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Hou J, Zhang Y, Zhang S, Geng X, Zhang J, Chen C, Zhang H. A novel angle extremum maximum method for recognition of pulse wave feature points. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105321. [PMID: 31986472 DOI: 10.1016/j.cmpb.2020.105321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Pulse wave is one of the biomedical signals that has been studied over the past years. Accurate recognition of feature points is the basis of verifying the connections between pulse waves and certain diseases. Therefore, the aim of the study is to discuss the use of angle mapping on feature points recognition. METHODS The mathematical method is based on the application of angle curve with parameter " k " on pulse wave. The data used is collected by PVDF sensor. Approximate curve and mathematical model are used for the discussion of the influence of parameter k and pulse wave amplitude by numerical calculation. The conclusion drawn from the numerical solution is that when k changes to maximize the angle extremum value, the corresponding position of angle extremum point is the feature point position. For the sampling rate f = 455Hz in this paper, k can be taken from 5 to 15. RESULTS We present the recognition results of unobvious feature points based on the "angle extremum maximum method" and corresponding angle values. The results are compared with traditional methods and the determination of angle threshold value is discussed. CONCLUSIONS This method can be used for accurate and efficient feature points identification, and it can be better applied to pulse waves with noise or unobvious feature points.
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Affiliation(s)
- Jiena Hou
- Institute of Microelectronics of Chinese Academy of Sciences, No. 3 Beitucheng West Road, Chaoyang District, Beijing 100029, China; University of Chinese Academy of Sciences, China; Beijing Key Laboratory for Next Generation RF Communication Chip Technology, China
| | - Yitao Zhang
- Institute of Microelectronics of Chinese Academy of Sciences, No. 3 Beitucheng West Road, Chaoyang District, Beijing 100029, China; Beijing Key Laboratory for Next Generation RF Communication Chip Technology, China
| | - Shaolong Zhang
- Institute of Microelectronics of Chinese Academy of Sciences, No. 3 Beitucheng West Road, Chaoyang District, Beijing 100029, China; Beijing Key Laboratory for Next Generation RF Communication Chip Technology, China
| | - Xingguang Geng
- Institute of Microelectronics of Chinese Academy of Sciences, No. 3 Beitucheng West Road, Chaoyang District, Beijing 100029, China; University of Chinese Academy of Sciences, China; Beijing Key Laboratory for Next Generation RF Communication Chip Technology, China
| | - Jun Zhang
- Institute of Microelectronics of Chinese Academy of Sciences, No. 3 Beitucheng West Road, Chaoyang District, Beijing 100029, China; University of Chinese Academy of Sciences, China; Beijing Key Laboratory for Next Generation RF Communication Chip Technology, China
| | - Chuanglu Chen
- Institute of Microelectronics of Chinese Academy of Sciences, No. 3 Beitucheng West Road, Chaoyang District, Beijing 100029, China; University of Chinese Academy of Sciences, China; Beijing Key Laboratory for Next Generation RF Communication Chip Technology, China
| | - Haiying Zhang
- Institute of Microelectronics of Chinese Academy of Sciences, No. 3 Beitucheng West Road, Chaoyang District, Beijing 100029, China; University of Chinese Academy of Sciences, China; Beijing Key Laboratory for Next Generation RF Communication Chip Technology, China.
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102
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Abstract
Despite the wide recognition of larger artery stiffness as a highly clinically relevant and independent prognostic biomarker, it has yet be incorporated into routine clinical practice and to take a more prominent position in clinical guidelines. An important reason may be the plethora of methods and devices claiming to measure arterial stiffness in humans. This brief review provides a concise overview of methods in use, indicating strengths and weaknesses. We classified and graded methods, highly weighing their scrutiny and purity in quantifying arterial stiffness, rather than focusing on their ease of application or the level at which methods have demonstrated their prognostic and diagnostic potential.
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Affiliation(s)
- Patrick Segers
- From the Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech Ghent (P.S.), University of Ghent, Belgium
| | - Ernst R Rietzschel
- Departments of Cardiology, Biobanking, and Cardiovascular Epidemiology (E.R.R.), University of Ghent, Belgium
- Ghent University Hospital, Belgium (E.R.R.)
| | - Julio A Chirinos
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, PA (J.A.C.)
