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Henry B, Merz M, Hoang H, Abdulkarim G, Wosik J, Schoettker P. Cuffless Blood Pressure in clinical practice: challenges, opportunities and current limits. Blood Press 2024; 33:2304190. [PMID: 38245864 DOI: 10.1080/08037051.2024.2304190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/07/2024] [Indexed: 01/22/2024]
Abstract
Background: Cuffless blood pressure measurement technologies have attracted significant attention for their potential to transform cardiovascular monitoring.Methods: This updated narrative review thoroughly examines the challenges, opportunities, and limitations associated with the implementation of cuffless blood pressure monitoring systems.Results: Diverse technologies, including photoplethysmography, tonometry, and ECG analysis, enable cuffless blood pressure measurement and are integrated into devices like smartphones and smartwatches. Signal processing emerges as a critical aspect, dictating the accuracy and reliability of readings. Despite its potential, the integration of cuffless technologies into clinical practice faces obstacles, including the need to address concerns related to accuracy, calibration, and standardization across diverse devices and patient populations. The development of robust algorithms to mitigate artifacts and environmental disturbances is essential for extracting clear physiological signals. Based on extensive research, this review emphasizes the necessity for standardized protocols, validation studies, and regulatory frameworks to ensure the reliability and safety of cuffless blood pressure monitoring devices and their implementation in mainstream medical practice. Interdisciplinary collaborations between engineers, clinicians, and regulatory bodies are crucial to address technical, clinical, and regulatory complexities during implementation. In conclusion, while cuffless blood pressure monitoring holds immense potential to transform cardiovascular care. The resolution of existing challenges and the establishment of rigorous standards are imperative for its seamless incorporation into routine clinical practice.Conclusion: The emergence of these new technologies shifts the paradigm of cardiovascular health management, presenting a new possibility for non-invasive continuous and dynamic monitoring. The concept of cuffless blood pressure measurement is viable and more finely tuned devices are expected to enter the market, which could redefine our understanding of blood pressure and hypertension.
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Affiliation(s)
- Benoit Henry
- Service of Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Maxime Merz
- Service of Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Harry Hoang
- Service of Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ghaith Abdulkarim
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jedrek Wosik
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Patrick Schoettker
- Service of Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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2
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Wong KFM, Huang W, Ee DYH, Ng EYK. Design and validation of dual-point time-differentiated photoplethysmogram (2PPG) wearable for cuffless blood pressure estimation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 253:108251. [PMID: 38824806 DOI: 10.1016/j.cmpb.2024.108251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/02/2024] [Accepted: 05/24/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND & OBJECTIVES Measurement of blood pressure (BP) in ambulatory patients is crucial for at high-risk cardiovascular patients. A non-obtrusive, non-occluding device that continuously measures BP via photoplethysmography will enable long-term ambulatory assessment of BP. The aim of this study is to validate the metasense 2PPG cuffless wearable design for continuous BP estimation without ECG. METHODS A customized high-speed electronic optical sensor architecture with laterally spaced reflectance pulse oximetry was designed into a simple unobtrusive low-power wearable in the form of a watch. 78 volunteers with a mean age of 32.72 ± 7.4 years (21 to 64), 51% male, 49% female were recruited with ECG-2PPG signals acquired. The fiducial features of the 2PPG morphologies were then attributed to the estimator. A 9-1 K-fold cross-validation was applied in the ML. RESULTS The correlation for PTT-SBP was 0.971 and for PTT-DBP was 0.954. The mean absolute error was 3.167±1.636 mmHg for SBP and 6.4 ± 3.9 mm Hg for DBP. The ambulatory estimate for SBP and DBP for an individual over 3 days with 8-hour recordings was 0.70-0.81 for SBP and 0.42-0.51 for DBP with a ± 2.65 mmHg for SBP and ±2.02 mmHg for DBP. For SBP, 98% of metasense measurements were within 15 mm Hg and for DBP, 91% of metasense measurements were within 10 mmHg CONCLUSIONS: The metasense device provides continuous, non-invasive BP estimations that are comparable to ambulatory BP meters. The portability and unobtrusiveness of this device, as well as the ability to continuously measure BP could one day enable long-term ambulatory BP measurement for precision cardiovascular therapeutic regimens.
