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Xiong L, Zhang Y, He B, Zhang K, Zhu J, Lang X. Optimum Parameters in Ultrasound Coherent Plane Wave Compounding for High LPWV Estimation: Validation on Phantom and Feasibility in 10 Subjects. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38700113 DOI: 10.1002/jum.16469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/12/2024] [Accepted: 04/13/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES The aim of this study is to determine the optimum and fine values of the number and transmission angles of tilted plane waves for coherent plane-wave compounding (CPWC)-based high local pulse wave velocity (LPWV) estimation. METHODS A Verasonics system incorporating a linear array probe L14-5/38 with 128 elements and a pulsatile pump, CompuFlow1000, were used to acquire radio frequency data of 3, 5, 7, and 9 tilted plane wave sequences with angle intervals from 0° to 12° with a coarse interval increment step of 1°, and the angle intervals from 0° to 2° with a fine interval increment step of 0.25° from a carotid vessel phantom with the LPWV of 13.42 ± 0.90 m/s. The mean value, standard deviation, and coefficients of variation (CV) of the estimated LPWVs were calculated to quantitatively assess the performance of different configurations for CPWC-based LPWV estimation. Ten healthy human subjects of two age groups were recruited to assess the in vivo feasibility of the optimum parameter values. RESULTS The CPWC technique with three plane waves (PRF of 12 kHz corresponding to a frame rate of 4000 Hz) with an interval of 0.75° had LPWVs of 13.52 ± 0.08 m/s with the lowest CV of 1.84% on the phantom, and 5.49 ± 1.46 m/s with the lowest CV of 12.35% on 10 subjects. CONCLUSIONS The optimum parameters determined in this study show the best repeatability of the LPWV measurements with a vessel phantom and 10 healthy subjects, which support further studies on larger datasets for potential applications.
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Affiliation(s)
- Li Xiong
- Department of Electronic Engineering, Information School, Yunnan University, Kunming, China
| | - Yufeng Zhang
- Department of Electronic Engineering, Information School, Yunnan University, Kunming, China
| | - Bingbing He
- Department of Electronic Engineering, Information School, Yunnan University, Kunming, China
| | - Kexin Zhang
- The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jingying Zhu
- Department of Electronic Engineering, Information School, Yunnan University, Kunming, China
| | - Xun Lang
- Department of Electronic Engineering, Information School, Yunnan University, Kunming, China
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Mohammadpoor Faskhodi M, A. Garcia-Gonzalez M, Fernandez-Chimeno M, Guede-Fernández F, Mateu-Mateus M, Capdevila L, J. Ramos-Castro J. On the use of fractional calculus to improve the pulse arrival time (PAT) detection when using photoplethysmography (PPG) and electrocardiography (ECG) signals. PLoS One 2024; 19:e0298354. [PMID: 38363753 PMCID: PMC10871495 DOI: 10.1371/journal.pone.0298354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/23/2024] [Indexed: 02/18/2024] Open
Abstract
The pulse arrival time (PAT) has been considered a surrogate measure for pulse wave velocity (PWV), although some studies have noted that this parameter is not accurate enough. Moreover, the inter-beat interval (IBI) time series obtained from successive pulse wave arrivals can be employed as a surrogate measure of the RR time series avoiding the use of electrocardiogram (ECG) signals. Pulse arrival detection is a procedure needed for both PAT and IBI measurements and depends on the proper fiducial points chosen. In this paper, a new set of fiducial points that can be tailored using several optimization criteria is proposed to improve the detection of successive pulse arrivals. This set is based on the location of local maxima and minima in the systolic rise of the pulse wave after fractional differintegration of the signal. Several optimization criteria have been proposed and applied to high-quality recordings of a database with subjects who were breathing at different rates while sitting or standing. When a proper fractional differintegration order is selected by using the RR time series as a reference, the agreement between the obtained IBI and RR is better than that for other state-of-the-art fiducial points. This work tested seven different traditional fiducial points. For the agreement analysis, the median standard deviation of the difference between the IBI and RR time series is 5.72 ms for the proposed fiducial point versus 6.20 ms for the best-performing traditional fiducial point, although it can reach as high as 9.93 ms for another traditional fiducial point. Other optimization criteria aim to reduce the standard deviation of the PAT (7.21 ms using the proposed fiducial point versus 8.22 ms to 15.4 ms for the best- and worst-performing traditional fiducial points) or to minimize the standard deviation of the PAT attributable to breathing (3.44 ms using the proposed fiducial point versus 4.40 ms to 5.12 ms for best- and worst-performing traditional fiducial points). The use of these fiducial points may help to better quantify the beat-to-beat PAT variability and IBI time series.
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Affiliation(s)
| | | | | | - Federico Guede-Fernández
- Department of Electronic Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
- Value for Health CoLAB, Lisbon, Portugal
| | - Marc Mateu-Mateus
- Department of Electronic Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Lluis Capdevila
- Laboratory of Sport Psychology, Department of Basic Psychology, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
- Sport Research Institute, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Juan J. Ramos-Castro
- Department of Electronic Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
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Freithaler M, Chandrasekhar A, Dhamotharan V, Landry C, Shroff SG, Mukkamala R. Smartphone-Based Blood Pressure Monitoring via the Oscillometric Finger Pressing Method: Analysis of Oscillation Width Variations Can Improve Diastolic Pressure Computation. IEEE Trans Biomed Eng 2023; 70:3052-3063. [PMID: 37195838 PMCID: PMC10640822 DOI: 10.1109/tbme.2023.3275031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Oscillometric finger pressing is a potential method for absolute blood pressure (BP) monitoring via a smartphone. The user presses their fingertip against a photoplethysmography-force sensor unit on a smartphone to steadily increase the external pressure on the underlying artery. Meanwhile, the phone guides the finger pressing and computes systolic BP (SP) and diastolic BP (DP) from the measured blood volume oscillations and finger pressure. The objective was to develop and evaluate reliable finger oscillometric BP computation algorithms. METHODS The collapsibility of thin finger arteries was exploited in an oscillometric model to develop simple algorithms for computing BP from the finger pressing measurements. These algorithms extract features from "width" oscillograms (oscillation width versus finger pressure functions) and the conventional "height" oscillogram for markers of DP and SP. Finger pressing measurements were obtained using a custom system along with reference arm cuff BP measurements from 22 subjects. Measurements were also obtained during BP interventions in some subjects for 34 total measurements. RESULTS An algorithm employing the average of width and height oscillogram features predicted DP with correlation of 0.86 and precision error of 8.6 mmHg with respect to the reference measurements. Analysis of arm oscillometric cuff pressure waveforms from an existing patient database provided evidence that the width oscillogram features are better suited to finger oscillometry. CONCLUSION Analysis of oscillation width variations during finger pressing can improve DP computation. SIGNIFICANCE The study findings may help in converting widely available devices into truly cuffless BP monitors for improving hypertension awareness and control.
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Baynard T, Griffith GJ, Wee SO, McMillan NJ, Bollaert RE, Motl RW, Fernhall B. Home-based exercise improves subclinical atherosclerosis marker in multiple sclerosis. Mult Scler Relat Disord 2023; 79:105002. [PMID: 37716212 DOI: 10.1016/j.msard.2023.105002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/12/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Using a 12-week, randomized controlled trial coupled with social cognitive theory behavioral coaching, we aimed to assess the effect of a home-based aerobic training intervention versus an attention-control on aerobic fitness, subclinical atherosclerosis, and mobility in persons with MS. METHODS Persons with MS with an expanded disability status scale score between 0 and 4 were randomized to a 12-week aerobic exercise (EX) (n = 26; 19 females; 49 yrs; 28.8 kg/m2) or attention-control (CON) condition (stretching; n = 22; 16 females; 44 yrs; 29.2 kg/m2). Aerobic capacity was assessed via a graded cycle ergometry test with indirect calorimetry. The co-primary measures of subclinical atherosclerosis assessed included carotid intima media thickness, a test of vasodilatory reactivity, and arterial stiffness. Mobility was assessed via a timed 25-foot walk test (T25FW) and a 6 min walk test. The EX group engaged in cycle ergometry 3d/wk with gradual increases in the intensity and duration of the exercise sessions. CON participated in standardized stretching designed to provide the same contact time as EX 3d/wk. Behavioral coaching took place via weekly phone/video chats to track adherence. RESULTS Aerobic capacity, vasodilatory reactivity, and T25FW speed increased only in the EX group, 7%, 16%, and 13% (p<0.05), respectively; whereas the CON group did not change. CONCLUSION The EX group had modest, yet significant, increases in aerobic capacity over the 12-week period, coupled with improvements in T25FW speed and vasodilatory reactivity. A home-based exercise intervention can improve outcomes of a subclinical marker of atherosclerosis, which provides a basis for examining these outcomes in persons prescreened for CVD-related comorbidities and/or mobility issues.
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Affiliation(s)
- Tracy Baynard
- Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL 60612; Currently affiliated with the Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125.
| | - Garett J Griffith
- Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL 60612; Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, 60611
| | - Sang Ouk Wee
- Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL 60612; Department of Kinesiology, California State University, San Bernardino, CA 92407
| | - Neil J McMillan
- Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL 60612; Department of Nutrition & Exercise Physiology, University of Missouri, Columbia, MO 65211
| | - Rachel E Bollaert
- Department of Physical Therapy, Marquette University, Milwaukee, WI 53201
| | - Robert W Motl
- Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL 60612
| | - Bo Fernhall
- Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL 60612
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Wieben O, Roberts GS, Corrado PA, Johnson KM, Roldán-Alzate A. Four-Dimensional Flow MR Imaging: Technique and Advances. Magn Reson Imaging Clin N Am 2023; 31:433-449. [PMID: 37414470 DOI: 10.1016/j.mric.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
4D Flow MRI is an advanced imaging technique for comprehensive non-invasive assessment of the cardiovascular system. The capture of the blood velocity vector field throughout the cardiac cycle enables measures of flow, pulse wave velocity, kinetic energy, wall shear stress, and more. Advances in hardware, MRI data acquisition and reconstruction methodology allow for clinically feasible scan times. The availability of 4D Flow analysis packages allows for more widespread use in research and the clinic and will facilitate much needed multi-center, multi-vendor studies in order to establish consistency across scanner platforms and to enable larger scale studies to demonstrate clinical value.
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Affiliation(s)
- Oliver Wieben
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Suite 1127, Madison, WI 53705-2275, USA; Department of Radiology, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Suite 1127, Madison, WI 53705-2275, USA.
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Madison, WI 53705-2275, USA
| | - Philip A Corrado
- Accuray Incorporated, 1414 Raleigh Road, Suite 330, DurhamChapel Hill, NC 27517, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Room 1133, Madison, WI 53705-2275, USA; Department of Radiology, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Room 1133, Madison, WI 53705-2275, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin-Madison, Room: 3035, 1513 University Avenue, Madison, WI 53706, USA; Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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Vainer BG. Radial artery pulse wave velocity: a new characterization technique and the instabilities associated with the respiratory phase and breath-holding. Physiol Meas 2023; 44. [PMID: 36657177 DOI: 10.1088/1361-6579/acb4dd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023]
Abstract
Objective. Pulse wave velocity (PWV) is a key diagnostic parameter of the cardiovascular system's state. However, approaches aimed at PWV characterization often suffer from inevitable drawbacks. Statistical results demonstrating how closely PWV in the radial artery (RA) and the respiration phase correlate, as well as RA PWV evolution during breath-holding (BH), have not yet been presented in the literature. The aims of this study are (a) to propose a simple robust technique for measuring RA PWV, (b) to reveal the phase relation between the RA PWV and spontaneous breathing, and (c) to disclose the influence of BH on the RA PWV.Approach.The high-resolution remote breathing monitoring method Sorption-Enhanced Infrared Thermography (SEIRT) and the new technique aimed at measuring RA PWV described in this paper were used synchronously, and their measurement data were processed simultaneously.Main results. Spontaneous breathing leaves a synchronous 'trace' on the RA PWV. The close linear correlation of the respiration phase and the phase of concomitant RA PWV changes is statistically confirmed in five tested people (Pearson's r is of the order of 0.5-0.8, P < 0.05). The BH appreciably affects the RA PWV. A phenomenon showing that the RA PWV is not indifferent to hypoxia is observed for the first time.Significance.The proposed technique for RA PWV characterization has high prospects in biomedical diagnostics. The presented pilot study deserves attention in the context of the mutual interplay between respiratory and cardiovascular systems. It may also be useful in cases where peripheral pulse wave propagation helps assess respiratory function.