- University of Pennsylvania Perelman School of Medicine, PA (J.A.C.)
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103
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Frey S, Jacobi D, Pichelin M, Cariou B, Mirallié E, Blanchard C. Improvement in arterial stiffness (pOpmètre®) after bariatric surgery. Results from a prospective study. ANNALES D'ENDOCRINOLOGIE 2020; 81:44-50. [PMID: 32081364 DOI: 10.1016/j.ando.2020.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/16/2019] [Accepted: 01/22/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Arterial stiffness (AS) is an independent predictor of cardiovascular risk, and could be used as a surrogate marker of improvement in cardiovascular risk following bariatric surgery. The aim of this study was to compare AS before and after surgery. METHODS One hundred and thirty-four patients undergoing bariatric surgery between May 2016 and January 2019 were prospectively included. AS was measured on pulse wave velocity (PWV) with the pOpmètre® device pre- and postoperatively. The main endpoint was change in PWV between baseline and 3 months post-surgery. RESULTS Overall, mean PWV was 6.87m/s preoperatively and 6.71m/s at 3 months (P=0.7148). Patients with pathologic PWV (>2 standard deviations from expected value for age) showed significant improvement at 3 months (31 patients; 10.1m/s preoperatively vs 7.5m/s at 3 months; P=0.007). These results did not correlate with improvement in other clinical or biological parameters following surgery (excess weight loss, mean blood pressure, fasting blood glucose, waist circumference, body composition). CONCLUSION These results suggest that pathological arterial stiffness may resolve following bariatric surgery independently of the other factors influencing cardiovascular risk in obesity.
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Affiliation(s)
- Samuel Frey
- Chirugie cancérologique digestive et endocrinienne (CCDE), institut des maladies de l'appareil digestif (IMAD), CHU de Nantes-Hôtel Dieu, Nantes, France
| | - David Jacobi
- Department of Endocrinology, CHU de Nantes, Nantes, France; Inserm, CNRS, l'institut du thorax, Université Nantes, Nantes, France
| | - Matthieu Pichelin
- Department of Endocrinology, CHU de Nantes, Nantes, France; Inserm, CNRS, l'institut du thorax, Université Nantes, Nantes, France
| | - Bertrand Cariou
- Department of Endocrinology, CHU de Nantes, Nantes, France; Inserm, CNRS, l'institut du thorax, Université Nantes, Nantes, France
| | - Eric Mirallié
- Chirugie cancérologique digestive et endocrinienne (CCDE), institut des maladies de l'appareil digestif (IMAD), CHU de Nantes-Hôtel Dieu, Nantes, France
| | - Claire Blanchard
- Chirugie cancérologique digestive et endocrinienne (CCDE), institut des maladies de l'appareil digestif (IMAD), CHU de Nantes-Hôtel Dieu, Nantes, France; Inserm, CNRS, l'institut du thorax, Université Nantes, Nantes, France.