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Affiliation(s)
- Kei Fong Mark Wong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University (NTU), Singapore
| | | | | | - Eddie Yin Kwee Ng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University (NTU), Singapore.
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3
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Li J, Chu H, Chen Z, Yiu CK, Qu Q, Li Z, Yu X. Recent Advances in Materials, Devices and Algorithms Toward Wearable Continuous Blood Pressure Monitoring. ACS NANO 2024; 18:17407-17438. [PMID: 38923501 DOI: 10.1021/acsnano.4c04291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Continuous blood pressure (BP) tracking provides valuable insights into the health condition and functionality of the heart, arteries, and overall circulatory system of humans. The rapid development in flexible and wearable electronics has significantly accelerated the advancement of wearable BP monitoring technologies. However, several persistent challenges, including limited sensing capabilities and stability of flexible sensors, poor interfacial stability between sensors and skin, and low accuracy in BP estimation, have hindered the progress in wearable BP monitoring. To address these challenges, comprehensive innovations in materials design, device development, system optimization, and modeling have been pursued to improve the overall performance of wearable BP monitoring systems. In this review, we highlight the latest advancements in flexible and wearable systems toward continuous noninvasive BP tracking with a primary focus on materials development, device design, system integration, and theoretical algorithms. Existing challenges, potential solutions, and further research directions are also discussed to provide theoretical and technical guidance for the development of future wearable systems in continuous ambulatory BP measurement with enhanced sensing capability, robustness, and long-term accuracy.
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Affiliation(s)
- Jian Li
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Hongwei Chu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Shenzhen Key Laboratory of Flexible Printed Electronics Technology, School of Science, Harbin Institute of Technology (Shenzhen), Shenzhen, 518055, China
| | - Zhenlin Chen
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Chun Ki Yiu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Qing'ao Qu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Zhiyuan Li
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Xinge Yu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
- City University of Hong Kong Shenzhen Research Institute, Shenzhen 518057, China
- Hong Kong Institute for Clean Energy, City University of Hong Kong, Kowloon, Hong Kong, China
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Liu ZD, Li Y, Zhang YT, Zeng J, Chen ZX, Liu JK, Miao F. HGCTNet: Handcrafted Feature-Guided CNN and Transformer Network for Wearable Cuffless Blood Pressure Measurement. IEEE J Biomed Health Inform 2024; 28:3882-3894. [PMID: 38687656 DOI: 10.1109/jbhi.2024.3395445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Biosignals collected by wearable devices, such as electrocardiogram and photoplethysmogram, exhibit redundancy and global temporal dependencies, posing a challenge in extracting discriminative features for blood pressure (BP) estimation. To address this challenge, we propose HGCTNet, a handcrafted feature-guided CNN and transformer network for cuffless BP measurement based on wearable devices. By leveraging convolutional operations and self-attention mechanisms, we design a CNN-Transformer hybrid architecture to learn features from biosignals that capture both local information and global temporal dependencies. Then, we introduce a handcrafted feature-guided attention module that utilizes handcrafted features extracted from biosignals as query vectors to eliminate redundant information within the learned features. Finally, we design a feature fusion module that integrates the learned features, handcrafted features, and demographics to enhance model performance. We validate our approach using two large wearable BP datasets: the CAS-BP dataset and the Aurora-BP dataset. Experimental results demonstrate that HGCTNet achieves an estimation error of 0.9 ± 6.5 mmHg for diastolic BP (DBP) and 0.7 ± 8.3 mmHg for systolic BP (SBP) on the CAS-BP dataset. On the Aurora-BP dataset, the corresponding errors are -0.4 ± 7.0 mmHg for DBP and -0.4 ± 8.6 mmHg for SBP. Compared to the current state-of-the-art approaches, HGCTNet reduces the mean absolute error of SBP estimation by 10.68% on the CAS-BP dataset and 9.84% on the Aurora-BP dataset. These results highlight the potential of HGCTNet in improving the performance of wearable cuffless BP measurements.
