Automated detection of the onset and systolic peak in the pulse wave using Hilbert transform

Feature Extraction Tool Using Temporal Landmarks in Arterial Blood Pressure and Photoplethysmography Waveforms

Arterial blood pressure (ABP) and photoplethysmography (PPG) waveforms both contain vital physiological information for the prevention and treatment of cardiovascular diseases. Extracted features from these waveforms have diverse clinical applications, including predicting hyper- and hypo-tension, estimating cardiac output from ABP, and monitoring blood pressure and nociception from PPG. However, the lack of standardized tools for feature extraction limits their exploration and clinical utilization. In this study, we propose an automatic feature extraction tool that first detects temporal location of landmarks within each cardiac cycle of ABP and PPG waveforms, including the systolic phase onset, systolic phase peak, dicrotic notch, and diastolic phase peak using the iterative envelope mean method. Then, based on these landmarks, extracts 852 features per cardiac cycle, encompassing time-, statistical-, and frequency-domains. The tool's ability to detect landmarks was evaluated using ABP and PPG waveforms from a large perioperative dataset (MLORD dataset) comprising 17,327 patients. We analyzed 34,267 cardiac cycles of ABP waveforms and 33,792 cardiac cycles of PPG waveforms. Additionally, to assess the tool's real-time landmark detection capability, we retrospectively analyzed 3,000 cardiac cycles of both ABP and PPG waveforms, collected from a Philips IntelliVue MX800 patient monitor. The tool's detection performance was assessed against markings by an experienced researcher, achieving average F1-scores and error rates for ABP and PPG as follows: (1) On MLORD dataset: systolic phase onset (99.77 %, 0.35 % and 99.52 %, 0.75 %), systolic phase peak (99.80 %, 0.30 % and 99.56 %, 0.70 %), dicrotic notch (98.24 %, 2.63 % and 98.72 %, 1.96 %), and diastolic phase peak (98.59 %, 2.11 % and 98.88 %, 1.73 %); (2) On real time data: systolic phase onset (98.18 %, 3.03 % and 97.94 %, 3.43 %), systolic phase peak (98.22 %, 2.97 % and 97.74 %, 3.77 %), dicrotic notch (97.72 %, 3.80 % and 98.16 %, 3.07 %), and diastolic phase peak (98.04 %, 3.27 % and 98.08 %, 3.20 %). This tool has significant potential for supporting clinical utilization of ABP and PPG waveform features and for facilitating feature-based machine learning models for various clinical applications where features derived from these waveforms play a critical role.

Real-Time Seismocardiogram Feature Extraction Using Adaptive Gaussian Mixture Models

Wearable systems can provide accurate cardiovascular evaluations by estimating hemodynamic indices in real-time. Key hemodynamic parameters can be non-invasively estimated using the seismocardiogram (SCG), a cardiomechanical signal whose features link to cardiac events like aortic valve opening (AO) and closing (AC). However, tracking a single SCG feature is unreliable due to physiological changes, motion artifacts, and external vibrations. This work proposes an adaptable Gaussian Mixture Model (GMM) to track multiple AO/AC correlated features in quasi-real-time from the SCG. The GMM calculates the likelihood of an extremum being an AO/AC feature for each SCG beat. The Dijkstra algorithm selects heartbeat-related extrema, and a Kalman filter updates the GMM parameters while filtering features. Tracking accuracy is tested on a porcine hypovolemia dataset with varying noise levels. Blood volume loss estimation accuracy is also evaluated using the tracked features on a previously developed model. Experimental results show a 4.5 ms tracking latency and average root mean square errors (RMSE) of 1.47 ms for AO and 7.67 ms for AC at 10 dB noise, and 6.18 ms for AO and 15.3 ms for AC at -10 dB noise. When considering all AO/AC correlated features, the combined RMSE remains in similar ranges, specifically 2.70 ms for AO and 11.91 ms for AC at 10 dB noise, and 7.50 ms for AO and 16.35 ms for AC at -10 dB noise. The proposed algorithm offers low latency and RMSE for all tracked features, making it suitable for real-time processing. These systems enable accurate, timely extraction of hemodynamic indices for many cardiovascular monitoring applications, including trauma care in field settings.