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Affiliation(s)
- Boris G Vainer
- Novosibirsk State University, Novosibirsk, Russia.,Rzhanov Institute of Semiconductor Physics SB RAS, Novosibirsk, Russia
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Yavarimanesh M, Cheng HM, Chen CH, Sung SH, Mahajan A, Chaer RA, Shroff SG, Hahn JO, Mukkamala R. Abdominal aortic aneurysm monitoring via arterial waveform analysis: towards a convenient point-of-care device. NPJ Digit Med 2022; 5:168. [PMID: 36329099 PMCID: PMC9633589 DOI: 10.1038/s41746-022-00717-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Abdominal aortic aneurysms (AAAs) are lethal but treatable yet substantially under-diagnosed and under-monitored. Hence, new AAA monitoring devices that are convenient in use and cost are needed. Our hypothesis is that analysis of arterial waveforms, which could be obtained with such a device, can provide information about AAA size. We aim to initially test this hypothesis via tonometric waveforms. We study noninvasive carotid and femoral blood pressure (BP) waveforms and reference image-based maximal aortic diameter measurements from 50 AAA patients as well as the two noninvasive BP waveforms from these patients after endovascular repair (EVAR) and from 50 comparable control patients. We develop linear regression models for predicting the maximal aortic diameter from waveform or non-waveform features. We evaluate the models in out-of-training data in terms of predicting the maximal aortic diameter value and changes induced by EVAR. The best model includes the carotid area ratio (diastolic area divided by systolic area) and normalized carotid-femoral pulse transit time ((age·diastolic BP)/(height/PTT)) as input features with positive model coefficients. This model is explainable based on the early, negative wave reflection in AAA and the Moens-Korteweg equation for relating PTT to vessel diameter. The predicted maximal aortic diameters yield receiver operating characteristic area under the curves of 0.83 ± 0.04 in classifying AAA versus control patients and 0.72 ± 0.04 in classifying AAA patients before versus after EVAR. These results are significantly better than a baseline model excluding waveform features as input. Our findings could potentially translate to convenient devices that serve as an adjunct to imaging.
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Affiliation(s)
| | - Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Hsien Sung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rabih A Chaer
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sanjeev G Shroff
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Ramakrishna Mukkamala
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Anderson CP, Park SY. Assessing pulse transit time to the skeletal muscle microcirculation using near-infrared spectroscopy. J Appl Physiol (1985) 2022; 133:593-605. [PMID: 35834626 PMCID: PMC9448340 DOI: 10.1152/japplphysiol.00173.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/06/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022] Open
Abstract
Pulse transit time (PTT) is the time it takes for pressure waves to propagate through the arterial system. Arterial stiffness assessed via PTT has been extensively examined in the conduit arteries; however, limited information is available about PTT to the skeletal muscle microcirculation. Therefore, the purpose of this study was to assess PTT to the skeletal muscle microcirculation (PTTm) with near-infrared spectroscopy (NIRS) and to determine whether PTTm provides unique information about vascular function that PTT assessed in the conduit arteries (PTTc) cannot provide. This pilot study was conducted with 10 (male = 5; female = 5) individuals of similar age (21.5 ± 1.2 yr). The feasibility of using the intersecting tangents method to derive PTTm with NIRS was assessed during reactive hyperemia with the cross-correlation of PTTm produced by the intersecting tangents method and a different algorithm that used signal spectral properties. To determine whether PTTm was distinct from PTTc, the cross-correlation of PTTm and PTTc during reactive hyperemia was assessed. Cross-correlation indicated agreement between PTTm derived from both algorithms (r2 = 0.77, P < 0.01) and a lack of agreement between PTTm and PTTc during reactive hyperemia (r2 = 0.07, P < 0.01). Therefore, we conclude that it is feasible to assess PTTm using NIRS, and PTTm provides unique information about vascular function, including skeletal muscle microvascular elasticity, which cannot be achieved with traditional PTTc. PTTm with NIRS may provide a comprehensive and noninvasive assessment of vascular function and health.NEW & NOTEWORTHY Pulse transit time to the skeletal muscle microcirculation can be assessed using near-infrared spectroscopy and the intersecting tangents method. Pulse transit analysis to the microcirculation provides a comprehensive assessment of the vascular response to postocclusive reactive hyperemia that pulse transit analysis in the conduit arteries cannot provide. Pulse transit time to the skeletal muscle microcirculation using near-infrared spectroscopy provides unique information about microvascular elasticity in the skeletal muscle. These findings indicate that the combination of near-infrared spectroscopy and pulse transit analysis may be a useful method for assessing the skeletal muscle microcirculation.
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Affiliation(s)
- Cody P Anderson
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska
| | - Song-Young Park
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska
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Bjerg L, Laugesen E, Andersen ST, Rosborg JF, Charles M, Vistisen D, Witte DR. Long-term effects of intensive multifactorial treatment on aortic stiffness and central hemodynamics after 13 years with screen-detected type 2 diabetes: the ADDITION-Denmark trial. Diabetol Metab Syndr 2022; 14:116. [PMID: 35978373 PMCID: PMC9382804 DOI: 10.1186/s13098-022-00890-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Peripheral and central hemodynamic indices are modifiable by lifestyle and medical intervention. We aimed to determine the long-term effect of intensive multifactorial treatment on peripheral and central hemodynamic indices among people with screen-detected diabetes. METHODS Between 2001 and 2006, people with screen-detected type 2 diabetes were included in the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) trial (NCT00237549, ClinicalTrials.gov). In the Danish arm, participants were invited to a clinical examination in 2015-2016, 13 years after inclusion and 8 years after trial-end. Out of 586 eligible participants who attended the clinical examination, 411 had a valid examination of central and peripheral hemodynamic indices (242 received intensive treatment and 169 received routine care). Carotid-femoral pulse wave velocity (cfPWV), central blood pressure and augmentation index were assessed by applanation tonometry. We used mixed-effect models to examine the intervention effect adjusting for cluster randomization and heart rate. RESULTS Randomization to intensive treatment during the trial-period was associated with a 0.58 m/s lower cfPWV (95% CI - 1.09 to - 0.06) at follow-up. Adjustment for blood pressure attenuated the association. Differences between intervention groups for central augmentation index were - 1.25% (95% CI: - 3.28 to 0.78), central pulse pressure - 1.74 mmHg (95% CI - 4.79 to 1.31), central systolic blood pressure - 3.06 mmHg (- 7.08 to 0.96), and central diastolic blood pressure - 1.70 mmHg (- 3.74 to 0.34). CONCLUSIONS Intensive multifactorial treatment of screen-detected type 2 diabetes has a sustained positive effect on aortic stiffness measured by cfPWV. Although all estimates pointed in favor of intensive treatment, we observed no clear beneficial effect on other hemodynamic indices.
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Affiliation(s)
- Lasse Bjerg
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, 8200 Aarhus N, Aarhus, Denmark.
- Department of Public Health, Aarhus University, Aarhus, Denmark.
- Viborg Regional Hospital, Viborg, Denmark.
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Signe Toft Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, 8200 Aarhus N, Aarhus, Denmark
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Internal Medicine, Gødstrup Regional Hospital, Herning, Denmark
| | - Jonas Frey Rosborg
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, 8200 Aarhus N, Aarhus, Denmark
| | - Morten Charles
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, 8200 Aarhus N, Aarhus, Denmark
- Research Unit of General Practice, Aarhus University, Aarhus, Denmark
| | - Dorte Vistisen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Daniel R Witte
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, 8200 Aarhus N, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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10
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Cho MJ, Choi HI, Kim HJ, Bunsawat K, Kunutsor SK, Jae SY. Comparison of the acute effects of ankle bathing versus moderate-intensity aerobic exercise on vascular function in young adults. Appl Physiol Nutr Metab 2022; 47:469-481. [PMID: 35380875 DOI: 10.1139/apnm-2021-0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We examined the efficacy of ankle bathing versus aerobic exercise to improve vascular function in young adults who were randomized to aerobic exercise (AE) (n = 13, 40%-60% of heart rate reserve), ankle bathing (AB) (n = 15, 43 °C), or a control condition (CON) (n = 14, ankle bathing, 36 °C) for 40 min. Conduit vessel function [brachial artery flow-mediated dilation (FMD)], carotid and femoral artery blood flow and shear rate (SR), and arterial stiffness [carotid-to-femoral pulse wave velocity (cf-PWV), augmentation index (AIx@75), β-stiffness index, and arterial compliance] were evaluated. Compared with CON, AE and AB increased FMD at 30 min and 90 min (interaction: p < 0.05); AB decreased carotid artery blood flow and SR at 30 min, while both AE and AB increased femoral artery blood flow and SR at 30 min and 90 min (interaction: p < 0.05); AE and AB decreased cf-PWV and AIx@75 at 30 min and 90 min (interaction: p < 0.05); and AE improved both carotid and femoral β-stiffness index and arterial compliance, while AB reduced β-stiffness index and increased arterial compliance only in the femoral artery (interaction: p < 0.05). These findings suggest that ankle bathing may serve as an alternative strategy for enhancing vascular function. Novelty: We observed similar improvements in conduit vessel function, femoral artery blood flow and shear rate, and arterial stiffness following ankle bathing and acute aerobic exercise in young adults. These findings have identified ankle bathing as a potential therapeutic strategy for enhancing vascular function, which may be particularly relevant for those with limited ability to engage in regular aerobic exercise.
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Affiliation(s)
- Min Jeong Cho
- Department of Sport Science, University of Seoul, Seoul, Republic of Korea
| | - Ho Il Choi
- Department of Sport Science, University of Seoul, Seoul, Republic of Korea
| | - Hyun Jeong Kim
- Department of Sport Science, University of Seoul, Seoul, Republic of Korea
| | - Kanokwan Bunsawat
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah, USA
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK
| | - Sae Young Jae
- Department of Sport Science, University of Seoul, Seoul, Republic of Korea.,Division of Urban Social Health, Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea
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Sugimoto H, Hamaoka T, Murai H, Hirai T, Mukai Y, Kusayama T, Takashima S, Kato T, Takata S, Usui S, Sakata K, Kawashiri M, Takamura M. Relationships between muscle sympathetic nerve activity and novel indices of arterial stiffness using single oscillometric cuff in patients with hypertension. Physiol Rep 2022; 10:e15270. [PMID: 35587702 PMCID: PMC9118049 DOI: 10.14814/phy2.15270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 06/15/2023] Open
Abstract
The arterial velocity pulse index (AVI) and arterial pressure-volume index (API) have been proposed as new arterial stiffness indices that can be measured using an oscillometric cuff. Sympathetic nerve activity (SNA) contributes to arterial stiffness via increasing vascular smooth muscle tone. However, the associations between SNA and the AVI or API are not understood. The purpose of this study was to evaluate the relationships between muscle sympathetic nerve activity (MSNA) and the AVI or API in healthy individuals and patients with hypertension (HT). Forty healthy individuals (40.1 ± 15.2 years, 8 females) (healthy group) and 40 patients with HT (60.2 ± 13.6, 18 females) (HT group) were included in this study. The AVI, API, MSNA, beat-by-beat blood pressure, and heart rate were recorded simultaneously. The AVI and API were higher in the HT group than in the healthy group (AVI, 26.1 ± 7.6 vs. 16.5 ± 4.0, p < 0.001; API, 31.2 ± 8.6 vs. 25.5 ± 7.2, p = 0.002). MSNA in the HT group was also higher than in the healthy group (p < 0.001). MSNA was correlated with the AVI, but not with the API, in both the healthy group (R = 0.52, p = 0.001) and HT group (R = 0.57, p < 0.001). MSNA was independently correlated with the AVI in multivariate analysis (ß = 0.34, p = 0.001). In conclusion, AVI, obtained by a simple and less user-dependent method, was related to the MSNA in healthy individuals and patients with HT.
