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Das H, Satapathy A, John J, Kar M, Mohakud S. Endothelial Dysfunction in Children With Nephrotic Syndrome: A Cross-Sectional Study. Cureus 2024; 16:e53628. [PMID: 38449929 PMCID: PMC10917071 DOI: 10.7759/cureus.53628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Background Children with nephrotic syndrome (NS) have a higher risk of cardiovascular morbidity. Studies on the evaluation of arterial stiffness and endothelial function and its predictive risk factors in these children are limited. Objective The primary objective of the study was to determine arterial stiffness by measuring carotid intimal medial thickness, flow-mediated dilatation, and physiological parameters in children with nephrotic syndrome to predict the risk of premature atherosclerosis as compared to controls. Participants A total number of 33 children with NS in the age group of 2-14 years in remission and 39 healthy controls were enrolled in the study. Out of 33 children with nephrotic syndrome, five were infrequently relapsing NS, eight were frequently relapsing, 16 were steroid dependent, and four were steroid-resistant NS. Intervention Relevant history, physical examination, anthropometric measurements, and laboratory investigations were done. Carotid intimal medial thickness (cIMT), flow-mediated dilatation (FMD), and other physiological parameters were measured in both children with NS and control groups. Outcome Carotid intimal medial thickness (cIMT), flow-mediated dilatation (FMD), and other physiological parameters were compared between children with NS and healthy controls for detecting arterial stiffness and endothelial dysfunction. Results Dyslipidaemia was seen in more than 50% of children during remission. There was neither significant difference in mean cIMT in the common carotid artery nor FMD between the control and study groups. There was a trend of lower Reactive Hyperemia Index (RHI) in children with NS. Conclusion Dyslipidemia persists even during the remission phase in NS. No statistically significant difference is observed in cIMT and percentage proportionate change in FMD in both the study and control groups. Nevertheless, RHI is notably lower in children with NS. These findings need further validation in future studies.
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Affiliation(s)
- Harapriya Das
- Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Amit Satapathy
- Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Joseph John
- Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Manisha Kar
- Physiology, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Sudipta Mohakud
- Radiology, All India Institute of Medical Sciences, Bhubaneswar, IND
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Hari Prakash KJ, Parija S, Kar M. Assessment of the relationship of systemic vascular dysfunction and cardiac autonomic neuropathy (CAN) with diabetic retinopathy. J Family Med Prim Care 2023; 12:3236-3241. [PMID: 38361899 PMCID: PMC10866220 DOI: 10.4103/jfmpc.jfmpc_909_23] [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: 06/03/2023] [Revised: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 02/17/2024] Open
Abstract
Context Diabetic retinopathy, a form of microvasculopathy, is the leading cause of the visual abnormality. However, there is no conclusive evidence of the relationship of systemic vascular dysfunction with retinal microvasculopathy. In addition, diabetes-associated cardiac autonomic neuropathy may also compromise vascular function. Aims The present study intends to correlate arterial stiffness, endothelial function, and heart rate variability (HRV) as a standardized measure of cardiac autonomic neuropathy with diabetic retinopathy. Settings and Design The present cross-sectional, observational study was conducted in the Department of Physiology. Materials and Methods Twenty subjects were recruited in group 1 (T2DM, type 2 diabetes mellitus patients, without retinopathy) and group 2 (T2DM with retinopathy). The vascular parameters such as heart rate, peripheral and central blood pressure, augmentation index [AIx (%)], brachial -ankle pulse wave velocity (baPWV), and reactive hyperaemia index (RHI) were recorded. Statistical Analysis Used Independent sample t-test (for parametric data) and Mann-Whitney U test (for non-parametric data) were employed to compare the variables of two groups. Spearman correlation was used to examine the relationship among the parameters. Linear regression analysis was performed to examine the important vascular predictor for diabetic retinopathy. Results baPWV was significantly higher in group 2 than in group 1 and positively associated with group 2. RHI was significantly less in group 2 than group 1 and negatively associated with group 2. Among HRV metrics, standard deviation of successive differences (SDSD), root mean square of successive differences between normal heartbeats (RMSSD), and high frequency (HF) power were significantly decreased in group 2 than in group 1. SDSD, RMSSD, and HF power were negatively associated with group 2. RHI emerged as a significant predictor of diabetic retinopathy following linear regression. Conclusions Overall, the result of the present study indicates that metabolic dysregulation of glucose may affect the normal functioning of the autonomic nervous system and vascular function. Therefore, screening of vascular function and cardiac autonomic tone may be advocated in diabetic patients in routine clinics to examine the existence of any comorbid condition, such as diabetic retinopathy, as systemic vascular changes may also affect ophthalmic vasculature.