PPGFeat: a novel MATLAB toolbox for extracting PPG fiducial points

Photoplethysmography is a non-invasive technique used for measuring several vital signs and for the identification of individuals with an increased disease risk. Its principle of work is based on detecting changes in blood volume in the microvasculature of the skin through the absorption of light. The extraction of relevant features from the photoplethysmography signal for estimating certain physiological parameters is a challenging task, where various feature extraction methods have been proposed in the literature. In this work, we present PPGFeat, a novel MATLAB toolbox supporting the analysis of raw photoplethysmography waveform data. PPGFeat allows for the application of various preprocessing techniques, such as filtering, smoothing, and removal of baseline drift; the calculation of photoplethysmography derivatives; and the implementation of algorithms for detecting and highlighting photoplethysmography fiducial points. PPGFeat includes a graphical user interface allowing users to perform various operations on photoplethysmography signals and to identify, and if required also adjust, the fiducial points. Evaluating the PPGFeat's performance in identifying the fiducial points present in the publicly available PPG-BP dataset, resulted in an overall accuracy of 99% and 3038/3066 fiducial points were correctly identified. PPGFeat significantly reduces the risk of errors in identifying inaccurate fiducial points. Thereby, it is providing a valuable new resource for researchers for the analysis of photoplethysmography signals.

Robust PPG Peak Detection Using Dilated Convolutional Neural Networks

Accurate peak determination from noise-corrupted photoplethysmogram (PPG) signal is the basis for further analysis of physiological quantities such as heart rate. Conventional methods are designed for noise-free PPG signals and are insufficient for PPG signals with low signal-to-noise ratio (SNR). This paper focuses on enhancing PPG noise-resiliency and proposes a robust peak detection algorithm for PPG signals distorted due to noise and motion artifact. Our algorithm is based on convolutional neural networks (CNNs) with dilated convolutions. We train and evaluate the proposed method using a dataset collected via smartwatches under free-living conditions in a home-based health monitoring application. A data generator is also developed to produce noisy PPG data used for model training and evaluation. The method performance is compared against other state-of-the-art methods and is tested with SNRs ranging from 0 to 45 dB. Our method outperforms the existing adaptive threshold, transform-based, and machine learning methods. The proposed method shows overall precision, recall, and F1-score of 82%, 80%, and 81% in all the SNR ranges. In contrast, the best results obtained by the existing methods are 78%, 80%, and 79%. The proposed method proves to be accurate for detecting PPG peaks even in the presence of noise.

Analysis on Four Derivative Waveforms of Photoplethysmogram (PPG) for Fiducial Point Detection

Fiducial points of photoplethysmogram (PPG), first derivative PPG (VPG), and second derivative PPG (APG) are essential in extracting numerous parameters to diagnose cardiovascular disease. However, the fiducial points were usually detected using complex mathematical algorithms. Inflection points from derivatives waveforms are not thoroughly studied, whereas they can significantly assist in peak detection. This study is performed to investigate the derivative waveforms of PPG and use them to detect the important peaks of PPG, VPG, and APG. PPGs with different morphologies from 43 ischemic heart disease subjects are analyzed. Inflection points of the derivative waveforms up to the fourth level are observed, and consistent information (derivative markers) is used to detect the fiducial points of PPG, VPG, and APG with proper sequence. Moving average filter and simple thresholding techniques are applied to detect the primary points in VPG and the third derivative waveform. A total of twelve out of twenty derivative markers are found reliable in detecting fiducial points of two common types of PPG. Systolic peaks are accurately detected with 99.64% sensitivity and 99.38% positive predictivity using the 43 IHD dataset and Complex System Laboratory (CSL) Pulse Oximetry Artifact Labels database. The study has introduced the fourth derivative PPG waveform with four main points, which are significantly valuable for detecting the fiducial points of PPG, VPG, and APG.