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Affiliation(s)
- Hiroyuki Sugimoto
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Takuto Hamaoka
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineHersheyPennsylvaniaUSA
| | - Hisayoshi Murai
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
- Kanazawa Municipal HospitalKanazawaJapan
| | - Tadayuki Hirai
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Yusuke Mukai
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Takashi Kusayama
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Shinichiro Takashima
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Takeshi Kato
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | | | - Soichiro Usui
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Kenji Sakata
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Masa‐Aki Kawashiri
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Masayuki Takamura
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
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12
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Abstract
Cuffless blood pressure (BP) measurement has become a popular field due to clinical need and technological opportunity. However, no method has been broadly accepted hitherto. The objective of this review is to accelerate progress in the development and application of cuffless BP measurement methods. We begin by describing the principles of conventional BP measurement, outstanding hypertension/hypotension problems that could be addressed with cuffless methods, and recent technological advances, including smartphone proliferation and wearable sensing, that are driving the field. We then present all major cuffless methods under investigation, including their current evidence. Our presentation includes calibrated methods (i.e., pulse transit time, pulse wave analysis, and facial video processing) and uncalibrated methods (i.e., cuffless oscillometry, ultrasound, and volume control). The calibrated methods can offer convenience advantages, whereas the uncalibrated methods do not require periodic cuff device usage or demographic inputs. We conclude by summarizing the field and highlighting potentially useful future research directions. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 24 is June 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ramakrishna Mukkamala
- Department of Bioengineering and Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;
| | - George S Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece; ,
| | - Alberto P Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia;
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13
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Xu L, Zhou S, Wang L, Yao Y, Hao L, Qi L, Yao Y, Han H, Mukkamala R, Greenwald SE. Improving the accuracy and robustness of carotid-femoral pulse wave velocity measurement using a simplified tube-load model. Sci Rep 2022; 12:5147. [PMID: 35338246 PMCID: PMC8956634 DOI: 10.1038/s41598-022-09256-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
Arterial stiffness, as measured by pulse wave velocity, for the early non-invasive screening of cardiovascular disease is becoming ever more widely used and is an independent prognostic indicator for a variety of pathologies including arteriosclerosis. Carotid-femoral pulse wave velocity (cfPWV) is regarded as the gold standard for aortic stiffness. Existing algorithms for cfPWV estimation have been shown to have good repeatability and accuracy, however, further assessment is needed, especially when signal quality is compromised. We propose a method for calculating cfPWV based on a simplified tube-load model, which allows for the propagation and reflection of the pulse wave. In-vivo cfPWV measurements from 57 subjects and numerical cfPWV data based on a one-dimensional model were used to assess the method and its performance was compared to three other existing approaches (waveform matching, intersecting tangent, and cross-correlation). The cfPWV calculated using the simplified tube-load model had better repeatability than the other methods (Intra-group Correlation Coefficient, ICC = 0.985). The model was also more accurate than other methods (deviation, 0.13 ms−1) and was more robust when dealing with noisy signals. We conclude that the determination of cfPWV based on the proposed model can accurately and robustly evaluate arterial stiffness.
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Affiliation(s)
- Lisheng Xu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China. .,Engineering Research Center of Medical Imaging and Intelligent Analysis, Ministry of Education, Shenyang, China. .,Neusoft Research of Intelligent Healthcare Technology, Co. Ltd., Shenyang, China.
| | - Shuran Zhou
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Lu Wang
- School of Computer Science and Engineering, Northeastern University, Shenyang, China
| | - Yang Yao
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Liling Hao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Lin Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Yudong Yao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Hongguang Han
- General Hospital of Northern Theater Command, Shenyang, China.
| | - Ramakrishna Mukkamala
- Department of Bioengineering, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Stephen E Greenwald
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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14
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Lubin M, Gerbelot R, Prada R, Porcherot J, Bonnet S. Evaluation of a dual-PPG system for pulse transit time monitoring. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1349-1352. [PMID: 34891534 DOI: 10.1109/embc46164.2021.9630814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This work presents a new dual-photoplethysmographic (PPG) system for pulse transit time (PTT) monitoring. An experiment has been set up in order to compare the PTT measurement between carotid and radial arteries from two systems: our physiological multimodal platform (PMP) and the Complior® tonometer. This work explores the comparison between such optical and mechanical modalities. The results show that the PPG device tends to overestimate the PTT (RMSE = 16 ms). Furthermore, both mechanical and optical signals have been superposed and demonstrated that pulse morphologies are quite similar.Clinical Relevance-Carotid-radial pulse wave velocity (PWV) is compared on a small cohort of subjects and significant differences are observed between optical and mechanical-based systems.
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15
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Liu W, Yao Y, Yang J, Song D, Zhang Y, Sun G, Xu L, Avolio A. Estimation of aortic pulse wave velocity based on waveform decomposition of central aortic pressure waveform. Physiol Meas 2021; 42. [PMID: 34479234 DOI: 10.1088/1361-6579/ac23a7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/03/2021] [Indexed: 12/21/2022]
Abstract
Objective.Aortic stiffness is associated with risk of cardiovascular events. Carotid-femoral pulse wave velocity (cfPWV) is the current noninvasive gold standard for assessing aortic stiffness. However, the cfPWV measurement is challenging, requiring simultaneous signals at the carotid and femoral sites.Approach.In this study, the aortic PWV is estimated using a single radial pressure waveform and compared with cfPWV. 111 subjects' aortic PWVs are estimated from the decomposition of the derived central aortic pressure waveform based on three types of reconstructed flow waveform: the peak of triangular flow waveform based on 30% ejection time (Q30%tri), the peak of triangular flow waveform based on inflection point (Qtri), and averaged flow waveform (Qavg). The central aortic pressure waveform is derived from a radial pressure waveform via a validated transfer function.Main results.TheQavgis used for estimating aortic PWV without the determination of the peak point of the triangular flow waveforms. The estimated aortic PWV shows good agreement with cfPWV. The mean difference ± SD is 0.29 ± 1.50 m s-1(r2 = 0.29,p< 0.001) for theQ30%tri; 0.27 ± 1.40 m s-1(r2 = 0.38,p < 0.001) for theQtri; 0.23 ± 1.39 m s-1(r2 = 0.40,p < 0.001) for theQavg. The correlation between estimated aortic PWV based onQ30%triand measured cfPWV is weak. The results ofQtriandQavgshow no obvious difference.Significance.The proposed method can be used as a less complex way than conventional measurement of cfPWV to further assess arterial stiffness and predict cardiovascular risks or events.
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Affiliation(s)
- Wenyan Liu
- College of Medicine and Biological and Information Engineering, Northeastern University, Shenyang 110167, People's Republic of China
| | - Yang Yao
- College of Medicine and Biological and Information Engineering, Northeastern University, Shenyang 110167, People's Republic of China
| | - Jinzhong Yang
- College of Medicine and Biological and Information Engineering, Northeastern University, Shenyang 110167, People's Republic of China
| | - Daiyuan Song
- College of Medicine and Biological and Information Engineering, Northeastern University, Shenyang 110167, People's Republic of China
| | - Yuelan Zhang
- Department of Cardiology, the First Hospital of China Medical University, Shenyang 110001, People's Republic of China
| | - Guozhe Sun
- Department of Cardiology, the First Hospital of China Medical University, Shenyang 110001, People's Republic of China
| | - Lisheng Xu
- College of Medicine and Biological and Information Engineering, Northeastern University, Shenyang 110167, People's Republic of China.,Neusoft Research of Intelligent Healthcare Technology, Co. Ltd Shenyang 110169, People's Republic of China
| | - Alberto Avolio
- Macquarie School of Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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16
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Liu B, Zhang Z, Di X, Wang X, Xie L, Xie W, Zhang J. The Assessment of Autonomic Nervous System Activity Based on Photoplethysmography in Healthy Young Men. Front Physiol 2021; 12:733264. [PMID: 34630151 PMCID: PMC8497893 DOI: 10.3389/fphys.2021.733264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/24/2021] [Indexed: 12/04/2022] Open
Abstract
Noninvasive assessment of autonomic nervous system (ANS) activity is of great importance, but the accuracy of the method used, which is primarily based on electrocardiogram-derived heart rate variability (HRV), has long been suspected. We investigated the feasibility of photoplethysmography (PPG) in ANS evaluation. Data of 32 healthy young men under four different ANS activation patterns were recorded: baseline, slow deep breathing (parasympathetic activation), cold pressor test (peripheral sympathetic activation), and mental arithmetic test (cardiac sympathetic activation). We extracted 110 PPG-based features to construct classification models for the four ANS activation patterns. Using interpretable models based on random forest, the main PPG features related to ANS activation were obtained. Results showed that pulse rate variability (PRV) exhibited similar changes to HRV across the different experiments. The four ANS patterns could be better classified using more PPG-based features compared with using HRV or PRV features, for which the classification accuracies were 0.80, 0.56, and 0.57, respectively. Sensitive features of parasympathetic activation included features of nonlinear (sample entropy), frequency, and time domains of PRV. Sensitive features of sympathetic activation were features of the amplitude and frequency domain of PRV of the PPG derivatives. Subsequently, these sensitive PPG-based features were used to fit the improved HRV parameters. The fitting results were acceptable (p < 0.01), which might provide a better method of evaluating ANS activity using PPG.
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Affiliation(s)
- Binbin Liu
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Zhe Zhang
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Xiaohui Di
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Xiaoni Wang
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Lin Xie
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Wenjun Xie
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Jianbao Zhang
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
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17
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Abstract
The aim of this study was to develop a robust algorithm to quantify pulse sharpness that can complement the limitations of radial augmentation index (rAIx) and explore the role of this quantitative sharpness index in reflecting vascular aging or arterial stiffness. The pulse sharpness index (PSI) was developed by combining the end point angle and virtual height, and 528 radial pulses were analyzed. The PSI could be uniformly applied to various waveform morphologies, even those with no or vague tidal waves, unlike the rAIx. Significant sex differences were identified in the rAIx and PSI (P < 0.01 for both), and significant age-dependent decreases in the PSI were observed (P < 0.01). In addition, the PSI and age were correlated (r = - 0.550) at least as strong as the rAIx and age (r = 0.532), and the PSI had a significant negative correlation with arterial stiffness (r = - 0.700). Furthermore, the multiple linear regression model for arterial stiffness using the PSI, age, sex and heart rate showed the excellent performance (cross-validated R2 = 0.701), and the PSI was found to have the greatest influence on arterial stiffness. This study confirmed that the PSI could be a quantitative index of vascular aging and has potential for use in inferring arterial stiffness with an advantage over the rAIx.
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Affiliation(s)
- Jang-Han Bae
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, Republic of Korea
| | - Young Ju Jeon
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, Republic of Korea.
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18
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Correlation of Pulse Wave Transit Time with Pulmonary Artery Pressure in a Porcine Model of Pulmonary Hypertension. Biomedicines 2021; 9:biomedicines9091212. [PMID: 34572397 PMCID: PMC8467418 DOI: 10.3390/biomedicines9091212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
For the non-invasive assessment of pulmonary artery pressure (PAP), surrogates like pulse wave transit time (PWTT) have been proposed. The aim of this study was to invasively validate for which kind of PAP (systolic, mean, or diastolic) PWTT is the best surrogate parameter. To assess both PWTT and PAP in six healthy pigs, two pulmonary artery Mikro-Tip™ catheters were inserted into the pulmonary vasculature at a fixed distance: one in the pulmonary artery trunk, and a second one in a distal segment of the pulmonary artery. PAP was raised using the thromboxane A2 analogue U46619 (TXA) and by hypoxic vasoconstriction. There was a negative linear correlation between PWTT and systolic PAP (r = 0.742), mean PAP (r = 0.712) and diastolic PAP (r = 0.609) under TXA. During hypoxic vasoconstriction, the correlation coefficients for systolic, mean, and diastolic PAP were consistently higher than for TXA-induced pulmonary hypertension (r = 0.809, 0.778 and 0.734, respectively). Estimation of sPAP, mPAP, and dPAP using PWTT is feasible, nevertheless slightly better correlation coefficients were detected for sPAP compared to dPAP. In this study we establish the physiological basis for future methods to obtain PAP by non-invasively measured PWTT.