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Affiliation(s)
| | | | - Manisha Kar
- Department of Physiology, AIIMS, Bhubaneswar, Odisha, India
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López-Galán E, Vitón-Castillo AA, Carrazana-Escalona R, Planas-Rodriguez M, Fernández-García AA, Cutiño-Clavel I, Pascau-Simon A, Connes P, Sánchez-Hechavarría ME, Muñoz-Bustos GA. Autonomic and Vascular Responses during Reactive Hyperemia in Healthy Individuals and Patients with Sickle Cell Anemia. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1141. [PMID: 37374344 DOI: 10.3390/medicina59061141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/07/2023] [Accepted: 05/10/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: To compare autonomic and vascular responses during reactive hyperemia (RH) between healthy individuals and patients with sickle cell anemia (SCA). Materials and Methods: Eighteen healthy subjects and 24 SCA patients were subjected to arterial occlusion for 3 min at the lower right limb level. The pulse rate variability (PRV) and pulse wave amplitude were measured through photoplethysmography using the Angiodin® PD 3000 device, which was placed on the first finger of the lower right limb 2 min before (Basal) and 2 min after the occlusion. Pulse peak intervals were analyzed using time-frequency (wavelet transform) methods for high-frequency (HF: 0.15-0.4) and low-frequency (LF: 0.04-0.15) bands, and the LF/HF ratio was calculated. Results: The pulse wave amplitude was higher in healthy subjects compared to SCA patients, at both baseline and post-occlusion (p < 0.05). Time-frequency analysis showed that the LF/HF peak in response to the post-occlusion RH test was reached earlier in healthy subjects compared to SCA patients. Conclusions: Vasodilatory function, as measured by PPG, was lower in SCA patients compared to healthy subjects. Moreover, a cardiovascular autonomic imbalance was present in SCA patients with high sympathetic and low parasympathetic activity in the basal state and a poor response of the sympathetic nervous system to RH. Early cardiovascular sympathetic activation (10 s) and vasodilatory function in response to RH were impaired in SCA patients.
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Affiliation(s)
- Erislandis López-Galán
- Departamento de Ciencias Básicas Biomédicas, Facultad de Medicina, Universidad de Ciencias Médicas de Santiago de Cuba, Santiago de Cuba 90100, Cuba
| | - Adrián Alejandro Vitón-Castillo
- Facultad de Ciencias Médicas "Dr. Ernesto Che Guevara de la Serna", Universidad de Ciencias Médicas de Pinar del Rio, Pinar del Rio 20100, Cuba
| | - Ramón Carrazana-Escalona
- Departamento de Ciencias Clínicas Básicas, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile
| | - Maylet Planas-Rodriguez
- Departamento de Ciencias Básicas Biomédicas, Facultad de Medicina, Universidad de Ciencias Médicas de Santiago de Cuba, Santiago de Cuba 90100, Cuba
| | | | - Ileana Cutiño-Clavel
- Departamento de Ciencias Básicas Biomédicas, Facultad de Medicina, Universidad de Ciencias Médicas de Santiago de Cuba, Santiago de Cuba 90100, Cuba
| | - Alexander Pascau-Simon
- Hospital General "Dr. Juan Bruno Zayas Alfonso", Laboratorio Vascular no Invasivo, Santiago de Cuba 90400, Cuba
| | - Philippe Connes
- LIBM Laboratory, Team "Vascular Biology and Red Blood Cell", Claude Bernard University Lyon 1, 69622 Lyon, France
| | - Miguel Enrique Sánchez-Hechavarría
- Grupo Bio-Bio Complejidad, Departamento de Ciencias Clínicas y Preclínicas, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile
- Núcleo Científico de Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Adventista de Chile, Chillán 3780000, Chile
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Bogatu L, Turco S, Mischi M, Schmitt L, Woerlee P, Bezemer R, Bouwman AR, Korsten EHHM, Muehlsteff J. New Hemodynamic Parameters in Peri-Operative and Critical Care-Challenges in Translation. SENSORS (BASEL, SWITZERLAND) 2023; 23:2226. [PMID: 36850819 PMCID: PMC9961222 DOI: 10.3390/s23042226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Hemodynamic monitoring technologies are evolving continuously-a large number of bedside monitoring options are becoming available in the clinic. Methods such as echocardiography, electrical bioimpedance, and calibrated/uncalibrated analysis of pulse contours are becoming increasingly common. This is leading to a decline in the use of highly invasive monitoring and allowing for safer, more accurate, and continuous measurements. The new devices mainly aim to monitor the well-known hemodynamic variables (e.g., novel pulse contour, bioreactance methods are aimed at measuring widely-used variables such as blood pressure, cardiac output). Even though hemodynamic monitoring is now safer and more accurate, a number of issues remain due to the limited amount of information available for diagnosis and treatment. Extensive work is being carried out in order to allow for more hemodynamic parameters to be measured in the clinic. In this review, we identify and discuss the main sensing strategies aimed at obtaining a more complete picture of the hemodynamic status of a patient, namely: (i) measurement of the circulatory system response to a defined stimulus; (ii) measurement of the microcirculation; (iii) technologies for assessing dynamic vascular mechanisms; and (iv) machine learning methods. By analyzing these four main research strategies, we aim to convey the key aspects, challenges, and clinical value of measuring novel hemodynamic parameters in critical care.