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104
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Argyris AA, Vrachatis DA, Papaioannou TG. Arteriosclerosis and arterial remodeling; different mechanisms in young adults. J Clin Hypertens (Greenwich) 2020; 22:185-186. [PMID: 31955504 DOI: 10.1111/jch.13810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Antonios A Argyris
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Theodore G Papaioannou
- First Department of Cardiology, Biomedical Engineering Unit, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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105
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Milan A, Maldari P, Iannaccone A, Leone D, Avenatti E, Molino P, Livigni S, Veglio F, Aprà F. Pulse wave velocity and short-term outcome in patients requiring intravascular volume expansion: a pilot study. Emerg Med J 2019; 37:217-222. [PMID: 31874921 DOI: 10.1136/emermed-2018-208089] [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: 08/28/2018] [Revised: 11/30/2019] [Accepted: 12/10/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Fluid therapy has a pivotal role in the management of acutely ill patients. However, whether or not a patient can tolerate additional intravascular volume is controversial and optimal strategy is unknown. Carotid femoral pulse wave velocity (cfPWV) evaluates arterial stiffness. OBJECTIVE To determine whether cfPWV can predict the ability of patients to tolerate clinically indicated acute fluid expansion. METHODS 50 consecutive patients requiring intravascular volume expansion were prospectively recruited in intensive care units. All subjects underwent transthoracic echocardiography, pulmonary ultrasound assessment, and a cfPWV study (S. Giovanni Bosco Hospital in Turin, Italy, between 2015 and 2016) at baseline and after 24 hours. Acute outcomes were registered at 24 hours ("soft" end points) and 30 days ('hard' end points: death, acute myocardial infarction, stroke, occurrence of atrial fibrillation, need for dialysis) after initial fluid therapy. Multivariate logistic regression was used to assess association of the initial cfPWV with outcomes. RESULTS cfPWV was significantly higher (10.6±3.6 vs 7.4±2.2 m/s, P<0.0001) in subjects who met the prespecified combined endpoints (hard or soft) than in those who did not. After adjustment for confounding factors, initial cfPWV was significantly and independently associated with the occurrence of hard events (OR=2.8 (95% CI 1.36 to 5.97), P=0.005; area under the receiver operating characteristic curve 84%). cfPWV of <9 m/s had a negative predictive value of 93%, excluding hard events associated with fluid expansion. CONCLUSION cfPWV appears to reflect the ability of the patient to tolerate an intravascular fluid expansion when clinically indicated. Increased cfPWV could help to identify subjects at greater risk of developing signs and symptoms of fluid overload.
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Affiliation(s)
- Alberto Milan
- Department of Medical Sciences, AOU CIttà della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | | | - Andrea Iannaccone
- Department of Medical Sciences, AOU CIttà della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Dario Leone
- Department of Medical Sciences, AOU CIttà della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Eleonora Avenatti
- Department of Medical Sciences, AOU CIttà della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Paola Molino
- High Dependency Unit, San Giovanni Bosco Hospital, Torino, Italy
| | - Sergio Livigni
- S.C. Anestesia e Rianimazione 2, San Giovanni Bosco Hospital, Torino, Italy
| | - Franco Veglio
- Department of Medical Sciences, AOU CIttà della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Franco Aprà
- High Dependency Unit, San Giovanni Bosco Hospital, Torino, Italy
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107
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Yu S, McEniery CM. Heart-Thigh Cuff Pulse Wave Velocity: Aiming for the Best of Both Worlds? Am J Hypertens 2019; 32:1048-1050. [PMID: 31504130 DOI: 10.1093/ajh/hpz141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shikai Yu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
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108
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Zambrana-Vinaroz D, Vicente-Samper JM, G Juan C, Esteve-Sala V, Sabater-Navarro JM. Non-Invasive Device for Blood Pressure Wave Acquisition by Means of Mechanical Transducer. SENSORS 2019; 19:s19194311. [PMID: 31590351 PMCID: PMC6806211 DOI: 10.3390/s19194311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 11/29/2022]
Abstract
Blood pressure wave monitoring provides interesting information about the patient’s cardiovascular function. For this reason, this article proposes a non-invasive device capable of capturing the vibrations (pressure waves) produced by the carotid artery by means of a pressure sensor encapsulated in a closed dome filled with air. When the device is placed onto the outer skin of the carotid area, the vibrations of the artery will exert a deformation in the dome, which, in turn, will lead to a pressure increase in its inner air. Then, the sensor inside the dome captures this pressure increase. By combining the blood pressure wave obtained with this device together with the ECG signal, it is possible to help the screening of the cardiovascular system, obtaining parameters such as heart rate variability (HRV) and pulse transit time (PTT). The results show how the pressure wave has been successfully obtained in the carotid artery area, discerning the characteristic points of this signal. The features of this device compare well with previous works by other authors. The main advantages of the proposed device are the reduced size, the cuffless condition, and the potential to be a continuous ambulatory device. These features could be exploited in ambulatory tests.
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Affiliation(s)
- David Zambrana-Vinaroz
- Neuroengineering research group, Miguel Hernández University of Elche, 03202 Elche, Spain.
| | | | - Carlos G Juan
- Neuroengineering research group, Miguel Hernández University of Elche, 03202 Elche, Spain.