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19
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Wan-Hua L, Zheng D, Li G, Zhou H, Chen F. Investigation on Pulse Wave Forward Peak Detection and Its Applications in Cardiovascular Health. IEEE Trans Biomed Eng 2021; 69:700-709. [PMID: 34375276 DOI: 10.1109/tbme.2021.3103552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The contours of the pulse wave vary greatly, which affect the accuracy of pulse wave peak detection and the reliability of subsequent peak-based cardiovascular health analyses. We proposed an algorithm to reliably detect the peak of forward pulse wave (forward peak) and proposed to use it for improving the accuracy in cardiovascular health analysis. METHODS A method based on Gaussian fitting was proposed to detect the forward peak. Then, the forward peak was utilized for instantaneous heart rate (HR), heart rate variability (HRV), and augmentation index (a cardiovascular risk marker reflecting arterial stiffness) estimations. The accuracy of HR/HRV obtained by forward peak was compared with that obtained by other photoplethymogram (PPG) characteristic points previously reported, using electrocardiogram-derived HR/HRV as gold standard. The correlation between augmentation index and age was calculated. The performance was verified using PPG-based pulse wave data with different contours while they were recorded at different locations from subjects with a wide range of age. RESULTS The proposed forward peak detection method had smaller estimation error when compared with the gold standard, than other PPG characteristic points in estimating HR/HRV. The augmentation index extracted from the proposed forward peak method was significantly correlated with age (p < 0.01). CONCLUSIONS The proposed algorithm can relatively reliably detect the forward peak and has a wide application prospect in cardiovascular health. SIGNIFICANCE Due to the convenience of PPG measurements, this proposed forward peak detection method has the potential to be widely used in the fields of wearable devices and telemedicine.
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20
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Ouyang V, Ma B, Pignatelli N, Sengupta S, Sengupta P, Mungulmare K, Fletcher RR. The use of multi-site photoplethysmography (PPG) as a screening tool for coronary arterial disease and atherosclerosis. Physiol Meas 2021; 42. [PMID: 32764197 DOI: 10.1088/1361-6579/abad48] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/07/2020] [Indexed: 11/11/2022]
Abstract
Objective. We present the design and validation of a non-invasive smart-phone based screening tool for atherosclerosis and coronary arterial disease (CAD), which is the leading cause of mortality worldwide.Approach. We designed a three-channel photoplethysmography (PPG) device that connects to a smart phone application for measuring pulse transit time (PTT) and pulse wave velocity (PWV) using PPG probes that are simultaneously clipped onto to the ear, index finger, and big toe, respectively. Validation was performed through a clinical study with 100 participants (age 20 to 77) at a research hospital in Nagpur, India. Study subjects were stratified by age and divided into three groups corresponding to the disease severity: CAD, hypertensive ('Pre-CAD'), and Healthy.Main results. PWV measurements derived from the Ear-Toe probe measurements yielded the best performance, with median PWV values increasing monotonically as a function of disease severity and age, as follows: 14.2 m s-1for the older-patient CAD group, 12.2 m s-1for the younger-patient CAD group, 11.6 m s-1for the older-patient Pre-CAD group, 10.2 m s-1for the younger-patient Pre-CAD group, 9.7 m s-1for the older healthy controls, and 8.4 m s-1for the younger healthy controls. Using just two simple features, the PTT and patient height, we demonstrate a machine learning prediction model for CAD with a median accuracy of 0.83 (AUC).Significance. This work demonstrates the ability to predict atherosclerosis and CAD using a single simple physiological measurement with a multi-site PPG tool that is electrically powered by a mobile phone and does not require any electrocardiogram reference. Furthermore, this method only requires a single anthropometric measurement, which is the patient's height.
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Affiliation(s)
- Victoria Ouyang
- Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Botong Ma
- Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Niccolo Pignatelli
- Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | | | | | | | - Richard Ribon Fletcher
- Massachusetts Institute of Technology, Cambridge, MA, United States of America.,University of Massachusetts Medical School, Worcester, MA, United States of America
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21
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Funck KL, Laugesen E, Høyem P, Stausbøl-Grøn B, Kim WY, Østergaard L, Grauballe D, Hansen TK, Buhl CS, Poulsen PL. Arterial stiffness and progression of cerebral white matter hyperintensities in patients with type 2 diabetes and matched controls: a 5-year cohort study. Diabetol Metab Syndr 2021; 13:71. [PMID: 34174943 PMCID: PMC8236189 DOI: 10.1186/s13098-021-00691-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Stroke is a serious complication in patients with type 2 diabetes (T2DM). Arterial stiffness may improve stroke prediction. We investigated the association between carotid-femoral pulse wave velocity [PWV] and the progression of cerebral white matter hyperintensities (WMH), a marker of stroke risk, in patients with T2DM and controls. METHODS In a 5-year cohort study, data from 45 patients and 59 non-diabetic controls were available for analysis. At baseline, participants had a mean (± SD) age of 59 ± 10 years and patients had a median (range) diabetes duration of 1.8 (0.8-3.2) years. PWV was obtained by tonometry and WMH volume by an automated segmentation algorithm based on cerebral T2-FLAIR and T1 MRI (corrected by intracranial volume, cWMH). High PWV was defined above 8.94 m/s (corresponding to the reference of high PWV above 10 m/s using the standardized path length method). RESULTS Patients with T2DM had a higher PWV than controls (8.8 ± 2.2 vs. 7.9 ± 1.4 m/s, p < 0.01). WMH progression were similar in the two groups (p = 0.5). One m/s increase in baseline PWV was associated with a 16% [95% CI 1-32%], p < 0.05) increase in cWMH volume at 5 years follow-up after adjustment for age, sex, diabetes, pulse pressure and smoking. High PWV was associated with cWMH progression in the combined cohort (p < 0.05). We found no interaction between diabetes and PWV on cWMH progression. CONCLUSIONS PWV is associated with cWMH progression in patients with type 2 diabetes and non-diabetic controls. Our results indicate that arterial stiffness may be involved early in the pathophysiology leading to cerebrovascular diseases.
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Affiliation(s)
- Kristian L Funck
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark.
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- The Danish Diabetes Academy, Odense, Denmark
| | - Pernille Høyem
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark
| | - Brian Stausbøl-Grøn
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Won Y Kim
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
- Neuroradiology Research Unit, Section of Neuroradiology, Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Dora Grauballe
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
- Neuroradiology Research Unit, Section of Neuroradiology, Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Troels K Hansen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Christian S Buhl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Per L Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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22
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Buraioli I, Lena D, Sanginario A, Leone D, Mingrone G, Milan A, Demarchi D. A New Noninvasive System for Clinical Pulse Wave Velocity Assessment: The Athos Device. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:133-142. [PMID: 33560991 DOI: 10.1109/tbcas.2021.3058010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This paper presents a low cost, noninvasive, clinical-grade Pulse Wave Velocity evaluation device. The proposed system relies on a simultaneous acquisition of femoral and carotid pulse waves to improve estimation accuracy and correctness. The sensors used are two high precision MEMS force sensors, encapsulated in two ergonomic probes, and connected to the main unit. Data are then wirelessly transmitted to a standard laptop, where a dedicated graphical user interface (GUI) runs for analysis and recording. Besides the interface, the Athos system provides a Matlab algorithm to process the signals quickly and achieve a reliable PWV assessment. To better compare the results at the end of each analysis, a detailed report is generated, including all the relevant examination information (subject data, mean PTT, and obtained PWV). A pre-clinical study was conducted to validate the system by realizing several Pulse Wave Velocity measurements on ten heterogeneous healthy subjects of different ages. The collected results were then compared with those measured by a well-established and largely more expensive clinical device (SphygmoCor).
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Kircher M, Elke G, Stender B, Hernandez Mesa M, Schuderer F, Dossel O, Fuld MK, Halaweish AF, Hoffman EA, Weiler N, Frerichs I. Regional Lung Perfusion Analysis in Experimental ARDS by Electrical Impedance and Computed Tomography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:251-261. [PMID: 32956046 DOI: 10.1109/tmi.2020.3025080] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Electrical impedance tomography is clinically used to trace ventilation related changes in electrical conductivity of lung tissue. Estimating regional pulmonary perfusion using electrical impedance tomography is still a matter of research. To support clinical decision making, reliable bedside information of pulmonary perfusion is needed. We introduce a method to robustly detect pulmonary perfusion based on indicator-enhanced electrical impedance tomography and validate it by dynamic multidetector computed tomography in two experimental models of acute respiratory distress syndrome. The acute injury was induced in a sublobar segment of the right lung by saline lavage or endotoxin instillation in eight anesthetized mechanically ventilated pigs. For electrical impedance tomography measurements, a conductive bolus (10% saline solution) was injected into the right ventricle during breath hold. Electrical impedance tomography perfusion images were reconstructed by linear and normalized Gauss-Newton reconstruction on a finite element mesh with subsequent element-wise signal and feature analysis. An iodinated contrast agent was used to compute pulmonary blood flow via dynamic multidetector computed tomography. Spatial perfusion was estimated based on first-pass indicator dilution for both electrical impedance and multidetector computed tomography and compared by Pearson correlation and Bland-Altman analysis. Strong correlation was found in dorsoventral (r = 0.92) and in right-to-left directions (r = 0.85) with good limits of agreement of 8.74% in eight lung segments. With a robust electrical impedance tomography perfusion estimation method, we found strong agreement between multidetector computed and electrical impedance tomography perfusion in healthy and regionally injured lungs and demonstrated feasibility of electrical impedance tomography perfusion imaging.
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Spronck B, Tan I, Reesink KD, Georgevsky D, Delhaas T, Avolio AP, Butlin M. Heart rate and blood pressure dependence of aortic distensibility in rats: comparison of measured and calculated pulse wave velocity. J Hypertens 2021; 39:117-126. [PMID: 32784350 PMCID: PMC7752216 DOI: 10.1097/hjh.0000000000002608] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 06/12/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES When assessing arterial stiffness, heart rate (HR) and blood pressure (BP) are potential confounders. It appears that the HR/BP dependences of pulse wave velocity (PWV) and distensibility are different, even though both assess arterial stiffness. This study aims to compare aortic PWV as measured using pulse transit time (PWVTT) and as calculated from distensibility (PWVdist) at the same measurement site and propose a solution to the disparity in dependences of PWVTT and PWVdist. METHODS Adult anaesthetized rats (n = 24) were randomly paced at HRs 300-500 bpm, at 50 bpm steps. At each step, aortic PWVTT (two pressure-tip catheters) and PWVdist (pressure-tip catheter and ultrasound wall-tracking; abdominal aorta) were measured simultaneously while BP was varied pharmacologically. RESULTS HR dependence of PWVdist paradoxically decreased at higher levels of BP. In addition, BP dependence of PWVdist was much larger than that of PWVTT. These discrepancies are explained in that standard PWVdist uses an approximate derivative of pressure to diameter, which overestimates PWV with increasing pulse pressure (PP). In vivo, PP decreases as HR increases, potentially causing a PWVdist decrease with HR. Estimating the full pressure-diameter curve for each HR corrected for this effect by enabling calculation of the true derivative at diastolic BP. This correction yielded a PWVdist that shows HR and BP dependences similar to those of PWVTT. As expected, BP dependence of all PWV metrics was much larger than HR dependence. CONCLUSION Measured and calculated PWV have different dependences on HR and BP. These differences are, at least in part, because of approximations made in using systolic and diastolic values to calculate distensibility.
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Affiliation(s)
- Bart Spronck
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Biomedical Engineering, School of Engineering & Applied Science, Yale University, New Haven, Connecticut, USA
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Koen D. Reesink
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Dana Georgevsky
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Alberto P. Avolio
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Wiegerinck AIP, Thomsen A, Hisdal J, Kalvøy H, Tronstad C. Electrical Impedance Plethysmography Versus Tonometry To Measure the Pulse Wave Velocity in Peripheral Arteries in Young Healthy Volunteers: a Pilot Study. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2021; 12:169-177. [PMID: 35111272 PMCID: PMC8776312 DOI: 10.2478/joeb-2021-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Indexed: 06/14/2023]
Abstract
The leading cause of health loss and deaths worldwide are cardiovascular diseases. A predictor of cardiovascular diseases and events is the arterial stiffness. The pulse wave velocity (PWV) can be used to estimate arterial stiffness non-invasively. The tonometer is considered as the gold standard for measuring PWV. This approach requires manual probe fixation above the artery and depends on the skills of the operator. Electrical impedance plethysmography (IPG) is an interesting alternative using skin surface sensing electrodes, that is miniaturizable, cost-effective and allows measurement of deeper arteries. The aim of this pilot study was to explore if IPG can be a suitable technique to measure pulse wave velocity in legs as an alternative for the tonometer technique. The PWV was estimated by differences in the ECG-gated pulse arrival times (PAT) at the a. femoralis, a. popliteal, a. tibialis dorsalis and a. dorsalis pedis in nine healthy young adults using IPG and the SphygmoCor tonometer as a reference. The estimated PWV results from bioimpedance and the tonometer were fairly in agreement, and the beat-to-beat variability in PAT was similar. This pilot study indicates that the use of IPG may be a good alternative for estimating PWV in the legs.