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Affiliation(s)
- Laura Bogatu
- Biomedical Diagnostics Lab (BM/d), Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Patient Care and Measurements, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Simona Turco
- Biomedical Diagnostics Lab (BM/d), Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Massimo Mischi
- Biomedical Diagnostics Lab (BM/d), Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Lars Schmitt
- Patient Care and Measurements, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Pierre Woerlee
- Biomedical Diagnostics Lab (BM/d), Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Rick Bezemer
- Patient Care and Measurements, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Arthur R. Bouwman
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Ziekenhuis, 5623 EJ Eindhoven, The Netherlands
| | - Erik H. H. M. Korsten
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Ziekenhuis, 5623 EJ Eindhoven, The Netherlands
| | - Jens Muehlsteff
- Patient Care and Measurements, Philips Research, 5656 AE Eindhoven, The Netherlands
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Ibtehaz N, Mahmud S, Chowdhury MEH, Khandakar A, Salman Khan M, Ayari MA, Tahir AM, Rahman MS. PPG2ABP: Translating Photoplethysmogram (PPG) Signals to Arterial Blood Pressure (ABP) Waveforms. Bioengineering (Basel) 2022; 9:692. [PMID: 36421093 PMCID: PMC9687508 DOI: 10.3390/bioengineering9110692] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 08/13/2023] Open
Abstract
Cardiovascular diseases are one of the most severe causes of mortality, annually taking a heavy toll on lives worldwide. Continuous monitoring of blood pressure seems to be the most viable option, but this demands an invasive process, introducing several layers of complexities and reliability concerns due to non-invasive techniques not being accurate. This motivates us to develop a method to estimate the continuous arterial blood pressure (ABP) waveform through a non-invasive approach using Photoplethysmogram (PPG) signals. We explore the advantage of deep learning, as it would free us from sticking to ideally shaped PPG signals only by making handcrafted feature computation irrelevant, which is a shortcoming of the existing approaches. Thus, we present PPG2ABP, a two-stage cascaded deep learning-based method that manages to estimate the continuous ABP waveform from the input PPG signal with a mean absolute error of 4.604 mmHg, preserving the shape, magnitude, and phase in unison. However, the more astounding success of PPG2ABP turns out to be that the computed values of Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Systolic Blood Pressure (SBP) from the estimated ABP waveform outperform the existing works under several metrics (mean absolute error of 3.449 ± 6.147 mmHg, 2.310 ± 4.437 mmHg, and 5.727 ± 9.162 mmHg, respectively), despite that PPG2ABP is not explicitly trained to do so. Notably, both for DBP and MAP, we achieve Grade A in the BHS (British Hypertension Society) Standard and satisfy the AAMI (Association for the Advancement of Medical Instrumentation) standard.
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Affiliation(s)
- Nabil Ibtehaz
- Department of Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Sakib Mahmud
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | | | - Amith Khandakar
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | | | - Mohamed Arselene Ayari
- Department of Civil and Architectural Engineering, Qatar University, Doha 2713, Qatar
- Technology Innovation and Engineering Education Unit (TIEE), Qatar University, Doha 2713, Qatar
| | - Anas M. Tahir
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - M. Sohel Rahman
- Department of CSE, BUET, ECE Building, West Palashi, Dhaka 1205, Bangladesh
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Bogatu LI, Turco S, Mischi M, Woerlee P, Bouwman A, Korsten EHHM, Muehlsteff J. A modelling framework for assessment of arterial compliance by fusion of oscillometry and pulse wave velocity information. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 196:105492. [PMID: 32603986 DOI: 10.1016/j.cmpb.2020.105492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/29/2020] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Measurement of arterial compliance is recognized as important for clinical use and for enabling better understanding of circulatory system regulation mechanisms. Estimation of arterial compliance involves either a direct measure of the ratio between arterial volume and pressure changes or an inference from the pulse wave velocity (PWV). In this study we demonstrate an approach to assess arterial compliance by fusion of these two information sources. The approach is based on combining oscillometry as used for blood pressure inference and PWV measurements based on ECG/PPG. Enabling reliable arterial compliance measurements will contribute to the understanding of regulation mechanisms of the arterial tree, possibly establishing arterial compliance as a key measure relevant in hemodynamic monitoring. METHODS A measurement strategy, a physiological model, and a framework based on Bayesian principles are developed for measuring changes in arterial compliance based on combining oscillometry and PWV data. A simulation framework is used to study and validate the algorithm and measurement principle in detail, motivated by previous experimental findings. RESULTS Simulations demonstrate the possibility of inferring arterial compliance via fusion of simultaneously acquired volume/pressure relationships and PWV data. In addition, the simulation framework demonstrates how Bayesian principles can be used to handle low signal - to - noise ratio and partial information loss. CONCLUSIONS The developed simulation framework shows the feasibility of the proposed approach for assessment of arterial compliance by combining multiple data sources. This represents a first step towards integration of arterial compliance measurements in hemodynamic monitoring using existing clinical technology. The Bayesian approach is of particular relevance for such patient monitoring settings, where measurements are repeated frequently, context is relevant, and data is affected by artefacts. In addition, the simulation framework is necessary for future clinical-study design, in order to determine device specifications and the extent to which noise affects the inference process.