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Liu L, Lu H, Whelan M, Chen Y, Ding X. CiGNN: A Causality-Informed and Graph Neural Network Based Framework for Cuffless Continuous Blood Pressure Estimation. IEEE J Biomed Health Inform 2024; 28:2674-2686. [PMID: 38478458 PMCID: PMC11100861 DOI: 10.1109/jbhi.2024.3377128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/27/2024] [Accepted: 03/04/2024] [Indexed: 05/07/2024]
Abstract
Causalityholds profound potentials to dissipate confusion and improve accuracy in cuffless continuous blood pressure (BP) estimation, an area often neglected in current research. In this study, we propose a two-stage framework, CiGNN, that seamlessly integrates causality and graph neural network (GNN) for cuffless continuous BP estimation. The first stage concentrates on the generation of a causal graph between BP and wearable features from the the perspective of causal inference, so as to identify features that are causally related to BP variations. This stage is pivotal for the identification of novel causal features from the causal graph beyond pulse transit time (PTT). We found these causal features empower better tracking in BP changes compared to PTT. For the second stage, a spatio-temporal GNN (STGNN) is utilized to learn from the causal graph obtained from the first stage. The STGNN can exploit both the spatial information within the causal graph and temporal information from beat-by-beat cardiac signals for refined cuffless continuous BP estimation. We evaluated the proposed method with three datasets that include 305 subjects (102 hypertensive patients) with age ranging from 20-90 and BP at different levels, with the continuous Finapres BP as references. The mean absolute difference (MAD) for estimated systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 3.77 mmHg and 2.52 mmHg, respectively, which outperformed comparison methods. In all cases including subjects with different age groups, while doing various maneuvers that induces BP changes at different levels and with or without hypertension, the proposed CiGNN method demonstrates superior performance for cuffless continuous BP estimation. These findings suggest that the proposed CiGNN is a promising approach in elucidating the causal mechanisms of cuffless BP estimation and can substantially enhance the precision of BP measurement.
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Affiliation(s)
- Lei Liu
- School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengdu611731China
| | - Huiqi Lu
- Institute of Biomedical EngineeringUniversity of OxfordOX1 2JDOxfordU.K.
| | - Maxine Whelan
- Centre for Healthcare and CommunitiesCoventry UniversityCV1 5FBCoventryU.K.
| | - Yifan Chen
- School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengdu611731China
| | - Xiaorong Ding
- School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengdu611731China
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6
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Slapničar G, Wang W, Luštrek M. Generalized channel separation algorithms for accurate camera-based multi-wavelength PTT and BP estimation. BIOMEDICAL OPTICS EXPRESS 2024; 15:3128-3146. [PMID: 38855660 PMCID: PMC11161386 DOI: 10.1364/boe.518562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 06/11/2024]
Abstract
Single-site multi-wavelength (MW) pulse transit time (PTT) measurement was recently proposed using contact sensors with sequential illumination. It leverages different penetration depths of light to measure the traversal of a cardiac pulse between skin layers. This enabled continuous single-site MW blood pressure (BP) monitoring, but faces challenges like subtle skin compression, which importantly influences the PPG morphology and subsequent PTT. We extended this idea to contact-free camera-based sensing and identified the major challenge of color channel overlap, which causes the signals obtained from a consumer RGB camera to be a mixture of responses in different wavelengths, thus not allowing for meaningful PTT measurement. To address this, we propose novel camera-independent data-driven channel separation algorithms based on constrained genetic algorithms. We systematically validated the algorithms on camera recordings of palms and corresponding ground-truth BP measurements of 13 subjects in two different scenarios, rest and activity. We compared the proposed algorithms against established blind source separation methods and against previous camera-specific physics-based method, showing good performance in both PTT reconstruction and BP estimation using a Random Forest regressor. The best-performing algorithm achieved mean absolute errors (MAEs) of 3.48 and 2.61 mmHg for systolic and diastolic BP in a leave-one-subject-out experiment with personalization, solidifying the proposed algorithms as enablers of novel contact-free MW PTT and BP estimation.