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109
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Thölking G, Schütte-Nütgen K, Schmitz J, Rovas A, Dahmen M, Bautz J, Jehn U, Pavenstädt H, Heitplatz B, Van Marck V, Suwelack B, Reuter S. A Low Tacrolimus Concentration/Dose Ratio Increases the Risk for the Development of Acute Calcineurin Inhibitor-Induced Nephrotoxicity. J Clin Med 2019; 8:jcm8101586. [PMID: 31581670 PMCID: PMC6832469 DOI: 10.3390/jcm8101586] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/18/2019] [Accepted: 09/27/2019] [Indexed: 11/16/2022] Open
Abstract
Fast tacrolimus metabolism is linked to inferior outcomes such as rejection and lower renal function after kidney transplantation. Renal calcineurin-inhibitor toxicity is a common adverse effect of tacrolimus therapy. The present contribution hypothesized that tacrolimus-induced nephrotoxicity is related to a low concentration/dose (C/D) ratio. We analyzed renal tubular epithelial cell cultures and 55 consecutive kidney transplant biopsy samples with tacrolimus-induced toxicity, the C/D ratio, C0, C2, and C4 Tac levels, pulse wave velocity analyses, and sublingual endothelial glycocalyx dimensions in the selected kidney transplant patients. A low C/D ratio (C/D ratio < 1.05 ng/mL×1/mg) was linked with higher C2 tacrolimus blood concentrations (19.2 ± 8.7 µg/L vs. 12.2 ± 5.2 µg/L respectively; p = 0.001) and higher degrees of nephrotoxicity despite comparable trough levels (6.3 ± 2.4 µg/L vs. 6.6 ± 2.2 µg/L respectively; p = 0.669). However, the tacrolimus metabolism rate did not affect the pulse wave velocity or glycocalyx in patients. In renal tubular epithelial cells exposed to tacrolimus according to a fast metabolism pharmacokinetic profile it led to reduced viability and increased Fn14 expression. We conclude from our data that the C/D ratio may be an appropriate tool for identifying patients at risk of developing calcineurin-inhibitor toxicity.
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Affiliation(s)
- Gerold Thölking
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany.
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Marienhospital Steinfurt, 48565 Steinfurt, Germany.
| | - Katharina Schütte-Nütgen
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany.
| | - Julia Schmitz
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany.
| | - Alexandros Rovas
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany.
| | - Maximilian Dahmen
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany.
| | - Joachim Bautz
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany.
| | - Ulrich Jehn
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany.
| | - Hermann Pavenstädt
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany.
| | - Barbara Heitplatz
- Gerhard-Domagk-Institute of Pathology, University Hospital of Münster, 48149 Münster, Germany.
| | - Veerle Van Marck
- Gerhard-Domagk-Institute of Pathology, University Hospital of Münster, 48149 Münster, Germany.
| | - Barbara Suwelack
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany.
| | - Stefan Reuter
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany.