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Affiliation(s)
- Laura I Bogatu
- Patient Care and Measurements, Philips Research, Eindhoven, 5656 AE, Netherlands; Biomedical Diagnostics, Eindhoven University of Technology, Eindhoven, 5612 AZ, Netherlands.
| | - Simona Turco
- Biomedical Diagnostics, Eindhoven University of Technology, Eindhoven, 5612 AZ, Netherlands.
| | - Massimo Mischi
- Biomedical Diagnostics, Eindhoven University of Technology, Eindhoven, 5612 AZ, Netherlands.
| | - Pierre Woerlee
- Biomedical Diagnostics, Eindhoven University of Technology, Eindhoven, 5612 AZ, Netherlands.
| | | | | | - Jens Muehlsteff
- Patient Care and Measurements, Philips Research, Eindhoven, 5656 AE, Netherlands.
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Allen J. Quantifying the Delays Between Multi-Site Photoplethysmography Pulse and Electrocardiogram R-R Interval Changes Under Slow-Paced Breathing. Front Physiol 2019; 10:1190. [PMID: 31607946 PMCID: PMC6774289 DOI: 10.3389/fphys.2019.01190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 09/03/2019] [Indexed: 12/05/2022] Open
Abstract
Objective: Objective assessment of autonomic function is important, including the investigation of slow-paced breathing to induce associated periodic changes in the cardiovascular system – such as blood pressure and heart rate. However, pulse changes across a range of peripheral body sites have seldom been explored with this challenge. The primary aim of this pilot study was to utilize multi-site photoplethysmography (MPPG) technology to quantify the phase delays, i.e., correlation lags, between changes in heart rate and changes in key pulse features with slow-paced breathing (0.1 Hz). Methods: Waveforms were collected simultaneously from the right and left ear lobes, thumbs, and great toes of 18 healthy adult subjects. Cross correlation lags between reference beat-to-beat changes in electrocardiogram (ECG) R-R wave interval and changes in pulse arrival time (foot of pulse; PATf) and also for pulse amplitude (foot-to-peak; AMP) were determined. Results: Relative to R-R changes, the median ear, thumb, and toe PATf correlation lags were 3.4, 2.9, and 2.1 beats, respectively; contrasting to AMP with 5.7, 6.0, and 6.9 beats, respectively. These PATf correlation lags in beats were significantly lower than for the AMP measure. Segmental differences between sites and timing measure variability have also been quantified. Conclusion: This pilot study has indicated bilateral similarity plus segmental differences for relative delays in PPG pulse timing and amplitude measures relative to R-R interval changes with paced breathing. These correlation and variability data are now available for comparison with cardiovascular patient groups to support development of autonomic function assessment techniques.
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Affiliation(s)
- John Allen
- Microvascular Diagnostics, Northern Medical Physics and Clinical Engineering Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom.,Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
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Contribution of systemic vascular reactivity to variability in pulse volume amplitude response during reactive hyperemia. Eur J Appl Physiol 2019; 119:753-760. [PMID: 30637458 DOI: 10.1007/s00421-018-04066-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of the present study was to investigate why the magnitude of reactive hyperemia (RH) observed by pulse volume amplitude (PVA) after arm occlusion differs greatly among study subjects. METHODS Healthy subjects (n = 12) in the age range of 22-30 years participated in this study. Vascular reactivity was assessed by measuring the changes in finger PVA simultaneously in the test (occluded arm) and control arm (contralateral non-occluded arm) using two separate Photoplethysmographic sensors. Short-term HRV was computed from simultaneously acquired lead II ECG signal to monitor the changes in cardiac sympathetic nervous activity. RESULTS The observed coefficient of variation for inter-subject variability in PVA response in test arm during second minute of RH was 115.3%. In the control arm, significantly reduced PVA was observed during the period of occlusion as well as RH. This observation was corroborated by simultaneously acquired short-term HRV which showed a significant rise in total power (p value < 0.005) and low-frequency (LF) power (p value < 0.05) during release of occlusion when compared to the baseline. A significant positive correlation (Spearman r = 0.33; p = 0.02) was observed between % change in PVA in the control arm and in the test arm for first 3 min of RH. CONCLUSIONS Sympathetic activation possibly plays an important role in mediating the inter-subject variability of vascular responses during reactive hyperemia which warrants simultaneous recording of both the test and the control arm responses during RH to accurately assess endothelial function.