Photoplethysmogram Analysis and Applications: An Integrative Review

Beyond its use in a clinical environment, photoplethysmogram (PPG) is increasingly used for measuring the physiological state of an individual in daily life. This review aims to examine existing research on photoplethysmogram concerning its generation mechanisms, measurement principles, clinical applications, noise definition, pre-processing techniques, feature detection techniques, and post-processing techniques for photoplethysmogram processing, especially from an engineering point of view. We performed an extensive search with the PubMed, Google Scholar, Institute of Electrical and Electronics Engineers (IEEE), ScienceDirect, and Web of Science databases. Exclusion conditions did not include the year of publication, but articles not published in English were excluded. Based on 118 articles, we identified four main topics of enabling PPG: (A) PPG waveform, (B) PPG features and clinical applications including basic features based on the original PPG waveform, combined features of PPG, and derivative features of PPG, (C) PPG noise including motion artifact baseline wandering and hypoperfusion, and (D) PPG signal processing including PPG preprocessing, PPG peak detection, and signal quality index. The application field of photoplethysmogram has been extending from the clinical to the mobile environment. Although there is no standardized pre-processing pipeline for PPG signal processing, as PPG data are acquired and accumulated in various ways, the recently proposed machine learning-based method is expected to offer a promising solution.

Automatic Onsets and Systolic Peaks Detection and Segmentation of Arterial Blood Pressure Waveforms using Fully Convolutional Neural Networks

Arterial blood pressure (ABP) waveform is a common physiological signal that contains a wealth of cardiovascular information. According to the cardiac cycle, the ABP waveform is divided into rapid ejection, systolic and diastolic phases. Therefore, the characteristic points of the arterial blood pressure waveform, i.e. their onsets, systolic peaks, represent the timing of the minimum and maximum pressures. It is important to detect these characteristic points accurately. Recently, many researchers have introduced some feature points detection methods, but the accuracy is not particularly high. In this paper, a deep learning method is proposed to achieve periodic segmentation and feature points detection of ABP signals using a one-dimensional U-Net network. The network can split the ABP signal into two parts and accurately detect the feature points. The method is validated on an ABP dataset of 126 people, 500 people each. Performances are good at different tolerance thresholds, with an average time difference of less than 1.5 ms. Finally, the method performs with 99.79% and 99.79% sensitivity, 99.99% and 99.94% positive predictivity, and 0.23% and 0.27% error rates for both onsets and systolic peaks at a tolerance threshold of 30 ms. To our knowledge, this is the first paper to use deep learning methods for the onsets and systolic peaks detections of ABP signals.

PPGTempStitch: A MATLAB Toolbox for Augmenting Annotated Photoplethsmogram Signals

An annotated photoplethysmogram (PPG) is required when evaluating PPG algorithms that have been developed to detect the onset and systolic peaks of PPG waveforms. However, few publicly accessible PPG datasets exist in which the onset and systolic peaks of the waveforms are annotated. Therefore, this study developed a MATLAB toolbox that stitches predetermined annotated PPGs in a random manner to generate a long, annotated PPG signal. With this toolbox, any combination of four annotated PPG templates that represent regular, irregular, fast rhythm, and noisy PPG waveforms can be stitched together to generate a long, annotated PPG. Furthermore, this toolbox can simulate real-life PPG signals by introducing different noise levels and PPG waveforms. The toolbox can implement two stitching methods: one based on the systolic peak and the other on the onset. Additionally, cubic spline interpolation is used to smooth the waveform around the stitching point, and a skewness index is used as a signal quality index to select the final signal output based on the stitching method used. The developed toolbox is free and open-source software, and a graphical user interface is provided. The method of synthesizing by stitching introduced in this paper is a data augmentation strategy that can help researchers significantly increase the size and diversity of annotated PPG signals available for training and testing different feature extraction algorithms.

Algorithm for Reliable Detection of Pulse Onsets in Cerebral Blood Flow Velocity Signals

Transcranial Doppler (TCD) ultrasound has been demonstrated to be a valuable tool for assessing cerebral hemodynamics via measurement of cerebral blood flow velocity (CBFV), with a number of established clinical indications. However, CBFV waveform analysis depends on reliable pulse onset detection, an inherently difficult task for CBFV signals acquired via TCD. We study the application of a new algorithm for CBFV pulse segmentation, which locates pulse onsets in a sequential manner using a moving difference filter and adaptive thresholding. The test data set used in this study consists of 92,012 annotated CBFV pulses, whose quality is representative of real world data. On this test set, the algorithm achieves a true positive rate of 99.998% (2 false negatives), positive predictive value of 99.998% (2 false positives), and mean temporal offset error of 6.10 ± 4.75 ms. We do note that in this context, the way in which true positives, false positives, and false negatives are defined caries some nuance, so care should be taken when drawing comparisons to other algorithms. Additionally, we find that 97.8% and 99.5% of onsets are detected within 10 and 30 ms, respectively, of the true onsets. The algorithm's performance in spite of the large degree of variation in signal quality and waveform morphology present in the test data suggests that it may serve as a valuable tool for the accurate and reliable identification of CBFV pulse onsets in neurocritical care settings.

