Wearable Ultrasound in Cardiovascular Monitoring: Clinical Evidence and Translational Challenges

doi:10.26599/AUDT.2026.260039

Abstract

Abstract:

Objective

Wearable ultrasound is emerging as a promising approach for continuous cardiovascular monitoring, extending conventional ultrasound from intermittent examinations to prolonged, hands-free assessment. This review summarizes recent progress in these major cardiovascular applications, with particular attention to their clinical validation and translational potential.

Methods

A literature search was performed using PubMed (January 2021 to August 2026) utilizing keywords related to wearable ultrasound (e.g., "wearable", "skin-mounted", "ultrasound", "Doppler") combined with cardiovascular terms. Eligible original research articles, including human studies, animal investigations, and ultrasound sensing-platform studies that demonstrated relevant mechanisms or technical feasibility, were selected.

Results

Recent advances in flexible transducers, stable acoustic coupling, and automated signal analysis have enabled continuous cardiac imaging, non-invasive blood pressure monitoring, and dynamic assessment of vascular hemodynamics and arterial stiffness. Current studies have demonstrated continuous acquisition of cardiac images and functional parameters, cuffless blood pressure tracking under dynamic conditions, and wearable measurement of vascular flow and local arterial mechanical properties. Among these applications, continuous cuffless blood pressure monitoring currently has the most mature clinical validation. However, most applications remain at the physiological validation or early clinical feasibility stage, and evidence for long-term reliability, generalizability, and clinical benefit is still limited.

Conclusion

Future research should focus on robust continuous monitoring in real-world patients and on demonstrating whether wearable ultrasound can provide clinically actionable information beyond conventional intermittent ultrasound.

Key words: Wearable ultrasound; Flexible ultrasonic transducer; Cuffless blood pressure; Continuous hemodynamic monitoring; Cardiovascular monitoring

Han Xiao, Ma Xia, Yu Fengxia, Cai Linkun, Ren Pengling, Shi Xian-Quan, Wang Zhenchang. Wearable Ultrasound in Cardiovascular Monitoring: Clinical Evidence and Translational Challenges. Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(4): 360-375.

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Figures/Tables 4

Figure 1

Table 1

Representative studies of wearable ultrasound for continuous cardiac function monitoring"

Author/year	Population	Device/mode	Integration level	Freq./depth	Cardiac target	Monitoring	Comparator	Key findings	Limitation/ evidence stage
US, ultrasound; CBF, cerebral blood flow; LV, left ventricle; DL, deep learning; PLAX, parasternal long-axis; PSAX, parasternal short-axis; A4C, apical four-chamber; A2C, apical two-chamber; EDV, end-diastolic volume; ESV, end-systolic volume; SV, stroke volume; CO, cardiac output; LVEF, left ventricular ejection fraction; PFO, patent foramen ovale; AV, aortic valve; RV, right ventricular; DSA, digital subtraction angiography; TEE, transesophageal echocardiography; GI, gastrointestinal; PDA, patent ductus arteriosus; NICU, neonatal intensive care unit; echo, echocardiography; f/u, follow-up. Evidence stage is graded as follows: Technical proof-of-concept, demonstration of device functionality in phantoms or very small samples; Physiological validation, evaluation of measurements or physiological responses in healthy volunteers; Early clinical feasibility, preliminary evaluation in patient populations via case series or small-scale clinical studies; Clinical reference-standard validation, systematic evaluation of measurement agreement or diagnostic performance against an established clinical reference method in a clinical cohort.
Wang/2021^[17]	Healthy volunteers	Stretchable US phased array (Doppler)	Wired probe	~2 MHz; ≤ 14 cm	Cardiac tissues; central vessels; CBF	Real-time monitoring	Commercial rigid phased array (Verasonics P4-2v)	Active beam focusing/steering (−20° to +20°); deep-tissue Doppler performance comparable to commercial device	Healthy only; no LV functional quantification Physiological validation
Hu/2023^[9]	Healthy volunteers	Orthogonal wearable cardiac imager (B/M-mode + DL)	Wired wearable patch	3 MHz	LV; standard echo views (PLAX, PSAX, A4C, A2C)	Rest/exercise/ recovery	Commercial echocardiography	Automated EDV, ESV, SV, CO, LVEF from continuous LV volume curves; good agreement with commercial echocardiography for LV volume and derived functional indices	Healthy only; limited clinical validation Physiological validation
Zhang/2025^[22]	1 adult PFO patient (49 y/o, bicuspid AV)	WISMED wearable US (W30PC)	Wireless wearable patch	Not reported (proprietary)	RV inflow/outflow tract; PFO occluder position	PFO closure (intraprocedural guidance + postop monitoring)	DSA + TEE (conventional PFO guidance)	Continuous hands-free imaging during intervention; real-time device guidance; avoids esophageal intubation	Single case/ Early clinical feasibility
Wang/2025^[23]	1 neonate (3.75 kg, GI bleeding, PFO/PDA)	Wearable phased-array echo (P2-5-64, color Doppler)	Wireless wearable patch	3.6 MHz	LV (volume, contractility); standard neonatal views	Perioperative anesthesia + NICU monitoring	Preoperative clinical echocardiography	Continuous contractility and volume assessment; guides fluid management in neonatal setting	Single case/ Early clinical feasibility