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Rajala S, Lindholm H, Taipalus T. Comparison of photoplethysmogram measured from wrist and finger and the effect of measurement location on pulse arrival time. Physiol Meas 2018; 39:075010. [DOI: 10.1088/1361-6579/aac7ac] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Carasca C, Magdas A, Tilea I, Incze A. Assessment of Post-Occlusive Reactive Hyperaemia in the Evaluation of Endothelial Function in Patients with Lower Extremity Artery Disease. ACTA MEDICA MARISIENSIS 2017. [DOI: 10.1515/amma-2017-0024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background: The aim was to assess endothelial function with photoplethysmography (PPG), by post-occlusive reactive hyperaemia (PORH) combined with alprostadil challenge test in patients with peripheral artery disease (PAD).
Methods: Forty-nine PAD patients stage II-III Fontaine (39 male, 10 female, mean age 68.45±5.86 years) and a control group of 49 healthy individuals (24 male, 25 female; mean age 25.1±3.8 for a young subgroup; 71.0±0.16 years for an elderly subgroup) were included. Ankle-brachial index (ABI) was assessed at baseline, peripheral perfusion (PP) and PORH were assessed at baseline and after the 30 minutes administration of parenteral alprostadil.
Results: After 3 minutes of arterial occlusion, peripheral perfusion increased from 0.69±0.94 mV/V to 2.27±2.42 mV/V (p<0.0001). After alprostadil challenge, peripheral perfusion increased from 0.84±1.24 mV/V to 4.52±3.52 mV/V (p<0.0001). In controls PP was 2.4±1.7 mV/V versus 3.8±1.5 mV/V, p<0.0001.
Conclusion: In patients with PAD, an increase in PORH after alprostadil challenge due to the release of nitric oxide (NO), provides information on the endothelial function and could reflect the presence of collaterals. In the healthy control group, the increase in PORH could reflect the integrity of main arterial branch. In PAD patients with an increase in PORH, conservative therapy should be preferred over surgical revascularisation.
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Affiliation(s)
- Cosmin Carasca
- University of Medicine and Pharmacy of Tirgu Mureş , Romania
| | - Annamaria Magdas
- Department of Internal Medicine IV , University of Medicine and Pharmacy of Tirgu Mureş , Romania
| | - Ioan Tilea
- Cardiovascular Rehabilitation Clinic, Department of Family Medicine, Institute of Cardiovascular Diseases and Transplantation Tîrgu-Mures, Romania , University of Medicine and Pharmacy of Tirgu Mureş , Romania
| | - Alexandru Incze
- Department of Internal Medicine IV , University of Medicine and Pharmacy of Tirgu Mureş , Romania
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Ubolsakka-Jones C, Sangthong B, Aueyingsak S, Jones DA. Older Women with Controlled Isolated Systolic Hypertension: Exercise and Blood Pressure. Med Sci Sports Exerc 2017; 48:983-9. [PMID: 26807635 DOI: 10.1249/mss.0000000000000883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Exercise is generally regarded as beneficial for health, but the consequent increases in blood pressure might pose a risk for hypertensive subjects. The purpose of this study was to determine blood pressure responses to dynamic exercise and sustained handgrip in patients with isolated systolic hypertension (ISH) who were stable on medication. METHODS Nineteen female ISH patients (66 ± 5 yr) and 19 age-matched normotensive (NT) female controls undertook a 5-min cycle exercise (60% heart rate reserve [HRR]) and a 2-min handgrip exercise (30% maximum voluntary contraction). Blood pressure responses were measured using an oscillometric cuff, together with heart rate and resting brachial pulse transit times. RESULTS Systolic blood pressure (SBP) levels after cycle exercise were 194 ± 18 and 153 ± 19 mm Hg for ISH and NT, respectively, with the increase above resting being greater for ISH (P < 0.001), and only small changes were found in diastolic blood pressure (DBP). During handgrip exercise, SBP rose to 168 ± 19 and 140 ± 8 mm Hg for ISH and NT, respectively. The increases above baseline were greater for ISH both during the exercise and postexercise circulatory occlusion (P = 0.017). The increase in DBP levels during exercise and postexercise occlusion were similar in ISH and NT, suggesting little difference in metaboreflex sensitivity. Pulse transit time was shorter for ISH compared with NT (166 ± 6 ms and 242 ± 24 ms, respectively, P < 0.001), indicating stiffer arteries, which would increase SBP but not DBP. CONCLUSION Despite being well controlled and normotensive control subjects at rest, ISH patients had high SBP responses to both dynamic and static exercises, which may constitute a risk for cardiovascular incidents.
