Feasibility and Normal Ranges of Arterial Intima-Media Thickness and Stiffness in 2-Year-Old Children: A Pilot Study

  • Bing Zhao
  • Fay H. Johnston
  • Marita Dalton
  • Kazuaki NegishiEmail author
Original Article



In adults, noninvasive assessments of vascular function have been established. However, little is known about the applicability and reference values of these techniques among children < 6 years old and none ≤ 2. We aimed to determine the feasibility of conducting noninvasive vascular assessments in 2-year-old children and the normal range of results in this age group.


Carotid intima-media thickness (cIMT) and abdominal aorta IMT (aaIMT), pulse wave velocity (PWV), arterial diameter change, stiffness index (β), and distensibility were assessed in 2-year-old children. IMT was assessed using an automatic contour detection.


The proportion of successful measurements was 72% (42/58) with cIMT 64%, aaIMT 67%, and PWV 43%. Average far wall cIMT was 0.51 mm and 0.40 for aaIMT. Mean PWV was 4.15 m/s, with relatively wider range in stiffness index and distensibility. Common carotid arteries had a higher mean distensibility of 4.58%/10 mmHg compared with 2.98%/10 mmHg for the abdominal aorta. The number of data points automatically detected at far wall cIMT was higher than that in aaIMT (left cIMT: 244 ± 13 and right: 240 ± 23 vs. abdominal 185 ± 63, p < 0.001). Better and more consistent quality was achieved for cIMT than aaIMT measurements. PWV measurement was only feasible in cooperative children with efficient distractions.


Noninvasive methods for early detection of cardiovascular risks were feasible in at least two-thirds of 2-year-old children. Given the greater feasibility and image quality, cIMT is a preferable option for assessing vascular health in young children.


Intima-media thickness Pulse wave velocity Arterial stiffness Children 



Abdominal aorta intima-media thickness


Association for European Paediatric Cardiology




Blood pressure


Body mass index


Carotid intima-media thickness


Cardiovascular disease


Diastolic blood pressure




End-systolic diameter


End-diastolic diameter




European Society of Cardiology


European Society of Hypertension


Intima-media thickness


Interquartile range


Mean arterial pressure








Pulse pressure


Pulse wave velocity


Systolic blood pressure


Artery stiffness index



The authors acknowledge the participants and their guardians of Latrobe Early Life Follow-Up Study. We would like to thank Ms. Melanie Reeves, Ms. Susan Denny, Ms. Krissi Creighton, Ms. Kylie Sawyer and Ms. Emerson Easley with preparing and assisting the clinical assessment, and the Hazelwood Health Study research team for their contributions to this study.


This study was funded by the Victorian Department of Health and Human Services. The report presents the views of the authors and does not represent the views of the Department.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Tasmanian Health and Medical Human Research Ethics Committee approved the study protocol (Ethics Reference Number: H0014875), which also conforms to the ethical guidelines of the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all guardians of the individual participants included in the study.

Supplementary material

246_2019_2088_MOESM1_ESM.docx (32 kb)
Supplementary material 1 (DOCX 32 KB)