Table 1

Table 2

Representative studies of wearable ultrasound for continuous non-invasive blood pressure monitoring"

Author/year	Population	Device/method	Target vessel	Calibration	Monitoring/duration	Comparator	Key findings	Integration	Evidence stage
US, ultrasound; BP, blood pressure; DBP, diastolic BP; PMUT, piezoelectric micromachined ultrasound transducer; PWV, pulse wave velocity; PPG, photoplethysmography; SBP, systolic BP; MAE, mean absolute error; SD, standard deviation; HR, heart rate; USoP, ultrasonic-system-on-patch; ML, machine learning; HIIT, high-intensity interval training; CO, cardiac output; ICU, intensive care unit; MAP, mean arterial pressure; ISO, International Organization for Standardization; MAD, mean absolute difference; SAFU, skin-adaptive focused ultrasound; BMI, body mass index; cath, cardiac catheterization. Evidence stage is graded as follows: Technical proof-of-concept, demonstration of device functionality in phantoms or very small samples; Physiological validation, evaluation of measurements or physiological responses in healthy volunteers; Early clinical feasibility, preliminary evaluation in patient populations via case series or small-scale clinical studies; Clinical reference-standard validation, systematic evaluation of measurement agreement or diagnostic performance against an established clinical reference method in a clinical cohort.
Wang/2018 [25]	1 healthy male volunteer	Conformal US patch; pulse-echo arterial wall tracking	Carotid artery + jugular vein	Yes; BP derived from vessel diameter–pressure relationship (brachial cuff for DBP reference)	Rest and exercise; continuous waveform monitoring; up to 2 h skin integration	Commercial tonometry	Continuous central and peripheral arterial pulse/BP waveforms from vessels up to ~4 cm deep; good agreement with tonometry	Wired probe	Technical proof-of-concept
Sempionatto/2021 [26]	Healthy volunteers	Multimodal epidermal patch (US + electrochemical sensors)	Carotid artery	Yes; commercial cuff BP calibration	Food intake, exercise, daily stimuli; continuous simultaneous monitoring	Commercial cuff BP monitor	Simultaneous BP/HR + glucose/lactate/caffeine/alcohol monitoring; detected expected BP/HR responses to exercise and metabolic changes	Wired wearable patch	Physiological validation
Zhou/2025(IEEE) [27]	17 healthy subjects (12M/5F, 22-36 y)	Wearable PMUT; pulse-echo arterial diameter + local PWV	Two sites along a single artery (local PWV)	Yes; initial BP cuff calibration required	Rest and dynamic BP changes; wearable/mobile monitoring	Cuff sphygmomanometer; PPG finger clip (waveform)	SBP/DBP MAE <4 mmHg, SD < 3 mmHg; HR error < 3 bpm; waveform r = 0.951-0.998	Wireless wearable (PMUT)	Physiological validation
Lin/2024 [5]	Healthy adult volunteers	Fully integrated USoP (A/B/M-mode + ML target tracking)	Carotid artery/central arteries	Yes; tonometer calibration for BP	Moving subjects; exercise (cycling, HIIT); ≤ 12 h continuous	Tonometer; reference BP devices	ML-based autonomous vascular target tracking (96.13% accuracy with domain adaptation); central BP error < 1.58 mmHg post-calibration; continuous BP/HR/CO	Fully integrated wireless system	Physiological validation
Zhou/2025(NatBE) [10]	117 participants (7 daily-activity, 85 outpatient, 21 catheterization, and 4 ICU participants)	Wearable US BP sensor; closely spaced sonographic windows + backing layer; arterial wall-motion sensing	Brachial and radial arteries (main)	Yes; reference calibration used	Daily activities; supine–standing challenge; cardiac catheterization; ICU 10–12 h	Cuff BP; invasive arterial line (cath lab & ICU)	Cath lab: Bland–Altman SBP 0.34 ± 3.90, MAP −0.18 ± 2.20, DBP −0.43 ± 2.66 mmHg; met ISO 81060-2 criteria; outpatient MAD ≤ 4.90 mmHg	Wireless wearable patch	Clinical reference-standard validation
Yuan/2025 [28]	Healthy volunteers; multiple small BP-validation cohorts	SAFU flexible US array (2.4 MHz, self-adhesive hydrogel); arterial wall tracking	Fingertip, radial, brachial, carotid (multi-artery)	Yes; vessel mechanics linked to reference BP	Multi-artery testing, exercise, 24-h BP monitoring	Mercury sphygmomanometer	SBP error 1.8 ± 2.98, DBP error 1.1 ± 2.43 mmHg (representative); 24-h monitoring ±2.48/±1.99 mmHg; robust to moderate misalignment	Flexible wearable patch	Physiological validation