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Affiliation(s)
- Chulee Ubolsakka-Jones
- 1School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, THAILAND; 2Faculty of Physical Therapy, Rungsit University, THAILAND; and 3School of Healthcare Science, Manchester Metropolitan University, ENGLAND
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Timimi AAK, Ali MAM, Chellappan K. A Novel AMARS Technique for Baseline Wander Removal Applied to Photoplethysmogram. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2017; 11:627-639. [PMID: 28489546 DOI: 10.1109/tbcas.2017.2649940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A new digital filter, AMARS (aligning minima of alternating random signal) has been derived using trigonometry to regulate signal pulsations inline. The pulses are randomly presented in continuous signals comprising frequency band lower than the signal's mean rate. Frequency selective filters are conventionally employed to reject frequencies undesired by specific applications. However, these conventional filters only reduce the effects of the rejected range producing a signal superimposed by some baseline wander (BW). In this work, filters of different ranges and techniques were independently configured to preprocess a photoplethysmogram, an optical biosignal of blood volume dynamics, producing wave shapes with several BWs. The AMARS application effectively removed the encountered BWs to assemble similarly aligned trends. The removal implementation was found repeatable in both ear and finger photoplethysmograms, emphasizing the importance of BW removal in biosignal processing in retaining its structural, functional and physiological properties. We also believe that AMARS may be relevant to other biological and continuous signals modulated by similar types of baseline volatility.
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van Velzen MHN, Loeve AJ, Niehof SP, Mik EG. Increasing accuracy of pulse transit time measurements by automated elimination of distorted photoplethysmography waves. Med Biol Eng Comput 2017; 55:1989-2000. [PMID: 28361357 PMCID: PMC5644691 DOI: 10.1007/s11517-017-1642-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 03/20/2017] [Indexed: 11/03/2022]
Abstract
Photoplethysmography (PPG) is a widely available non-invasive optical technique to visualize pressure pulse waves (PWs). Pulse transit time (PTT) is a physiological parameter that is often derived from calculations on ECG and PPG signals and is based on tightly defined characteristics of the PW shape. PPG signals are sensitive to artefacts. Coughing or movement of the subject can affect PW shapes that much that the PWs become unsuitable for further analysis. The aim of this study was to develop an algorithm that automatically and objectively eliminates unsuitable PWs. In order to develop a proper algorithm for eliminating unsuitable PWs, a literature study was conducted. Next, a '7Step PW-Filter' algorithm was developed that applies seven criteria to determine whether a PW matches the characteristics required to allow PTT calculation. To validate whether the '7Step PW-Filter' eliminates only and all unsuitable PWs, its elimination results were compared to the outcome of manual elimination of unsuitable PWs. The '7Step PW-Filter' had a sensitivity of 96.3% and a specificity of 99.3%. The overall accuracy of the '7Step PW-Filter' for detection of unsuitable PWs was 99.3%. Compared to manual elimination, using the '7Step PW-Filter' reduces PW elimination times from hours to minutes and helps to increase the validity, reliability and reproducibility of PTT data.