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Affiliation(s)
- A. I. P. Wiegerinck
- Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - A. Thomsen
- Department of Physics, University of Oslo, Oslo, Norway
| | - J. Hisdal
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - H. Kalvøy
- Department of Clinical & Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - C. Tronstad
- Department of Clinical & Biomedical Engineering, Oslo University Hospital, Oslo, Norway
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Li YH, Harfiya LN, Purwandari K, Lin YD. Real-Time Cuffless Continuous Blood Pressure Estimation Using Deep Learning Model. SENSORS 2020; 20:s20195606. [PMID: 33007891 PMCID: PMC7584036 DOI: 10.3390/s20195606] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
Blood pressure monitoring is one avenue to monitor people’s health conditions. Early detection of abnormal blood pressure can help patients to get early treatment and reduce mortality associated with cardiovascular diseases. Therefore, it is very valuable to have a mechanism to perform real-time monitoring for blood pressure changes in patients. In this paper, we propose deep learning regression models using an electrocardiogram (ECG) and photoplethysmogram (PPG) for the real-time estimation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) values. We use a bidirectional layer of long short-term memory (LSTM) as the first layer and add a residual connection inside each of the following layers of the LSTMs. We also perform experiments to compare the performance between the traditional machine learning methods, another existing deep learning model, and the proposed deep learning models using the dataset of Physionet’s multiparameter intelligent monitoring in intensive care II (MIMIC II) as the source of ECG and PPG signals as well as the arterial blood pressure (ABP) signal. The results show that the proposed model outperforms the existing methods and is able to achieve accurate estimation which is promising in order to be applied in clinical practice effectively.
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Affiliation(s)
- Yung-Hui Li
- Department of Computer Science and Information Engineering, National Central University, Taoyuan 32001, Taiwan; (Y.-H.L.); (L.N.H.); (K.P.)
| | - Latifa Nabila Harfiya
- Department of Computer Science and Information Engineering, National Central University, Taoyuan 32001, Taiwan; (Y.-H.L.); (L.N.H.); (K.P.)
| | - Kartika Purwandari
- Department of Computer Science and Information Engineering, National Central University, Taoyuan 32001, Taiwan; (Y.-H.L.); (L.N.H.); (K.P.)
| | - Yue-Der Lin
- Department of Automatic Control Engineering, Feng Chia University, Taichung 40724, Taiwan
- Correspondence:
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Li Y, Marais L, Khettab H, Quan Z, Aasmul S, Leinders R, Schüler R, Morrissey PE, Greenwald S, Segers P, Vanslembrouck M, Bruno RM, Boutouyrie P, O’Brien P, de Melis M, Baets R. Silicon photonics-based laser Doppler vibrometer array for carotid-femoral pulse wave velocity (PWV) measurement. BIOMEDICAL OPTICS EXPRESS 2020; 11:3913-3926. [PMID: 33014575 PMCID: PMC7510919 DOI: 10.1364/boe.394921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 06/01/2023]
Abstract
Pulse wave velocity (PWV) is a reference measure for aortic stiffness, itself an important biomarker of cardiovascular risk. To enable low-cost and easy-to-use PWV measurement devices that can be used in routine clinical practice, we have designed several handheld PWV sensors using miniaturized laser Doppler vibrometer (LDV) arrays in a silicon photonics platform. The LDV-based PWV sensor design and the signal processing protocol to obtain pulse transit time (PTT) and carotid-femoral PWV in a feasibility study in humans, are described in this paper. Compared with a commercial reference PWV measurement system, measuring arterial pressure waveforms by applanation tonometry, LDV-based displacement signals resulted in more complex signals. However, we have shown that it is possible to identify reliable fiducial points for PTT calculation using the maximum of the 2nd derivative algorithm in LDV-based signals, comparable to those obtained by the reference technique, applanation tonometry.
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Affiliation(s)
- Yanlu Li
- Photonics Research Group, Ghent University-imec, Technologiepark-Zwijnaarde 126, 9052, Ghent, Belgium
- Center for Nano- and Biophotonics, Ghent University, Technologiepark-Zwijnaarde 126, 9052, Ghent, Belgium
| | - Louise Marais
- INSERM U970, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Hakim Khettab
- INSERM U970, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Zhiheng Quan
- Photonic Packaging Group, Tyndall National Institute, Lee Maltings Complex Dyke Parade, T12R5CP, Cork, Ireland
| | - Soren Aasmul
- Medtronic Bakken Research Center, Endepolsdomein 5, 6229 GW, Maastricht, The Netherlands
| | - Rob Leinders
- Medtronic Bakken Research Center, Endepolsdomein 5, 6229 GW, Maastricht, The Netherlands
| | - Ralf Schüler
- SIOS Messtechnik GmbH, Am Vogelherd 46, 98693, Ilmenau, Germany
| | - Padraic E. Morrissey
- Photonic Packaging Group, Tyndall National Institute, Lee Maltings Complex Dyke Parade, T12R5CP, Cork, Ireland
| | - Stephen Greenwald
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, E1 2AT, London, UK
| | - Patrick Segers
- IBiTech-bioMMeda, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Michael Vanslembrouck
- Photonics Research Group, Ghent University-imec, Technologiepark-Zwijnaarde 126, 9052, Ghent, Belgium
- Center for Nano- and Biophotonics, Ghent University, Technologiepark-Zwijnaarde 126, 9052, Ghent, Belgium
| | - Rosa M. Bruno
- INSERM U970, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre Boutouyrie
- INSERM U970, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Peter O’Brien
- Photonic Packaging Group, Tyndall National Institute, Lee Maltings Complex Dyke Parade, T12R5CP, Cork, Ireland
| | - Mirko de Melis
- Medtronic Bakken Research Center, Endepolsdomein 5, 6229 GW, Maastricht, The Netherlands
| | - Roel Baets
- Photonics Research Group, Ghent University-imec, Technologiepark-Zwijnaarde 126, 9052, Ghent, Belgium
- Center for Nano- and Biophotonics, Ghent University, Technologiepark-Zwijnaarde 126, 9052, Ghent, Belgium
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Cividjian A, Harbaoui B, Chambonnet C, Bonnet J, Paquet C, Courand P, Lantelme P. Comprehensive assessment of coronary pulse wave velocity in anesthetized pigs. Physiol Rep 2020; 8:e14424. [PMID: 32400103 PMCID: PMC7218253 DOI: 10.14814/phy2.14424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Coronary stiffness represents a new paradigm for interventional cardiology and can be assessed by coronary pulse wave velocity (CoPWV). Assessing CoPWV is complex because of the coexistence of backward and forward waves. OBJECTIVES Evaluate the feasibility, repeatability, and capacity of methods assessing CoPWV to detect predictable velocity changes. METHODS CoPWV was measured from distal and proximal pressure guidewires in the left anterior descending artery of 10 pigs under general anesthesia. Four methods were studied: the tangent intersection method applied to the forward (FW) and backward (BK) waves, as well as the dicrotic notch (DIC) and template matching (TM) methods. All were evaluated at baseline, during various arterial pressure and heart rate conditions, during simulated flow limitation (balloon inflation), and after increasing coronary stiffness (stent insertion). RESULTS All the methods were significantly different between them (p ≤ .05) showing a systematic trend toward higher CoPWV when compared to the FW method (.05 < p<.10). Results were found to be significantly correlated only between the BK and FW methods and between the DIC and TM methods (p ≤ .05). CoPWV increased with arterial pressure increase, this increase being significant for the DIC and TM methods and partly for the FW method (p ≤ .05). Conversely, heart rate had no systematic impact on CoPWV. The lowest variability was found for the DIC and TM methods (p ≤ .05). Only the BK and TM methods remained applicable during flow limitation; stent increased CoPWV when measured by the BK method only (p ≤ .05). CONCLUSION Although CoPWV can be measured by various methods, the BK and TM methods seem the most appropriate for clinical studies.
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Affiliation(s)
- Andrei Cividjian
- Hospices Civils de LyonFédération de Cardiologie Croix‐Rousse ‐ Lyon‐SudLyonFrance
- Univ LyonINSA‐LyonUniversité Claude Bernard Lyon 1UJM‐Saint EtienneCNRSInsermCREATIS UMR 5220, U1206LyonFrance
- Alpha‐2 LtdLyonFrance
- i‐COR TechnologiesLyonFrance
| | - Brahim Harbaoui
- Hospices Civils de LyonFédération de Cardiologie Croix‐Rousse ‐ Lyon‐SudLyonFrance
- Univ LyonINSA‐LyonUniversité Claude Bernard Lyon 1UJM‐Saint EtienneCNRSInsermCREATIS UMR 5220, U1206LyonFrance
| | - Carole Chambonnet
- Hospices Civils de LyonFédération de Cardiologie Croix‐Rousse ‐ Lyon‐SudLyonFrance
| | | | | | - Pierre‐Yves Courand
- Hospices Civils de LyonFédération de Cardiologie Croix‐Rousse ‐ Lyon‐SudLyonFrance
- Univ LyonINSA‐LyonUniversité Claude Bernard Lyon 1UJM‐Saint EtienneCNRSInsermCREATIS UMR 5220, U1206LyonFrance
| | - Pierre Lantelme
- Hospices Civils de LyonFédération de Cardiologie Croix‐Rousse ‐ Lyon‐SudLyonFrance
- Univ LyonINSA‐LyonUniversité Claude Bernard Lyon 1UJM‐Saint EtienneCNRSInsermCREATIS UMR 5220, U1206LyonFrance
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Balestrini CS, Al-Khazraji BK, Suskin N, Shoemaker JK. Does vascular stiffness predict white matter hyperintensity burden in ischemic heart disease with preserved ejection fraction? Am J Physiol Heart Circ Physiol 2020; 318:H1401-H1409. [PMID: 32357114 DOI: 10.1152/ajpheart.00057.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The survival rate of patients with ischemic heart disease (IHD) is increasing. However, survivors experience increased risk for neurological complications. The mechanisms for this increased risk are unknown. We tested the hypothesis that patients with IHD have greater carotid and cerebrovascular stiffness, and these indexes predict white matter small vessel disease. Fifty participants (age, 40-78 yr), 30 with IHD with preserved ejection fraction and 20 healthy age-matched controls, were studied using ultrasound imaging of the common carotid artery (CCA) and middle cerebral artery (MCA), as well as magnetic resonance imaging (T1, T2-FLAIR), to measure white matter lesion volume (WMLv). Carotid β-stiffness provided the primary measure of peripheral vascular stiffness. Carotid-cerebral pulse wave transit time (ccPWTT) provided a marker of cerebrovascular stiffness. Pulsatility index (PI) and resistive index (RI) of the MCA were calculated as measures of downstream cerebrovascular resistance. When compared with controls, patients with IHD exhibited greater β-stiffness [8.5 ± 3.3 vs. 6.8 ± 2.2 arbitrary units (AU); P = 0.04], MCA PI (1.1 ± 0.20 vs. 0.98 ± 0.18 AU; P = 0.02), and MCA RI (0.66 ± 0.06 vs. 0.62 ± 0.07 AU; P = 0.04). There was no difference in WMLv between IHD and control groups (0.95 ± 1.2 vs. 0.86 ± 1.4 mL; P = 0.81). In pooled patient data, WMLv correlated with both β-stiffness (R = 0.34, P = 0.02) and cerebrovascular ccPWTT (R = -0.43, P = 0.02); however, β-stiffness and ccPWTT were not associated (P = 0.13). In multivariate analysis, WMLv remained independently associated with ccPWTT (P = 0.02) and carotid β-stiffness (P = 0.04). Patients with IHD expressed greater β-stiffness and cerebral microvascular resistance. However, IHD did not increase risk of WMLv or cerebrovascular stiffness. Nonetheless, pooled data indicate that both carotid and cerebrovascular stiffness are independently associated with WMLv.NEW & NOTEWORTHY This study found that patients with ischemic heart disease (IHD) with preserved ejection fraction and normal blood pressures exhibit greater carotid β-stiffness, as well as middle cerebral artery pulsatility and resistive indexes, than controls. White matter lesion volume (WMLv) was not different between vascular pathology groups. Cerebrovascular pulse wave transit time (ccPWTT) and carotid β-stiffness independently associate with WMLv in pooled participant data, suggesting that regardless of heart disease history, ccPWTT and β-stiffness are associated with structural white matter damage.