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Association Between HDL Cholesterol and QTc Interval: A Population-Based Epidemiological Study. J Clin Med 2019; 8:jcm8101527. [PMID: 31547597 PMCID: PMC6832837 DOI: 10.3390/jcm8101527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 01/06/2023] Open
Abstract
Previous experimental studies showed that increasing high-density lipoprotein cholesterol (HDL) cholesterol shortens cardiac ventricular repolarization and the QT interval corrected for heart rate (QTc). However, little is known about the epidemiological relationship between HDL and QTc. The potential antiarrhythmic effect of HDL cholesterol remains a speculative hypothesis. In this cross-sectional population based study in adults living in the Italian-speaking part of Switzerland, we aimed to explore the association between HDL cholesterol and the QTc interval in the general population. A total of 1202 subjects were screened. electrocardiogram (ECG) recordings, measurements of lipid parameters and other laboratory tests were performed. QTc was corrected using Bazett’s (QTcBaz) and Framingham (QTcFram) formulas. HDL was categorized according to percentile distributions: <25th (HDL-1; ≤1.39 mmol/L); 25th–<50th (HDL-2; 1.40–1.69 mmol/L); 50th–<75th (HDL-3; 1.69–1.99 mmol/L); and ≥75th (HDL-4; ≥2.0 mmol/L). After exclusion procedures, data of 1085 subjects were analyzed. Compared with the HDL reference group (HDL-1), HDL-2 and HDL-3 were associated with a reduction of QTcBaz and QTcFram duration in crude (HDL-2, QTcBaz/QTcFram: β-11.306/–10.186, SE 4.625/4.016; p = 0.016/0.012; HDL-3, β-12.347/–12.048, SE 4.875/4.233, p = 0.012/<0.001) and adjusted (HDL-2: β-11.697/–10.908, SE 4.333/4.151, p < 0.001/0.010; HDL-3 β-11.786/–11.002, SE 4.719/4.521, p = 0.014/0.016) linear regression models in women. In adjusted logistic regression models higher HDL, were also associated with lower risk of prolonged QTcBaz/QTcFram (HDL-2: OR 0.16/0.17, CI 0.03–0.83/0.47–0.65; HDL-3: OR 0.10/0.14, CI 0.10–0.64/0.03–0.63) in women. Restricted cubic spline analysis confirmed a non linear association (p < 0.001). The present findings indicate an epidemiological association between HDL cholesterol and QTc duration. To draw firm conclusions, further investigations in other populations and with a prospective cohort design are needed.
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111
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Fabian V, Matera L, Bayerova K, Havlik J, Kremen V, Pudil J, Sajgalik P, Zemanek D. Noninvasive Assessment of Aortic Pulse Wave Velocity by the Brachial Occlusion-Cuff Technique: Comparative Study. SENSORS 2019; 19:s19163467. [PMID: 31398931 PMCID: PMC6719951 DOI: 10.3390/s19163467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/18/2019] [Accepted: 08/06/2019] [Indexed: 01/14/2023]
Abstract
Cardiovascular diseases are one of most frequent cause of morbidity and mortality in the world. There is an emerging need for integrated, non-invasive, and easy-to-use clinical tools to assess accurately cardiovascular system primarily in the preventative medicine. We present a novel design for a non-invasive pulse wave velocity (PWV) assessment method integrated in a single brachial blood pressure monitor allowing for up to 100 times more sensitive recording of the pressure pulsations based on a brachial occlusion-cuff (suprasystolic) principle. The monitor prototype with built-in proprietary method was validated with a gold standard reference technique SphygmoCor VX device. The blood pressure and PWV were assessed on twenty-five healthy individuals (9 women, age (37 ± 13) years) in a supine position at rest by a brachial cuff blood pressure monitor prototype, and immediately re-tested using a gold standard method. PWV using our BP monitor was (6.67 ± 0.96) m/s compared to PWV determined by SphygmoCor VX (6.15 ± 1.01) m/s. The correlation between methods using a Pearson’s correlation coefficient was r = 0.88 (p < 0.001). The study demonstrates the feasibility of using a single brachial cuff build-in technique for the assessment of the arterial stiffness from a single ambulatory blood pressure assessment.
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Affiliation(s)
- Vratislav Fabian
- Department of Physics, Faculty of Electrical Engineering, Czech Technical University in Prague, 166 27 Prague, Czech Republic.
| | - Lukas Matera
- Department of Physics, Faculty of Electrical Engineering, Czech Technical University in Prague, 166 27 Prague, Czech Republic
| | - Kristyna Bayerova
- 2nd Department of Internal Medicine-Cardiology and Angiology of General University Hospital and 1st Medical Faculty of Charles University, 128 08 Prague, Czech Republic
| | - Jan Havlik
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, 166 27 Prague, Czech Republic
| | - Vaclav Kremen
- Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, 160 00 Prague, Czech Republic
| | - Jan Pudil
- 2nd Department of Internal Medicine-Cardiology and Angiology of General University Hospital and 1st Medical Faculty of Charles University, 128 08 Prague, Czech Republic
| | - Pavol Sajgalik
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 559 05, USA
| | - David Zemanek
- 2nd Department of Internal Medicine-Cardiology and Angiology of General University Hospital and 1st Medical Faculty of Charles University, 128 08 Prague, Czech Republic
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