for HMOD assessment are indicated depending on findings at the initial clinical assessment, whether results are likely to change management, and local availability and resources. Echocardiography remains the preferred initial test and may add prognostic information in most patients. Identification of premature atherosclerosis by ultrasound or coronary artery calcium score or arterial stiffness by pulse wave velocity may be indicated in young and middle-aged individuals with arterial hypertension or blood pressure close to treatment threshold, if likely to change management. CONCLUSION:HMOD is a marker of high cardiovascular risk. Basic assessment should be performed in all patients with arterial hypertension, and more advanced tests in selected patients. LAY SUMMARY:High blood pressure (hypertension) leads to damage of the heart, arteries, eyes, brain, and kidneys, collectively termed hypertension-mediated organ damage (HMOD). Presence of HMOD is associated with a 2-3-fold increased risk of subsequent cardiovascular disease. The hypertension guidelines, therefore, recommend looking for HMOD in the evaluation of patients with hypertension to identify high-risk individuals. To help clinicians make informed decisions on what type of test to choose for HMOD assessment, we have compared the recommendations of the most important recently issued hypertension guidelines.Key findings are:Basic HMOD screening of heart and kidney function should be performed in all individuals with hypertension, including taking an electrocardiogram and blood and urine tests to evaluate kidney function.Targeted advanced HMOD assessment in specialized health care is recommended in selected individuals based on findings in the initial evaluation. This may include ultrasound examination of the heart, kidneys or arteries, measurement of arterial stiffness or imaging of the heart, brain or arteries by computed tomography or magnetic resonance imaging.