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Affiliation(s)
| | | | - Neville Suskin
- Cardiac Rehabilitation and Secondary Prevention Program of Saint Joseph's Health Care London, London, Ontario, Canada.,Division of Cardiology, Department of Medicine, and Program of Experimental Medicine, Western University, London, Ontario, Canada
| | - J Kevin Shoemaker
- School of Kinesiology, Western University, London, Ontario, Canada.,Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
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Deng L, Zhang Y, Chen Z, Zhao Z, Zhang K, Wu J. Regional Upstroke Tracking for Transit Time Detection to Improve the Ultrasound-Based Local PWV Estimation in Carotid Arteries. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:691-702. [PMID: 31714222 DOI: 10.1109/tuffc.2019.2951922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pulse wave velocity (PWV) is the most important index for quantifying the elasticity of an artery. The accurate estimation of the local PWV is of great relevance to the early diagnosis and effective prevention of arterial stiffness. In ultrasonic transit time-based local PWV estimation, the locations of time fiduciary point (TFP) in the upstrokes of the propagating pulse waves (PWs) are inconsistent because of the reflected waves and ultrasonic noise. In this study, a regional upstroke tracking (RUT) approach that involved identifying the most similar TFP-centered region in the upstrokes is proposed to detect the time delay for improving the local PWV estimation. Five RUT algorithms with different tracking points are assessed via simulation and clinical experiments. To quantitatively evaluate the RUT algorithms, the normalized root-mean-squared errors and standard deviations of the estimated PWVs are calculated using an ultrasound simulation model. The reproducibility of the five RUT algorithms based on 30 human subjects is also evaluated using the Bland-Altman analysis and coefficient of variation (CV). The obtained results show that the RUT algorithms with only three tracking points provide greater accuracy, precision, and reproducibility for the local PWV estimation than the TFP methods. Compared with the TFP methods, the RUT algorithms reduce the mean errors from 12.23% ± 3.10% to 7.13% ± 2.31%, as well as the CVs from 21.76% to 13.39%. In conclusion, the proposed RUT algorithms are superior to the TFP methods for local carotid PWV estimation.
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Liu I, Ni S, Peng K. Enhancing the Robustness of Smartphone Photoplethysmography: A Signal Quality Index Approach. SENSORS 2020; 20:s20071923. [PMID: 32235543 PMCID: PMC7181214 DOI: 10.3390/s20071923] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 01/01/2023]
Abstract
Heart rate variability (HRV) provides essential health information such as the risks of heart attacks and mental disorders. However, inconvenience related to the accurate detection of HRV limits its potential applications. The ubiquitous use of smartphones makes them an excellent choice for regular and portable health monitoring. Following this trend, smartphone photoplethysmography (PPG) has recently garnered prominence; however, the lack of robustness has prevented both researchers and practitioners from embracing this technology. This study aimed to bridge the gap in the literature by developing a novel smartphone PPG quality index (SPQI) that can filter corrupted data. A total of 226 participants joined the study, and results from 1343 samples were used to validate the proposed sinusoidal function-based model. In both the correlation coefficient and Bland–Altman analyses, the agreement between HRV measurements generated by both the smartphone PPG and the reference electrocardiogram improved when data were filtered through the SPQI. Our results support not only the proposed approach but also the general value of using smartphone PPG in HRV analysis.
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Affiliation(s)
- Ivan Liu
- Data Science and Information Technology Research Center, Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen 518055, China; (I.L.); (K.P.)
| | - Shiguang Ni
- Graduate School at Shenzhen, Tsinghua University, Shenzhen 518055, China
- Correspondence:
| | - Kaiping Peng
- Data Science and Information Technology Research Center, Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen 518055, China; (I.L.); (K.P.)
- Department of Psychology, Tsinghua University, Beijing 100084, China
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Krogager C, Banghøj AM, Poulsen PL, Kirkegaard MG, Thorsteinsson B, Tarnow L, Hansen KW, Laugesen E. Effect of 12 weeks continuous positive airway pressure on day and night arterial stiffness and blood pressure in patients with type 2 diabetes and obstructive sleep apnea: A randomized controlled trial. J Sleep Res 2020; 29:e12978. [DOI: 10.1111/jsr.12978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/10/2019] [Accepted: 12/12/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Christoffer Krogager
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- Diagnostic Centre Regional Hospital Silkeborg Silkeborg Denmark
- Department of Endocrinology and Internal Medicine Aarhus University Hospital Aarhus Denmark
- The Danish Diabetes Academy Odense Denmark
| | - Anne Margareta Banghøj
- Department of Cardiology, Nephrology and Endocrinology Nordsjællands Hospital Hillerød Denmark
| | - Per L. Poulsen
- Department of Endocrinology and Internal Medicine Aarhus University Hospital Aarhus Denmark
| | - Martin G. Kirkegaard
- Elective Surgery Centre Sleep Disorders Clinic Regional Hospital Silkeborg Silkeborg Denmark
| | - Birger Thorsteinsson
- Department of Cardiology, Nephrology and Endocrinology Nordsjællands Hospital Hillerød Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Lise Tarnow
- Department of Cardiology, Nephrology and Endocrinology Nordsjællands Hospital Hillerød Denmark
- Steno Diabetes Center Zealand Holbæk Denmark
| | - Klavs W. Hansen
- Diagnostic Centre Regional Hospital Silkeborg Silkeborg Denmark
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine Aarhus University Hospital Aarhus Denmark
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Guede-Fernández F, Ferrer-Mileo V, Mateu-Mateus M, Ramos-Castro J, García-González MÁ, Fernández-Chimeno M. A photoplethysmography smartphone-based method for heart rate variability assessment: device model and breathing influences. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101717] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yamashita K. Pulse-wave transit time with ventilator-induced variation for the prediction of fluid responsiveness. Acute Med Surg 2020; 7:AMS2484. [PMID: 32002187 PMCID: PMC6985177 DOI: 10.1002/ams2.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/18/2019] [Accepted: 12/26/2019] [Indexed: 12/05/2022] Open
Abstract
Aim Although pulse pressure variation is a good predictor of fluid responsiveness, its measurement is invasive. Therefore, a technically simple, non‐invasive method is needed for evaluating circulatory status to prevent fluid loading and optimize hemodynamic status. We focused in the pulse‐wave transit time (PWTT) defined as the time interval between electrocardiogram R wave to plethysmograph upstroke, which has been recently introduced to non‐invasively assess cardiovascular response. In the present study, we evaluated the efficacy of pulse‐wave transit time (PWTT) with ventilator‐induced variation (PWTTV) in predicting fluid responsiveness. Methods We evaluated six domestic pigs weighing 46.0 ± 3.5 kg. After anesthesia induction, electrocardiogram, femoral arterial blood pressure, plethysmograph on the tail, and carotid artery blood flow were monitored and hemorrhage was induced by withdrawing 20 mL/kg blood over 20 min; 5 mL/kg blood volume was then autotransfused over 10 min. Then PWTTV and pulse pressure variation were measured at tidal volumes of 6 and 12 mL/kg. Results Area under the receiver operating curve values for the prediction of a >10% change in carotid artery blood flow were 0.979 for pulse pressure variation and 0.993 for PWTTV at a tidal volume of 6 mL/kg and 0.979 and 0.979, respectively, at a tidal volume of 12 mL/kg (all P < 0.0001). Conclusions Measured non‐invasively, PWTTV showed similar utility to pulse pressure variation in predicting >10% changes in carotid artery blood flow induced by autotransfusion.
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Affiliation(s)
- Koichi Yamashita
- Division of Critical Care CenterKochi Red Cross HospitalKochiJapan
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Di Rienzo M, Rizzo G, Işilay ZM, Lombardi P. SeisMote: A Multi-Sensor Wireless Platform for Cardiovascular Monitoring in Laboratory, Daily Life, and Telemedicine. SENSORS (BASEL, SWITZERLAND) 2020; 20:E680. [PMID: 31991918 PMCID: PMC7038355 DOI: 10.3390/s20030680] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 02/05/2023]
Abstract
This article presents a new wearable platform, SeisMote, for the monitoring of cardiovascular function in controlled conditions and daily life. It consists of a wireless network of sensorized nodes providing simultaneous multiple measures of electrocardiogram (ECG), acceleration, rotational velocity, and photoplethysmogram (PPG) from different body areas. A custom low-power transmission protocol was developed to allow the concomitant real-time monitoring of 32 signals (16 bit @200 Hz) from up to 12 nodes with a jitter in the among-node time synchronization lower than 0.2 ms. The BluetoothLE protocol may be used when only a single node is needed. Data can also be collected in the off-line mode. Seismocardiogram and pulse transit times can be derived from the collected data to obtain additional information on cardiac mechanics and vascular characteristics. The employment of the system in the field showed recordings without data gaps caused by transmission errors, and the duration of each battery charge exceeded 16 h. The system is currently used to investigate strategies of hemodynamic regulation in different vascular districts (through a multisite assessment of ECG and PPG) and to study the propagation of precordial vibrations along the thorax. The single-node version is presently exploited to monitor cardiac patients during telerehabilitation.
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Affiliation(s)
- Marco Di Rienzo
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milano, Italy; (G.R.); (Z.M.I.); (P.L.)
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van Velzen MHN, Niehof SP, Mik EG, Loeve AJ. Measuring pulse wave velocity with a novel, simple sensor on the finger tip: a feasibility study in healthy volunteers. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab3ad8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vernstrøm L, Laugesen E, Grove EL, Baier JM, Gullaksen S, Hvas AM, Poulsen PL, Funck KL. Differential vascular effects of aspirin in people with Type 2 diabetes without cardiovascular disease and matched controls without diabetes. Diabet Med 2019; 36:1141-1148. [PMID: 31006118 DOI: 10.1111/dme.13978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2019] [Indexed: 12/31/2022]
Abstract
AIM We investigated whether the effect of low-dose aspirin on endothelium-dependent vasodilation and arterial stiffness in people with Type 2 diabetes is different from a matched control group. We examined acute and chronic effects, and effects over the 24h dosing interval. METHODS In an open-label parallel group intervention study, we included 21 participants with Type 2 diabetes and 21 age- and sex-matched controls. Endothelium-dependent vasodilation was assessed as the reactive hyperaemia index (lnRHI) measured by peripheral arterial tonometry (EndoPAT® ). Arterial stiffness was assessed as pulse wave velocity (PWV) measured by applanation tonometry (SphygmoCor® ). Measurements were performed prior to aspirin intake and 1h after aspirin administration (75 mg). Participants were then treated for 6 days, and measurements were repeated at 24 h and 1 h after aspirin intake. RESULTS Baseline lnRHI did not differ between groups. The controls had an immediate increase in lnRHI after the first aspirin tablet. This was not observed in participants with diabetes (difference between groups; P < 0.05). After 1 week, both groups demonstrated increased lnRHI compared with baseline (P < 0.01). In participants with diabetes, lnRHI was significantly lower 24 h after aspirin administration compared with 1 h after administration (P < 0.05). This difference was not observed in controls (P = 0.84, difference between groups; P = 0.12). The effect on PWV did not differ between groups. CONCLUSION Aspirin had a reduced immediate effect on endothelium-dependent vasodilation in participants with diabetes. Both groups had improved endothelial function after 1 week of treatment. Further, the effect of aspirin on endothelial function may be declining during a 24 h dosing interval in people with Type 2 diabetes. (Clinical Trial Registry No: 2016-000515-32).