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Affiliation(s)
- Marit H N van Velzen
- Department of Anesthesiology, Laboratory of Experimental Anesthesiology, Erasmus University Medical Center, Room Ee2381, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Arjo J Loeve
- Department of BioMechanical Engineering, Faculty 3mE, Delft University of Technology, Delft, The Netherlands
| | - Sjoerd P Niehof
- Department of Anesthesiology, Laboratory of Experimental Anesthesiology, Erasmus University Medical Center, Room Ee2381, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Egbert G Mik
- Department of Anesthesiology, Laboratory of Experimental Anesthesiology, Erasmus University Medical Center, Room Ee2381, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Khare P, Talwar A, Chandran D, Guleria R, Jaryal AK, Kumar G, Trivedi A, Deepak KK. Impaired systemic vascular reactivity & raised high-sensitivity C reactive protein levels in chronic obstructive pulmonary disease. Indian J Med Res 2016; 143:205-12. [PMID: 27121518 PMCID: PMC4859129 DOI: 10.4103/0971-5916.180209] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES Chronic obstructive pulmonary disease (COPD) is characterized by slowly progressive airflow limitaion, chronic lung inflammation and associated systemic manifestations. The objective of this preliminary study was to investigate the levels of high sensitivity C reactive protein (hs CRP) and tumour necrosis factor-α (TNF-α) as markers of systemic inflammation and assessment of systemic vascular reactivity that may play an important role in development of cardiovascular disease in COPD patients. METHODS Systemic vascular reactivity was assessed non-invasively by measuring peripheral pulse waveform changes during reactive hyperemia (RH) in 16 COPD patients and 14 controls by photoplethysmography technique (PPG). Parameters measured were pulse wave amplitude (PWA), slope and pulse transit time (PTT). Tumour necrosis factor-α (TNF-α) and hs CRP were measured as markers of inflammation. RESULTS PWA during the 1 st , 2 nd and 3 rd minutes post release of occlusion were significantly higher than the baseline means in controls, whereas in the patient group there was no significant change in the PWA during any of the observed time periods following release of occlusion, in comparison to the baseline means. Similar results were observed in slope values for patients and controls. Maximum percentage change in PWA during RH with reference to baseline was significantly lower in patients as compared to controls (26.78±20.19 vs 57.20±19.80%, p<0.001). Maximum percentage change in slope during RH with reference to baseline was significantly lower in patients as compared to controls (19.77±10.73 vs 39.25±13.49%, P<0.001). A vascular tone response as represented by PTT was also impaired in the 3 rd minute of RH as compared to baseline mean values in COPD patients only. INTERPRETATION & CONCLUSIONS Our findings showed raised hs CRP levels and impaired systemic vascular reactivity in COPD patients. Whether these may increase the risk of cardiovascular disease in COPD patients need to be confirmed in future studies with large sample size and appropriate study design.
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Affiliation(s)
| | - Anjana Talwar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Investigation of peripheral photoplethysmographic morphology changes induced during a hand-elevation study. J Clin Monit Comput 2015; 30:727-36. [PMID: 26318315 DOI: 10.1007/s10877-015-9761-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/23/2015] [Indexed: 10/23/2022]
Abstract
A hand-elevation study was carried out in the laboratory in order to alter peripheral blood flow with the aim of increasing understanding of factors affecting the morphology of peripheral photoplethysmographic signals. Photoplethysmographic (PPG) signals were recorded from twenty healthy volunteer subjects during a hand-elevation study in which the right hand was raised and lowered relative to heart level, while the left hand remained static. Red and infrared (IR) PPG signals were obtained from the right and left index fingers using a custom-made PPG processing system. PPG features were identified using a feature-detection algorithm based on the first derivative of the PPG signal. The systolic PPG amplitude, the reflection index, crest time, pulse width at half height, and delta T were calculated from 20 s IR PPG signals from three positions of the right hand with respect to heart level (-50, 0, +50 cm) in 19 volunteers. PPG features were found to change with hand elevation. On lowering the hand to 50 cm below heart level, ac systolic PPG amplitudes from the finger decreased by 68.32 %, while raising the arm increased the systolic amplitude by 69.99 %. These changes in amplitude were attributed to changes in hydrostatic pressure and the veno-arterial reflex. Other morphological variables, such as crest time, were found to be statistically significantly different across hand positions, indicating increased vascular resistance on arm elevation than on dependency. It was hypothesized that these morphological PPG changes were influenced by changes in downstream venous resistance, rather than arterial, or arteriolar, resistance. Changes in hand position relative to heart level can significantly affect the morphology of the peripheral ac PPG waveform. These alterations are due to a combination of physical effects and physiological responses to changes in hand position, which alter vascular resistance. Care should be taken when interpreting morphological data derived from PPG signals and methods should be standardized to take these effects into account.
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Mashayekhi G, Zahedi E, Movahedian Attar H, Sharifi F. Flow mediated dilation with photoplethysmography as a substitute for ultrasonic imaging. Physiol Meas 2015; 36:1551-71. [PMID: 26057334 DOI: 10.1088/0967-3334/36/7/1551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Flow mediated dilation (FMD) is a non-invasive method for endothelial function assessment providing an index extracted from ultrasonic B-mode images. Although utilized in the research community, the difficulty of its application and high cost of ultrasonic devices prevent it from being widely used in clinical settings. In this study we show that substituting the ultrasonic device with more easily handled and low cost photoplethysmography and electrocardiography is possible. We introduce new indices based on the photoplethysmogram (PPG) and electrocardiogram (ECG) and show that they are correlated with the ultrasound-based FMD Index. To this end, a conventional ultrasound FMD test was carried out whereas PPG and ECG were simultaneously recorded from 20 healthy volunteers (13 M, 7 F) in the age range of 23-32 years. Our results show a significant correlation between our proposed index and ultrasound FMD when using the ECG in conjunction with the PPG (R = 0.77, p < 0.000 01). Using the PPG alone produces a lower correlation (R = 0.72, p < 0.0001). Compared to conventional FMD, the proposed method is low cost and does not require any special operator skills. Hence it may be easily utilized as a screening tool in locations deprived of high-end ultrasound imaging devices.