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Affiliation(s)
- Gašper Slapničar
- Department of Intelligent Systems, Jožef Stefan Institute, Jamova cesta 39, 1000 Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Jamova cesta 39, 1000 Ljubljana, Slovenia
| | - Wenjin Wang
- Biomedical Engineering Department, Southern University of Science and Technology, 1088 Xueyuan Blvd, Nanshan, Shenzhen, Guangdong, China
| | - Mitja Luštrek
- Department of Intelligent Systems, Jožef Stefan Institute, Jamova cesta 39, 1000 Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Jamova cesta 39, 1000 Ljubljana, Slovenia
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Dong S, Wang Q, Wang S, Zhou C, Wang H. Hypotension prediction index for the prevention of hypotension during surgery and critical care: A narrative review. Comput Biol Med 2024; 170:107995. [PMID: 38325215 DOI: 10.1016/j.compbiomed.2024.107995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/17/2023] [Accepted: 01/13/2024] [Indexed: 02/09/2024]
Abstract
Surgeons and anesthesia clinicians commonly face a hemodynamic disturbance known as intraoperative hypotension (IOH), which has been linked to more severe postoperative outcomes and increases mortality rates. Increased occurrence of IOH has been positively associated with mortality and incidence of myocardial infarction, stroke, and organ dysfunction hypertension. Hence, early detection and recognition of IOH is meaningful for perioperative management. Currently, when hypotension occurs, clinicians use vasopressor or fluid therapy to intervene as IOH develops but interventions should be taken before hypotension occurs; therefore, the Hypotension Prediction Index (HPI) method can be used to help clinicians further react to the IOH process. This literature review evaluates the HPI method, which can reliably predict hypotension several minutes before a hypotensive event and is beneficial for patients' outcomes.
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Affiliation(s)
- Siwen Dong
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Qing Wang
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - Shuai Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Congcong Zhou
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Hongwei Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China; Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China.
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8
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Yao C, Sun T, Huang S, He M, Liang B, Shen Z, Huang X, Liu Z, Wang H, Liu F, Chen HJ, Xie X. Personalized Machine Learning-Coupled Nanopillar Triboelectric Pulse Sensor for Cuffless Blood Pressure Continuous Monitoring. ACS NANO 2023; 17:24242-24258. [PMID: 37983291 DOI: 10.1021/acsnano.3c09766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
A wearable system that can continuously track the fluctuation of blood pressure (BP) based on pulse signals is highly desirable for the treatments of cardiovascular diseases, yet the sensitivity, reliability, and accuracy remain challenging. Since the correlations of pulse waveforms to BP are highly individualized due to the diversity of the patients' physiological characteristics, wearable sensors based on universal designs and algorithms often fail to derive BP accurately when applied on individual patients. Herein, a wearable triboelectric pulse sensor based on a biomimetic nanopillar layer was developed and coupled with Personalized Machine Learning (ML) to provide accurate and continuous monitoring of BP. Flexible conductive nanopillars as the triboelectric layer were fabricated through soft lithography replication of a cicada wing, which could effectively enhance the sensor's output performance to detect weak signal characteristics of pulse waveform for BP derivation. The sensors were coupled with a personalized Partial Least-Squares Regression (PLSR) ML to derive unknown BP based on individual pulse characteristics with reasonable accuracy, avoiding the issue of individual variability that was encountered by General PLSR ML or formula algorithms. The cuffless and intelligent design endow this ML-sensor as a highly promising platform for the care and treatments of hypertensive patients.