Identification of Pulse Onset on Cerebral Blood Flow Velocity Waveforms: A Comparative Study

The low cost, simple, noninvasive, and continuous measurement of cerebral blood flow velocity (CBFV) by transcranial Doppler is becoming a common clinical tool for the assessment of cerebral hemodynamics. CBFV monitoring can also help with noninvasive estimation of intracranial pressure and evaluation of mild traumatic brain injury. Reliable CBFV waveform analysis depends heavily on its accurate beat-to-beat delineation. However, CBFV is inherently contaminated with various types of noise/artifacts and has a wide range of possible pathological waveform morphologies. Thus, pulse onset detection is in general a challenging task for CBFV signal. In this paper, we conducted a comprehensive comparative analysis of three popular pulse onset detection methods using a large annotated dataset of 92,794 CBFV pulses—collected from 108 subarachnoid hemorrhage patients admitted to UCLA Medical Center. We compared these methods not only in terms of their accuracy and computational complexity, but also for their sensitivity to the selection of their parameters' values. The results of this comprehensive study revealed that using optimal values of the parameters obtained from sensitivity analysis, one method can achieve the highest accuracy for CBFV pulse onset detection with true positive rate (TPR) of 97.06% and positive predictivity value (PPV) of 96.48%, when error threshold is set to just less than 10 ms. We conclude that the high accuracy and low computational complexity of this method (average running time of 4ms/pulse) makes it a reliable algorithm for CBFV pulse onset detection.

Use of zero-frequency resonator for automatically detecting systolic peaks of photoplethysmogram signal

This work investigates the application of zero-frequency resonator (ZFR) for detecting systolic peaks of photoplethysmogram (PPG) signals. Based on the authors' studies, they propose an automated noise-robust method, which consists of the central difference operation, the ZFR, the mean subtraction and averaging, the peak determination, and the peak rejection/acceptance rule. The method is evaluated using different kinds of PPG signals taken from the standard MIT-BIH polysomnographic database and Complex Systems Laboratory database and the recorded PPG signals at their Biomedical System Lab. The method achieves an average sensitivity (Se) of 99.95%, positive predictivity (Pp) of 99.89%, and overall accuracy (OA) of 99.84% on a total number of 116,673 true peaks. Evaluation results further demonstrate the robustness of the ZFR-based method for noisy PPG signals with a signal-to-noise ratio (SNR) ranging from 30 to 5 dB. The method achieves an average Se = 99.76%, Pp = 99.84%, and OA = 99.60% for noisy PPG signals with a SNR of 5 dB. Various results show that the method yields better detection rates for both noise-free and noisy PPG signals. The method is simple and reliable as compared with the complexity of signal processing techniques and detection performance of the existing detection methods.

Shannon's Energy Based Algorithm in ECG Signal Processing

Physikalisch-Technische Bundesanstalt (PTB) database is electrocardiograms (ECGs) set from healthy volunteers and patients with different heart diseases. PTB is provided for research and teaching purposes by National Metrology Institute of Germany. The analysis method of complex QRS in ECG signals for diagnosis of heart disease is extremely important. In this article, a method on Shannon energy (SE) in order to detect QRS complex in 12 leads of ECG signal is provided. At first, this algorithm computes the Shannon energy (SE) and then makes an envelope of Shannon energy (SE) by using the defined threshold. Then, the signal peaks are determined. The efficiency of the algorithm is tested on 70 cases. Of all 12 standard leads, ECG signals include 840 leads of the PTB Diagnostic ECG Database (PTBDB). The algorithm shows that the Shannon energy (SE) sensitivity is equal to 99.924%, the detection error rate (DER) is equal to 0.155%, Positive Predictivity (+P) is equal to 99.922%, and Classification Accuracy (Acc) is equal to 99.846%.