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Affiliation(s)
- G Mashayekhi
- Biomedical Engineering Lab., School of Electrical Engineering, Sharif University of Technology, Tehran, Iran
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Discrimination between different degrees of coronary artery disease using time-domain features of the finger photoplethysmogram in response to reactive hyperemia. Biomed Signal Process Control 2015. [DOI: 10.1016/j.bspc.2014.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chang K, Yoon S, Sheth N, Seidel M, Antalek M, Ahad J, Darlington T, Ikeda A, Kato GJ, Ackerman H, Gorbach AM. Rapid vs. delayed infrared responses after ischemia reveal recruitment of different vascular beds. QUANTITATIVE INFRARED THERMOGRAPHY JOURNAL 2015; 12:173-183. [PMID: 26435756 PMCID: PMC4589278 DOI: 10.1080/17686733.2015.1046677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Continuous infrared imaging revealed transient changes in forearm temperature during arterial occlusion, reperfusion, and recovery in a healthy subject group. Processing the imaging data with the k-means algorithm further revealed reactive vascular sites in the skin with rapid or delayed temperature amplification. The observed temporal and spatial diversity of blood-flow-derived forearm temperature allow consideration of thermal-imaging guided placement of skin sensors to achieve enhanced sensitivity in monitoring of skin hemodynamics.
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Affiliation(s)
- Ken Chang
- Infrared Imaging and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Stephen Yoon
- Infrared Imaging and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Niral Sheth
- Infrared Imaging and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Miles Seidel
- Infrared Imaging and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Antalek
- Infrared Imaging and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - James Ahad
- Infrared Imaging and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Thomas Darlington
- Infrared Imaging and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Allison Ikeda
- The Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Gregory J. Kato
- The Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Division of Hematology/Oncology, Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hans Ackerman
- The Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Alexander M. Gorbach
- Infrared Imaging and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
- Corresponding author.
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Keikhosravi A, Aghajani H, Zahedi E. Discrimination of bilateral finger photoplethysmogram responses to reactive hyperemia in diabetic and healthy subjects using a differential vascular model framework. Physiol Meas 2013; 34:513-25. [DOI: 10.1088/0967-3334/34/5/513] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Chandran DS, Jaryal AK, Jyotsna VP, Deepak KK. Impaired endothelium mediated vascular reactivity in endogenous Cushing's syndrome. Endocr J 2011; 58:789-99. [PMID: 21778615 DOI: 10.1507/endocrj.ej11-0030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Endogenous Cushing's syndrome (CS) is associated with a high incidence of cardiovascular morbidity and mortality resulting from the co-existence of multiple cardiovascular risk factors which probably induce a state of endothelial dysfunction. Recently, studies conducted in vitro as well as in normal human subjects suggest a direct role of cortisol in the causation of vascular dysfunction in this disorder. We non-invasively assessed the vascular reactivity and its potential association with elevated cortisol levels in patients of CS. A single time point observational study was conducted in 18 patients of CS and 15 age and gender matched healthy subjects. Vascular reactivity was assessed non-invasively by measuring the peripheral pulse wave form changes during reactive hyperemia (RH) using digital photoplethysmography (PPG). Parameters measured were pulse wave form amplitude (PWA), slope and pulse transit time (PTT). Maximal percentage changes in PWA during RH with reference to baseline were significantly lower in the patients as compared to controls [23.19% (13.19-53.54) vs 61.71% (38.21-95.36); p=0.0079]. Normalized PTT responses during the 1(st) minute of RH were blunted in the patients as compared to controls (1.036 ± 0.026 vs 1.056 ± 0.029; p=0.0425). Percentage changes in PTT during the 2(nd) minute of RH were negatively correlated to the morning cortisol levels in patients (r = -0.6328; p=0.0064). The present study showed that endothelium mediated vascular reactivity along with myogenic regulation of vascular tone is impaired in CS. Hypercortisolism possibly plays an important role in the causation of impaired vascular reactivity and endothelial dysfunction in CS.
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Affiliation(s)
- Dinu S Chandran
- Department of Physiology, All India Institute of Medical Sciences, Ansari Nagal, New Delhi, India
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