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Affiliation(s)
- Chuanjie Yao
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Tiancheng Sun
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Shuang Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Mengyi He
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Baoming Liang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Zhiran Shen
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Xinshuo Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Zhengjie Liu
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - HaoLin Wang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Fanmao Liu
- The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou 510080, China
| | - Hui-Jiuan Chen
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Xi Xie
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
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9
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Mohammed H, Chen HB, Li Y, Sabor N, Wang JG, Wang G. Meta-Analysis of Pulse Transition Features in Non-Invasive Blood Pressure Estimation Systems: Bridging Physiology and Engineering Perspectives. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2023; 17:1257-1281. [PMID: 38015673 DOI: 10.1109/tbcas.2023.3334960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The pulse transition features (PTFs), including pulse arrival time (PAT) and pulse transition time (PTT), hold significant importance in estimating non-invasive blood pressure (NIBP). However, the literature showcases considerable variations in terms of PTFs' correlation with blood pressure (BP), accuracy in NIBP estimation, and the comprehension of the relationship between PTFs and BP. This inconsistency is exemplified by the wide-ranging correlations reported across studies investigating the same feature. Furthermore, investigations comparing PAT and PTT have yielded conflicting outcomes. Additionally, PTFs have been derived from various bio-signals, capturing distinct characteristic points like the pulse's foot and peak. To address these inconsistencies, this study meticulously reviews a selection of such research endeavors while aligning them with the biological intricacies of blood pressure and the human cardiovascular system (CVS). Each study underwent evaluation, considering the specific signal acquisition locale and the corresponding recording procedure. Moreover, a comprehensive meta-analysis was conducted, yielding multiple conclusions that could significantly enhance the design and accuracy of NIBP systems. Grounded in these dual aspects, the study systematically examines PTFs in correlation with the specific study conditions and the underlying factors influencing the CVS. This approach serves as a valuable resource for researchers aiming to optimize the design of BP recording experiments, bio-signal acquisition systems, and the fine-tuning of feature engineering methodologies, ultimately advancing PTF-based NIBP estimation.
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Charlton PH, Allen J, Bailón R, Baker S, Behar JA, Chen F, Clifford GD, Clifton DA, Davies HJ, Ding C, Ding X, Dunn J, Elgendi M, Ferdoushi M, Franklin D, Gil E, Hassan MF, Hernesniemi J, Hu X, Ji N, Khan Y, Kontaxis S, Korhonen I, Kyriacou PA, Laguna P, Lázaro J, Lee C, Levy J, Li Y, Liu C, Liu J, Lu L, Mandic DP, Marozas V, Mejía-Mejía E, Mukkamala R, Nitzan M, Pereira T, Poon CCY, Ramella-Roman JC, Saarinen H, Shandhi MMH, Shin H, Stansby G, Tamura T, Vehkaoja A, Wang WK, Zhang YT, Zhao N, Zheng D, Zhu T. The 2023 wearable photoplethysmography roadmap. Physiol Meas 2023; 44:111001. [PMID: 37494945 PMCID: PMC10686289 DOI: 10.1088/1361-6579/acead2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/04/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023]
Abstract
Photoplethysmography is a key sensing technology which is used in wearable devices such as smartwatches and fitness trackers. Currently, photoplethysmography sensors are used to monitor physiological parameters including heart rate and heart rhythm, and to track activities like sleep and exercise. Yet, wearable photoplethysmography has potential to provide much more information on health and wellbeing, which could inform clinical decision making. This Roadmap outlines directions for research and development to realise the full potential of wearable photoplethysmography. Experts discuss key topics within the areas of sensor design, signal processing, clinical applications, and research directions. Their perspectives provide valuable guidance to researchers developing wearable photoplethysmography technology.