  1. 1.
    Roth GA, Huffman MD, Moran AE et al (2015) Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation 132(17):1667–1678. CrossRefGoogle Scholar
  2. 2.
    Kesteloot H, Sans S, Kromhout D (2006) Dynamics of cardiovascular and all-cause mortality in Western and Eastern Europe between 1970 and 2000. Eur Heart J 27(1):107–113. CrossRefGoogle Scholar
  3. 3.
    Lozano R, Naghavi M, Foreman K et al (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2095–2128. CrossRefGoogle Scholar
  4. 4.
    Cardiovascular diseases (CVDs), Fact Sheet (2017) World Health Organization. Accessed May 2017
  5. 5.
    Lorenz MW, Markus HS, Bots ML et al (2007) Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 115(4):459–467. CrossRefGoogle Scholar
  6. 6.
    Laurent S, Cockcroft J, Van Bortel L et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27(21):2588–2605. CrossRefGoogle Scholar
  7. 7.
    Doyon A, Kracht D, Bayazit AK et al (2013) Carotid artery intima-media thickness and distensibility in children and adolescents: reference values and role of body dimensions. Hypertension (Dallas Tex 1979) 62(3):550–556. CrossRefGoogle Scholar
  8. 8.
    Kelishadi R, Poursafa P (2014) A review on the genetic, environmental, and lifestyle aspects of the early-life origins of cardiovascular disease. Curr Probl Pediatr Adolesc Health Care 44(3):54–72. CrossRefGoogle Scholar
  9. 9.
    Gillman MW (2005) Developmental origins of health and disease. N Engl J Med 353(17):1848–1850. CrossRefGoogle Scholar
  10. 10.
    Singhal A, Lucas A (2004) Early origins of cardiovascular disease: is there a unifying hypothesis? Lancet 363(9421):1642–1645. CrossRefGoogle Scholar
  11. 11.
    McGill HC Jr, McMahan CA, Herderick EE et al (2000) Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr 72(5):1307 s–1315 sCrossRefGoogle Scholar
  12. 12.
    Thurn D, Doyon A, Sozeri B et al (2015) Aortic pulse wave velocity in healthy children and adolescents: reference values for the vicorder device and modifying factors. Am J hypertens 28(12):1480–1488. CrossRefGoogle Scholar
  13. 13.
    Sass C, Herbeth B, Chapet O et al (1998) Intima-media thickness and diameter of carotid and femoral arteries in children, adolescents and adults from the Stanislas cohort: effect of age, sex, anthropometry and blood pressure. J Hypertens 16(11):1593–1602CrossRefGoogle Scholar
  14. 14.
    Bohm B, Hartmann K, Buck M et al (2009) Sex differences of carotid intima-media thickness in healthy children and adolescents. Atherosclerosis 206(2):458–463. CrossRefGoogle Scholar
  15. 15.
    Ried-Larsen M, Grontved A, Moller NC et al (2014) Associations between objectively measured physical activity intensity in childhood and measures of subclinical cardiovascular disease in adolescence: prospective observations from the European Youth Heart Study. Br J Sports Med 48(20):1502–1507. CrossRefGoogle Scholar
  16. 16.
    Melody S, Dalton M, Dennekamp M et al (2017) The Latrobe Early Life Follow-up (ELF) Cohort Study Volume 1: Description of the cohort and preliminary assessment of possible associations between mine fire emissions and parent-reported perinatal outcomes.
  17. 17.
    Salomaa V, Riley W, Kark JD et al (1995) Non-insulin-dependent diabetes mellitus and fasting glucose and insulin concentrations are associated with arterial stiffness indexes. The ARIC Study. Atherosclerosis Risk in Communities Study. Circulation 91(5):1432–1443CrossRefGoogle Scholar
  18. 18.
    Kawasaki T, Sasayama S, Yagi S et al (1987) Non-invasive assessment of the age related changes in stiffness of major branches of the human arteries. Cardiovasc Res 21(9):678–687CrossRefGoogle Scholar
  19. 19.
    Mikola H, Pahkala K, Niinikoski H et al (2017) Cardiometabolic determinants of carotid and aortic distensibility from childhood to early adulthood. Hypertension (Dallas, Tex: 1979) 70(2):452–460. Google Scholar
  20. 20.
    Dawson JD, Sonka M, Blecha MB et al (2009) Risk factors associated with aortic and carotid intima-media thickness in adolescents and young adults: the Muscatine Offspring Study. J Am Coll Cardiol 53(24):2273–2279. CrossRefGoogle Scholar
  21. 21.
    Breton CV, Yao J, Millstein J et al (2016) Prenatal air pollution exposures, DNA methyl transferase genotypes, and associations with newborn LINE1 and alu methylation and childhood blood pressure and carotid intima-media thickness in the children’s health study. Environ Health Perspect 124(12):1905–1912. CrossRefGoogle Scholar
  22. 22.
    Mansia G, De Backer G, Dominiczak A et al (2007) 2007 ESH-ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood Press 16(3):135–232. CrossRefGoogle Scholar
  23. 23.
    Jourdan C, Wuhl E, Litwin M et al (2005) Normative values for intima-media thickness and distensibility of large arteries in healthy adolescents. J Hypertens 23(9):1707–1715CrossRefGoogle Scholar
  24. 24.
    Baroncini LA, Sylvestre Lde C, Pecoits Filho R (2016) Assessment of Intima-Media Thickness in Healthy Children Aged 1 to 15 Years. Arquivos Brasileiros de Cardiologia 106(4):327–332. Google Scholar
  25. 25.
    Dalla Pozza R, Ehringer-Schetitska D, Fritsch P et al (2015) Intima media thickness measurement in children: A statement from the Association for European Paediatric Cardiology (AEPC) Working Group on Cardiovascular Prevention endorsed by the Association for European Paediatric Cardiology. Atherosclerosis 238(2):380–387. CrossRefGoogle Scholar
  26. 26.
    Reusz GS, Cseprekal O, Temmar M et al (2010) Reference values of pulse wave velocity in healthy children and teenagers. Hypertension (Dallas, Tex: 1979) 56(2):217–224. Google Scholar
  27. 27.
    Mora-Urda AI, Molina MD, Mill JG et al (2017) Carotid-Femoral Pulse Wave Velocity in Healthy Spanish Children: Reference Percentile Curves. J Clin Hypertens (Greenwich Conn) 19(3):227–234. CrossRefGoogle Scholar
  28. 28.
    Kis E, Cseprekal O, Kerti A et al (2011) Measurement of pulse wave velocity in children and young adults: a comparative study using three different devices. Hypertens Res 34(11):1197–1202. CrossRefGoogle Scholar
  29. 29.
    Elmenhorst J, Hulpke-Wette M, Barta C et al (2015) Percentiles for central blood pressure and pulse wave velocity in children and adolescents recorded with an oscillometric device. Atherosclerosis 238(1):9–16. CrossRefGoogle Scholar
  30. 30.
    Hidvegi EV, Illyes M, Benczur B et al (2012) Reference values of aortic pulse wave velocity in a large healthy population aged between 3 and 18 years. J Hypertens 30(12):2314–2321. CrossRefGoogle Scholar
  31. 31.
    Litwin M, Feber J, Ruzicka M (2016) Vascular aging: lessons from pediatric hypertension. Can J Cardiol 32(5):642–649. CrossRefGoogle Scholar
  32. 32.
    Touboul PJ, Hennerici MG, Meairs S et al (2007) Mannheim carotid intima-media thickness consensus (2004–2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovascular diseases (Basel, Switzerland) 23(1):75–80.
  33. 33.
    Lurbe E, Agabiti-Rosei E, Cruickshank JK et al (2016) 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens 34(10):1887–1920. CrossRefGoogle Scholar
  34. 34.
    McCloskey K, Vuillermin P, Ponsonby AL et al (2014) Aortic intima-media thickness measured by trans-abdominal ultrasound as an early life marker of subclinical atherosclerosis. Acta Paediatr (Oslo, Norway: 1992) 103(2):124–130. Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia
  2. 2.Sydney Medical School Nepean, Charles Perkins Centre Nepean, Faculty of Medicine and HealthThe University of SydneySydneyAustralia

Personalised recommendations