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Affiliation(s)
- L Vernstrøm
- Department of Endocrinology and Internal Medicine, Aarhus, Denmark
| | - E Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus, Denmark
| | - E L Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J M Baier
- Department of Endocrinology and Internal Medicine, Aarhus, Denmark
| | - S Gullaksen
- Department of Endocrinology and Internal Medicine, Aarhus, Denmark
| | - A-M Hvas
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Biochemistry, Thrombosis & Haemostasis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - P L Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus, Denmark
| | - K L Funck
- Department of Endocrinology and Internal Medicine, Aarhus, Denmark
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Nabeel PM, Kiran VR, Joseph J, Abhidev VV, Sivaprakasam M. Local Pulse Wave Velocity: Theory, Methods, Advancements, and Clinical Applications. IEEE Rev Biomed Eng 2019; 13:74-112. [PMID: 31369386 DOI: 10.1109/rbme.2019.2931587] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Local pulse wave velocity (PWV) is evolving as one of the important determinants of arterial hemodynamics, localized vessel stiffening associated with several pathologies, and a host of other cardiovascular events. Although PWV was introduced over a century ago, only in recent decades, due to various technological advancements, has emphasis been directed toward its measurement from a single arterial section or from piecewise segments of a target arterial section. This emerging worldwide trend in the exploration of instrumental solutions for local PWV measurement has produced several invasive and noninvasive methods. As of yet, however, a univocal opinion on the ideal measurement method has not emerged. Neither have there been extensive comparative studies on the accuracy of the available methods. Recognizing this reality, makes apparent the need to establish guideline-recommended standards for the measurement methods and reference values, without which clinical application cannot be pursued. This paper enumerates all major local PWV measurement methods while pinpointing their salient methodological considerations and emphasizing the necessity of global standardization. Further, a summary of the advancements in measuring modalities and clinical applications is provided. Additionally, a detailed discussion on the minimally explored concept of incremental local PWV is presented along with suggestions of future research questions.
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Thambiraj G, Gandhi U, Devanand V, Mangalanathan U. Noninvasive cuffless blood pressure estimation using pulse transit time, Womersley number, and photoplethysmogram intensity ratio. Physiol Meas 2019; 40:075001. [DOI: 10.1088/1361-6579/ab1f17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Heusinkveld MHG, Delhaas T, Lumens J, Huberts W, Spronck B, Hughes AD, Reesink KD. Augmentation index is not a proxy for wave reflection magnitude: mechanistic analysis using a computational model. J Appl Physiol (1985) 2019; 127:491-500. [PMID: 31161882 PMCID: PMC6711407 DOI: 10.1152/japplphysiol.00769.2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The augmentation index (AIx) is deemed to capture the deleterious effect on left ventricular (LV) work of increased wave reflection associated with stiffer arteries. However, its validity as a proxy for wave reflection magnitude has been questioned. We hypothesized that, in addition to increased wave reflection due to increased pulse wave velocity, LV myocardial shortening velocity influences AIx. Using a computational model of the circulation, we investigated the isolated and combined influences of myocardial shortening velocity vs,LV and arterial stiffness on AIx. Aortic blood pressure waveforms were characterized using AIx and the reflected wave pressure amplitude (p^bw, obtained using wave separation analysis). Our reference simulation (normal vs,LV and arterial stiffness) was characterized by an AIx of 21%. A realistic reduction in vs,LV caused AIx to increase from 21 to 42%. An arterial stiffness increase, characterized by a relevant 1.0 m/s increase in carotid-femoral pulse wave velocity, caused AIx to increase from 21 to 41%. Combining the reduced vs,LV and increased arterial stiffness resulted in an AIx of 54%. In a multistep parametric analysis, both vs,LV and arterial stiffness were about equal determinants of AIx, whereas p^bw was only determined by arterial stiffness. Furthermore, the relation between increased AIx and LV stroke work was only ≈50% explained by an increase in arterial stiffness, the other factor being vs,LV. The p^bw, on the other hand, related less ambiguously to LV stroke work. We conclude that the AIx reflects both cardiac and vascular properties and should not be considered an exclusively vascular parameter. NEW & NOTEWORTHY We used a state-of-the-art computational model to mechanistically investigate the validity of the augmentation index (AIx) as a proxy for (changes in) wave reflection. In contrary to current belief, we found that LV contraction velocity influences AIx as much as increased arterial stiffness, and increased AIx does not necessarily relate to an increase in LV stroke work. Wave reflection magnitude derived from considering pressure, as well as flow, does qualify as a determinant of LV stroke work.
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Affiliation(s)
| | - Tammo Delhaas
- CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands
| | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands
| | - Wouter Huberts
- CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands
| | - Bart Spronck
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, United Kingdom
| | - Koen D Reesink
- CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands
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Papaioannou TG, Fasoulis R, Toumpaniaris P, Tsioufis C, Dilaveris P, Soulis D, Koutsouris D, Tousoulis D. Assessment of arterial baroreflex sensitivity by different computational analyses of pressure wave signals alone. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 172:25-34. [PMID: 30902125 DOI: 10.1016/j.cmpb.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Baroreflex sensitivity (BRS) is an important indicator of the functionality of the arterial baroreceptors, and its assessment may have major research and clinical implications. An important requirement for its quantification is the continuous recording of electrocardiography (ECG) signal, so as to extract the RR interval, in parallel with continuous beat-to-beat blood pressure recording. We aimed to accurately calculate the RR Interval from pressure wave recordings per se, namely, the Pulse Interval (PI) using various arterial pulse wave analysis algorithms and to evaluate the precision and accuracy of BRS values calculated with the PI compared to BRS values calculated with the RR Interval. METHODS We analyzed the open access data of the Eurobavar study, which contains a set of ECG and arterial blood pressure (BP) wave signals recorded at 11 European centers. Pressure waveforms were continuously recorded by the Finapres apparatus which uses a finger cuff. The cuff pressure around the finger is dynamically adjusted by a servo-system to equal intra-arterial pressure, thus allowing the continuous recording of beat-to-beat BP waves. RR Interval was calculated from the ECG, whereas, PI was extracted from the arterial pulse waveforms, using 4 different methods (minimum, maximum, maximum 1st derivative and intersecting tangents method). BRS values were estimated by time domain and frequency domain methods. In order to compare agreement, accuracy, precision, variability, and the association between the reference BRS using the RR Interval and the BRS values using PI, standard statistical methods (i.e. intraclass correlation coefficients, RMSE, regression analysis) and Bland-Altman methods were performed. RESULTS We found that analysis of pressure waves alone by frequency-based (i.e. spectral) methods, provides the most accurate results of BRS estimation compared to time-domain methods (ICC > 0.9, R > 0.9, RMSE > 0.8 ms/mmHg). Concerning the spectral method, any algorithm for PI calculation is sufficient, as all show excellent agreement with the respective RR-intervals determined by ECG time series. Only the intersecting tangents and the maximum 1st derivative methods for PI calculation produce the most accurate results in time domain BRS estimation. CONCLUSION BRS estimation by proper analysis of pressure wave signals alone is feasible and accurate. Further studies are needed to investigate the clinical validity and relevance of the different BRS estimations in diagnostic, prognostic and therapeutic levels.
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Affiliation(s)
- Theodore G Papaioannou
- First Department of Cardiology, Units of Biomedical Engineering (TGP, DS), Hypertension (KT), e-Cardiology (PD), Hippokration Hospital, Medical School, National and Kapodistrian University of Athens. 114 Vas. Sophias ave., Athens 11527, Greece.
| | - Romanos Fasoulis
- First Department of Cardiology, Units of Biomedical Engineering (TGP, DS), Hypertension (KT), e-Cardiology (PD), Hippokration Hospital, Medical School, National and Kapodistrian University of Athens. 114 Vas. Sophias ave., Athens 11527, Greece; Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens. 9, Iroon Polytechniou Str., Athens 15780, Greece
| | - Petros Toumpaniaris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens. 9, Iroon Polytechniou Str., Athens 15780, Greece
| | - Constantinos Tsioufis
- First Department of Cardiology, Units of Biomedical Engineering (TGP, DS), Hypertension (KT), e-Cardiology (PD), Hippokration Hospital, Medical School, National and Kapodistrian University of Athens. 114 Vas. Sophias ave., Athens 11527, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, Units of Biomedical Engineering (TGP, DS), Hypertension (KT), e-Cardiology (PD), Hippokration Hospital, Medical School, National and Kapodistrian University of Athens. 114 Vas. Sophias ave., Athens 11527, Greece
| | - Dimitrios Soulis
- First Department of Cardiology, Units of Biomedical Engineering (TGP, DS), Hypertension (KT), e-Cardiology (PD), Hippokration Hospital, Medical School, National and Kapodistrian University of Athens. 114 Vas. Sophias ave., Athens 11527, Greece
| | - Dimitrios Koutsouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens. 9, Iroon Polytechniou Str., Athens 15780, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Units of Biomedical Engineering (TGP, DS), Hypertension (KT), e-Cardiology (PD), Hippokration Hospital, Medical School, National and Kapodistrian University of Athens. 114 Vas. Sophias ave., Athens 11527, Greece
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Radha M, de Groot K, Rajani N, Wong CCP, Kobold N, Vos V, Fonseca P, Mastellos N, Wark PA, Velthoven N, Haakma R, Aarts RM. Estimating blood pressure trends and the nocturnal dip from photoplethysmography. Physiol Meas 2019; 40:025006. [DOI: 10.1088/1361-6579/ab030e] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Zuo J, Chang G, Tan I, Butlin M, Chu SL, Avolio A. Central aortic pressure improves prediction of cardiovascular events compared to peripheral blood pressure in short-term follow-up of a hypertensive cohort. Clin Exp Hypertens 2018; 42:16-23. [PMID: 30554536 DOI: 10.1080/10641963.2018.1557682] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The aim of this study was to assess indices of a comprehensive panel of central aortic pressure and arterial stiffness for prediction of cardiovascular events in a hypertensive cohort.Methods: Noninvasive measurements of central aortic blood pressure, brachial pressure, wave reflection augmentation index, pressure amplification, pulse wave velocity (PWV) and carotid intima-media thickness (IMT) were obtained in 675 hypertensive patients (age 61 ± 9 years, 425 males) for a mean follow-up period 25 ± 4 months. The primary endpoints were defined as cardiovascular disease (CVD) events or death from CVD.Results: After adjusting for confounding factors, central systolic (cSBP) and pulse pressure (cPP) showed higher hazard ratios (HR/10 mmHg) for cardiovascular events (CV) compared to peripheral pressure indices (pSBP, pPP) at age >60 years (cSBP: HR = 1.18, pSBP: HR = 1.17, p = 0.034; cPP: HR = 1.28, pPP: HR = 1.2, p = 0.019). Each SD increase in IMT and in central augmented pressure (cAP) entailed a 1.4 times higher risk of increased total events in elderly patients (age >60 years). For males, each SD increase in cAP was associated with 1.36 times higher risk of increased total events. For females, each SD increase in cAIx and cAP was associated with 0.4 and 0.5 times lower risk of increased total and major CV, respectively. This sex difference is most likely due to lack of age-related increase of cAIx in females after age >60 years compared to males.Conclusions: Central pressure improved prediction of CVD compared to peripheral pressure during a relatively short-term follow up of approximately 2 years at age >60 years.
