An in silico study of the effects of cardiovascular aging on carotid flow waveforms and indexes in a virtual population

Irene Suriani (Corresponding author), R. Arthur Bouwman, Massimo Mischi, Kevin D. Lau

Research output: Contribution to journalArticleAcademicpeer-review


Cardiovascular aging is strongly associated with increased risk of cardiovascular disease and mortality. Moreover, health and lifestyle factors may accelerate age-induced alterations, such as increased arterial stiffness and wall dilation, beyond chronological age, making the clinical assessment of cardiovascular aging an important prompt for preventative action. Carotid flow waveforms contain information about age-dependent cardiovascular properties, and their ease of measurement via noninvasive Doppler ultrasound (US) makes their analysis a promising tool for the routine assessment of cardiovascular aging. In this work, the impact of different aging processes on carotid waveform morphology and derived indexes is studied in silico, with the aim of establishing the clinical potential of a carotid US-based assessment of cardiovascular aging. One-dimensional (1-D) hemodynamic modeling was employed to generate an age-specific virtual population (VP) of N = 5,160 realistic carotid hemodynamic waveforms. The resulting VP was statistically validated against in vivo aging trends in waveforms and indexes from the literature, and simulated waveforms were studied in relation to age and underlying cardiovascular parameters. In our study, the carotid flow augmentation index (FAI) significantly increased with age (with a median increase of 50% from the youngest to the oldest age group) and was strongly correlated to local arterial stiffening (r = 0.94). The carotid pulsatility index (PI), which showed less pronounced age variation, was inversely correlated with the reflection coefficient at the carotid branching (r = −0.88) and directly correlated with carotid net forward wave energy (r = 0.90), corroborating previous literature where it was linked to increased risk of cerebrovascular damage in the elderly. There was a high correlation between corrected carotid flow time (ccFT) and cardiac output (CO) (r = 0.99), which was not affected by vascular age. This study highlights the potential of carotid waveforms as a valuable tool for the assessment of cardiovascular aging.
Original languageEnglish
Pages (from-to)H877-H899
Number of pages23
JournalAmerican Journal of Physiology : Heart and Circulatory Physiology
Issue number4
Early online date12 Jan 2024
Publication statusPublished - 1 Apr 2024


This research is funded by Netherlands Organization for Scientific Research Grant HTSM17878 (to M. Mischi).

FundersFunder number
Nederlandse Organisatie voor Wetenschappelijk OnderzoekHTSM17878


    • Aged
    • Aging
    • Cardiovascular Diseases
    • Carotid Arteries/diagnostic imaging
    • Hemodynamics
    • Humans
    • Ultrasonography
    • carotid flow waveforms
    • cardiovascular aging
    • hemodynamic waveform analysis
    • virtual population
    • one-dimensional modeling


    Dive into the research topics of 'An in silico study of the effects of cardiovascular aging on carotid flow waveforms and indexes in a virtual population'. Together they form a unique fingerprint.

    Cite this