Table 2

Table 3

Representative studies of wearable ultrasound for vascular hemodynamics and arterial stiffness assessment"

Study	Population	Device	Target	Key parameter	Comparator	Key quantitative finding	Integration	Evidence stage
PLR, passive leg raising; CW, continuous-wave; ccFT, corrected carotid flow time; SV, stroke volume; AUROC, area under the receiver operating characteristic curve; CABG, coronary artery bypass grafting; TEE, transesophageal echocardiography; CCA, common carotid artery; CPB, cardiopulmonary bypass; IJ, internal jugular; VTI, velocity-time integral; LVET, left ventricular ejection time; CSA, cross-sectional area; US, ultrasound; HT, hypertension; SAFU, skin-adaptive focused ultrasound; BP, blood pressure; PWV, pulse wave velocity; PW, pulsed-wave; MAE, mean absolute error; MAPE, mean absolute percentage error; ccVTI, carotid velocity-time integral; Δ, change. Evidence stage is graded as follows: Technical proof-of-concept, demonstration of device functionality in phantoms or very small samples; Physiological validation, evaluation of measurements or physiological responses in healthy volunteers; Early clinical feasibility, preliminary evaluation in patient populations via case series or small-scale clinical studies; Clinical reference-standard validation, systematic evaluation of measurement agreement or diagnostic performance against an established clinical reference method in a clinical cohort.
Kenny/2023 Front Biosci Elite [11]	19 volunteers; 36 PLR	Wireless CW Doppler patch	Carotid	ccFT	Non-invasive pulse-contour SV	8,856 cycles; ccFT tracks SV change (AUROC 0.77 for +5% ΔSV)	Wireless patch	Physiological validation
Kenny/2021 Bioengineering [31]	2 CABG patients (proof-of-principle)	Wireless CW Doppler patch (4 MHz)	Carotid	ccVTIΔ	TEE	10-beat averaged ccVTIΔ: AUROC 0.95 for +10% ΔSV	Wireless patch	Early clinical feasibility
Kenny/2025 CHEST Crit Care [32]	CABG patients (post-op)	Wireless CW Doppler patch	Carotid	ΔccFT	TEE ΔSV	Validated ΔccFT for detecting ≥10% SV change	Wireless patch	Clinical reference-standard validation
Munding/2023 [33]	14 on-pump CABG patients	Hands-free CW Doppler patch	Carotid	Max CCA velocity	CPB pump flow	13.6% ΔCCA velocity ↔ 10% ΔCPB flow	Hands-free patch	Early clinical feasibility
Kenny/2023 Ultrasound J [36]	2 illustrative cases (1 healthy + 1 clinical)	Wireless CW Doppler patch (4 MHz)	Carotid + IJ vein	ccFT, VTI, venous Doppler	Non-invasive SV (case 1); clinical context (case 2)	"Doppler Starling curve" framework; differential preload-output responses	Wireless patch	Early clinical feasibility
Hofer/2025 [35]	347 participants; 137,521 cycles	Wireless CW Doppler patch	Carotid	ccFT/LVET (4 correction equations)	— (reference distribution)	Mean ccFT 295–311 ms across correction formulas; 99.1% signal validity across 137,521 cycles	Wireless patch	Physiological validation
Kong/2026 [12]	In vitro + human volunteers	Wearable T-shaped B-mode + Doppler patch (8.5 MHz, 1.3 mm)	Carotid	CSA + VTI → volumetric flow	Commercial US system	In vitro max deviation 6.3%; simultaneous dual-axis imaging	T-shaped array patch	Physiological validation
Yuan/2025 [28]	Paired subgroups (n = 2 per pair): HT/normo, elderly/young, athlete/sedentary	SAFU flexible pulse-echo array (2.4 MHz)	Radial (stiffness); multiple sites (BP)	β-stiffness index, local PWV	Arteriosclerosis detector (VBP-9)	HT β = 13.1 vs normo β = 9.9; PWV relative error < 25%	Flexible self-adhesive array	Early clinical feasibility
Li/2026 [37]	In vitro phantom only	Stretchable PW Doppler patch (5.05 MHz, 6 transducers, ~30% stretch)	Flow phantom	Flow velocity	Reference pump velocity	MAE 3.56 cm/s, MAPE 5.99% (20-100 cm/s)	Stretchable patch	Technical proof-of-concept

Table 3

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