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Affiliation(s)
- Junli Zuo
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiaotong School of Medicine, Shanghai, China.,Department of Geriatrics, Ruijin Hospital North, Shanghai Jiaotong School of Medicine, Shanghai, China
| | - Guili Chang
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiaotong School of Medicine, Shanghai, China
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Shao-Li Chu
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiaotong School of Medicine, Shanghai, China
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Wang HY, Jiao QP, Chen SY, Sheng J, Jiang H, Lu J, Zheng SB, Fang NY. Efficacy and Safety of Policosanol Plus Fenofibrate Combination Therapy in Elderly Patients with Mixed Dyslipidemia: A Randomized, Controlled Clinical Study. Am J Med Sci 2018; 356:254-261. [PMID: 30286820 DOI: 10.1016/j.amjms.2018.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Policosanol is a mixture of long-chain alcohols isolated from sugar cane. This controlled, randomized clinical trial was designed to compare the efficacy and safety of fenofibrate, policosanol and a combination of these 2 in lowering low-density-lipoprotein cholesterol (LDL-C) in elderly patients with mixed dyslipidemia. METHODS A total of 102 patients aged ≥60years were randomly assigned into 3 groups: patients receiving a 24-week therapy of fenofibrate (200 mg/day), policosanol (20 mg/day) or fenofibrate + policosanol combination. Lipids were evaluated at baseline, after 16 and after 24 weeks of therapy. Brachial-ankle pulse wave velocity (ba-PWV) was performed, and SF-36 questionnaires were used to evaluate the patients' quality of life. The primary endpoint was the percentage reduction in LDL-C. The secondary end points included percentage change in nonhigh density lipoprotein cholesterol (non-HDL-C), total cholesterol (TC), triglyceride, high-density-lipoprotein cholesterol (HDL-C), ba-PWV and SF-36 scores. Safety was assessed by adverse events and laboratory parameters. RESULTS LDL-C, non-HDL-C and TC were decreased, respectively after treatment with policosanol for 24 weeks (P < 0.01). Treatment with policosanol + fenofibrate resulted in significantly greater reductions in TC, non-HDL-C and LDL-C compared to fenofibrate alone (P < 0.01, respectively). There were significant increases in SF-36 scores in the policosanol and policosanol + fenofibrate groups (P < 0.05), and significant improvements of ba-PWV in the 2 groups (P < 0.01). There were no serious adverse events or significant changes in laboratory variables after any of the treatment regimens. CONCLUSIONS Policosanol + fenofibrate combination therapy significantly improved lipid parameters, arterial stiffness, and quality of life, with good tolerability.
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Affiliation(s)
- Hai-Ya Wang
- Department of Geriatrics, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qing-Ping Jiao
- Department of Geriatrics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Shu-Yan Chen
- Department of Geriatrics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Sheng
- Department of Geriatrics, Shanghai Ninth People's Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hua Jiang
- Department of Geriatrics, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Jie Lu
- Department of Geriatrics, Minhang Central Hospital, Shanghai,China
| | - Song-Bai Zheng
- Department of Geriatrics, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
| | - Ning-Yuan Fang
- Department of Geriatrics, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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In Vitro Validation of 4D Flow MRI for Local Pulse Wave Velocity Estimation. Cardiovasc Eng Technol 2018; 9:674-687. [PMID: 30218205 DOI: 10.1007/s13239-018-00377-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/04/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Arterial stiffness has predictive value for cardiovascular disease (CVD). Local artery stiffness can provide insight on CVD pathology and may be useful for diagnosis and prognosis. However, current methods are invasive, require real-time expertise for measurement, or are limited by arterial region. 4D Flow MRI can non-invasively measure local stiffness by estimating local pulse wave velocity (PWV). This technique can be applied to vascular regions, previously accessible only by invasive stiffness measurement methods. MRI PWV data can also be analyzed post-exam. However, 4D Flow MRI requires validation before it is used in vivo to measure local PWV. METHODS PWV, calculated from 4D Flow MRI and a benchtop experiment, was compared with petersons elastic modulus (PEM) of in vitro models. PEM was calculated using high-speed camera images and pressure transducers. Three transit-time algorithms were analyzed for PWV measurement accuracy and precision. RESULTS PWV from 4D Flow MRI and reference benchtop experiments show strong correlation with PEM (R2 = 0.99). The cross correlation transit-time algorithm showed the lowest percent difference between 4D Flow MRI and benchtop experiments (4-7%), and the point to point of 50% upstroke algorithm had the highest transit-time vs. distance data average R2 (0.845). CONCLUSION 4D Flow MRI is a feasible method for estimating local PWV in simple in vitro models and is a viable tool for clinical analysis. In addition, choice in transit-time algorithm depends on flow waveform shape and arterial region. This study strengthens the validity of 4D Flow MRI local PWV measurement in simple models. However, this technique requires validation in more complex models before it is used in vivo.
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Shih CC, Qian X, Ma T, Han Z, Huang CC, Zhou Q, Shung KK. Quantitative Assessment of Thin-Layer Tissue Viscoelastic Properties Using Ultrasonic Micro-Elastography With Lamb Wave Model. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:1887-1898. [PMID: 29993652 DOI: 10.1109/tmi.2018.2820157] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Characterizing the viscoelastic properties of thin-layer tissues with micro-level thickness has long remained challenging. Recently, several micro-elastography techniques have been developed to improve the spatial resolution. However, most of these techniques have not considered the medium boundary conditions when evaluating the viscoelastic properties of thin-layer tissues such as arteries and corneas; this might lead to estimation bias or errors. This paper aims to integrate the Lamb wave model with our previously developed ultrasonic micro-elastography imaging system for obtaining accurate viscoelastic properties in thin-layer tissues. A 4.5-MHz ring transducer was used to generate an acoustic radiation force for inducing tissue displacements to produce guided wave, and the wave propagation was detected using a confocally aligned 40-MHz needle transducer. The phase velocity and attenuation were obtained from k-space by both the impulse and the harmonic methods. The measured phase velocity was fit using the Lamb wave model with the Kelvin-Voigt model. Phantom experiments were conducted using 7% and 12% gelatin and 1.5% agar phantoms with different thicknesses (2, 3, and 4 mm). Biological experiments were performed on porcine cornea and rabbit carotid artery ex vivo. Thin-layer phantoms with different thicknesses were confirmed to have the same elasticity; this was consistent with the estimates of bulk phantoms from mechanical tests and the shear wave rheological model. The trend of the measured attenuations was also confirmed with the viscosity results obtained using the Lamb wave model. Through the impulse and harmonic methods, the shear viscoelasticity values were estimated to be 8.2 kPa for $0.9~\text {Pa}{\cdot} \text {s}$ and 9.6 kPa for $0.8~\text {Pa}{\cdot} \text {s}$ in the cornea and 27.9 kPa for $0.1~\text {Pa}\cdot \text {s}$ and 26.5 kPa for $0.1~\text {Pa}\cdot \text {s}$ in the artery.
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Peltokangas M, Suominen V, Vakhitov D, Korhonen J, Verho J, Mattila VM, Romsi P, Lekkala J, Vehkaoja A, Oksala N. Effects of Percutaneous Transluminal Angioplasty of Superficial Femoral Artery on Photoplethysmographic Pulse Transit Times. IEEE J Biomed Health Inform 2018; 23:1058-1065. [PMID: 29994622 DOI: 10.1109/jbhi.2018.2851388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We analyze the changes in upper and lower limb pulse transit times (PTT) caused by peripheral artery disease (PAD) and its treatment with percutaneous transluminal angioplasty (PTA) of the superficial femoral artery. PTTs were extracted from the photoplethysmograms (PPG) recorded from an index finger and 2nd toes. PTTs were defined between the R-peaks of the ECG and different reference points of the PPG: foot and peak points, maxima of 1st and 2nd derivative, and by means of intersecting tangents method. Also the PTTs between the toe and finger pulses were analyzed. Our sample consists of 24 subjects examined before and after the PTA and in 1-month follow-up visit. Also 28 older than 65 years controls having normal ankle-to-brachial pressure index (ABI) and no history in cardiovascular diseases as well as 21 younger subjects were examined. The differences between the groups and pre- and post-treatment phases were analyzed by means of non-parametric statistical tests. The changes in the PTTs of upper limb and non-treated lower limb were negligible. The agreement with the reference values, ABI and toe pressures, was studied by kappa-analysis, resulting in kappa-values of 0.33-0.91. Differences in PTTs were found between pre-treatment state of the treated limb, post-treatment state and the follow-up visit, as well as between the pre-treatment state and controls. If patients' age and systolic blood pressure were taken into consideration, the method of lower limb PTT calculation from the peak point turns out feasible in finding the markers of PAD and monitoring post-treatment vascular remodellation.
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Bae JH, Kim JU, Kim J. Harmonic analysis of pulse morphology variability for pulse smoothness assessment. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2018.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Proenca M, Grossenbacher O, Dasen S, Moser V, Ostojic D, Lemkaddem A, Ferrario D, Lemay M, Wolf M, Fauchere JC, Karen T. Performance Assessment of a Dedicated Reflectance Pulse Oximeter in a Neonatal Intensive Care Unit. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:1502-1505. [PMID: 30440677 DOI: 10.1109/embc.2018.8512504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The measurement of peripheral oxygen saturation (SpO2) in neonatal intensive care units (NICUs) poses a significant challenge. Motion artifacts due to the patient's limb motion induce many false alarms, which in turn cause an additional workload for the medical staff and anxiety for the parents. We developed a reflectance pulse oximeter dedicated to be placed at the patient's forehead, which is less prone to such artifacts. We trained our algorithms for SpO2 estimation on 8 adult healthy volunteers participating in a controlled desaturation study. We then validated our SpO2 monitoring system on 25 newborn patients monitored in an NICU. We further evaluated the versatility and resilience to low signal-tonoise ratios (SNR) of our solution by testing it on signals acquired in a low-perfusion region (upper right part of the chest) of our adult volunteers. We obtained an SpO2 estimation accuracy ($A _{\mathbf {rms}}$) of 1.9 % and 3.1 % at the forehead and the chest in our adult volunteers, respectively. These performances were obtained after automatic rejection of 0.1 % and 30.0 %, respectively, of low-SNR signals by our dedicated quality index. In the dataset recorded on newborn patients in the NICU, we obtained an accuracy of 3.9 % after automatic rejection of 11.7 % of low-SNR signals by our quality index. These analyses were carried out following the procedures suggested by the ISO 80601-2-61:2011 standard, which specifies a target $A _{\mathbf {rms}} \le $ 4 % for SpO2 monitoring applications. These promising results suggest that reflectance pulse oximeters can achieve clinically acceptable accuracy, while being placed at locations less sensitive to limb motion artifacts - such as the forehead - thereby reducing the amount of SpO2-related false alarms in NICUs.
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Feng J, Huang Z, Zhou C, Ye X. Study of continuous blood pressure estimation based on pulse transit time, heart rate and photoplethysmography-derived hemodynamic covariates. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2018; 41:403-413. [PMID: 29633173 DOI: 10.1007/s13246-018-0637-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 04/04/2018] [Indexed: 01/12/2023]
Abstract
It is widely recognized that pulse transit time (PTT) can track blood pressure (BP) over short periods of time, and hemodynamic covariates such as heart rate, stiffness index may also contribute to BP monitoring. In this paper, we derived a proportional relationship between BP and PPT-2 and proposed an improved method adopting hemodynamic covariates in addition to PTT for continuous BP estimation. We divided 28 subjects from the Multi-parameter Intelligent Monitoring for Intensive Care database into two groups (with/without cardiovascular diseases) and utilized a machine learning strategy based on regularized linear regression (RLR) to construct BP models with different covariates for corresponding groups. RLR was performed for individuals as the initial calibration, while recursive least square algorithm was employed for the re-calibration. The results showed that errors of BP estimation by our method stayed within the Association of Advancement of Medical Instrumentation limits (- 0.98 ± 6.00 mmHg @ SBP, 0.02 ± 4.98 mmHg @ DBP) when the calibration interval extended to 1200-beat cardiac cycles. In comparison with other two representative studies, Chen's method kept accurate (0.32 ± 6.74 mmHg @ SBP, 0.94 ± 5.37 mmHg @ DBP) using a 400-beat calibration interval, while Poon's failed (- 1.97 ± 10.59 mmHg @ SBP, 0.70 ± 4.10 mmHg @ DBP) when using a 200-beat calibration interval. With additional hemodynamic covariates utilized, our method improved the accuracy of PTT-based BP estimation, decreased the calibration frequency and had the potential for better continuous BP estimation.
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Affiliation(s)
- Jingjie Feng
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, People's Republic of China
| | - Zhongyi Huang
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, People's Republic of China
| | - Congcong Zhou
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, People's Republic of China
| | - Xuesong Ye
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, People's Republic of China. .,State Key Laboratory of CAD & CG, Zhejiang University, Hangzhou, 310027, People's Republic of China.
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