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Affiliation(s)
- Peter H Charlton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, United Kingdom
- Research Centre for Biomedical Engineering, City, University of London, London, EC1V 0HB, United Kingdom
| | - John Allen
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5RW, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Raquel Bailón
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Stephanie Baker
- College of Science and Engineering, James Cook University, Cairns, 4878 Queensland, Australia
| | - Joachim A Behar
- Faculty of Biomedical Engineering, Technion Israel Institute of Technology, Haifa, 3200003, Israel
| | - Fei Chen
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, 518055 Guandong, People’s Republic of China
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, United States of America
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
| | - David A Clifton
- Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ, United Kingdom
| | - Harry J Davies
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Cheng Ding
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
- Department of Biomedical Engineering, Emory University, Atlanta, GA 30322, United States of America
| | - Xiaorong Ding
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China
| | - Jessilyn Dunn
- Department of Biomedical Engineering, Duke University, Durham, NC 27708-0187, United States of America
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC 27708-0187, United States of America
- Duke Clinical Research Institute, Durham, NC 27705-3976, United States of America
| | - Mohamed Elgendi
- Biomedical and Mobile Health Technology Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, 8008, Switzerland
| | - Munia Ferdoushi
- Department of Electrical and Computer Engineering, University of Southern California, 90089, Los Angeles, California, United States of America
- The Institute for Technology and Medical Systems (ITEMS), Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Daniel Franklin
- Institute of Biomedical Engineering, Translational Biology & Engineering Program, Ted Rogers Centre for Heart Research, University of Toronto, Toronto, M5G 1M1, Canada
| | - Eduardo Gil
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Md Farhad Hassan
- Department of Electrical and Computer Engineering, University of Southern California, 90089, Los Angeles, California, United States of America
- The Institute for Technology and Medical Systems (ITEMS), Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Jussi Hernesniemi
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, 33720, Finland
- Tampere Heart Hospital, Wellbeing Services County of Pirkanmaa, Tampere, 33520, Finland
| | - Xiao Hu
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, 30322, Georgia, United States of America
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, 30322, Georgia, United States of America
- Department of Computer Sciences, College of Arts and Sciences, Emory University, Atlanta, GA 30322, United States of America
| | - Nan Ji
- Hong Kong Center for Cerebrocardiovascular Health Engineering (COCHE), Hong Kong Science and Technology Park, Hong Kong, 999077, People’s Republic of China
| | - Yasser Khan
- Department of Electrical and Computer Engineering, University of Southern California, 90089, Los Angeles, California, United States of America
- The Institute for Technology and Medical Systems (ITEMS), Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Spyridon Kontaxis
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Ilkka Korhonen
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, 33720, Finland
| | - Panicos A Kyriacou
- Research Centre for Biomedical Engineering, City, University of London, London, EC1V 0HB, United Kingdom
| | - Pablo Laguna
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Jesús Lázaro
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Chungkeun Lee
- Digital Health Devices Division, Medical Device Evaluation Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju, 28159, Republic of Korea
| | - Jeremy Levy
- Faculty of Biomedical Engineering, Technion Israel Institute of Technology, Haifa, 3200003, Israel
- Faculty of Electrical and Computer Engineering, Technion Institute of Technology, Haifa, 3200003, Israel
| | - Yumin Li
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, People’s Republic of China
| | - Chengyu Liu
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, People’s Republic of China
| | - Jing Liu
- Analog Devices Inc, San Jose, CA 95124, United States of America
| | - Lei Lu
- Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ, United Kingdom
| | - Danilo P Mandic
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Vaidotas Marozas
- Department of Electronics Engineering, Kaunas University of Technology, 44249 Kaunas, Lithuania
- Biomedical Engineering Institute, Kaunas University of Technology, 44249 Kaunas, Lithuania
| | - Elisa Mejía-Mejía
- Research Centre for Biomedical Engineering, City, University of London, London, EC1V 0HB, United Kingdom
| | - Ramakrishna Mukkamala
- Department of Bioengineering and Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Meir Nitzan
- Department of Physics/Electro-Optic Engineering, Lev Academic Center, 91160 Jerusalem, Israel
| | - Tania Pereira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, Porto, 4200-465, Portugal
- Faculty of Engineering, University of Porto, Porto, 4200-465, Portugal
| | | | - Jessica C Ramella-Roman
- Department of Biomedical Engineering and Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33174, United States of America
| | - Harri Saarinen
- Tampere Heart Hospital, Wellbeing Services County of Pirkanmaa, Tampere, 33520, Finland
| | - Md Mobashir Hasan Shandhi
- Department of Biomedical Engineering, Duke University, Durham, NC 27708-0187, United States of America
| | - Hangsik Shin
- Department of Digital Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Gerard Stansby
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
- Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, United Kingdom
| | - Toshiyo Tamura
- Future Robotics Organization, Waseda University, Tokyo, 1698050, Japan
| | - Antti Vehkaoja
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, 33720, Finland
- PulseOn Ltd, Espoo, 02150, Finland
| | - Will Ke Wang
- Department of Biomedical Engineering, Duke University, Durham, NC 27708-0187, United States of America
| | - Yuan-Ting Zhang
- Hong Kong Center for Cerebrocardiovascular Health Engineering (COCHE), Hong Kong Science and Technology Park, Hong Kong, 999077, People’s Republic of China
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, 999077, People’s Republic of China
| | - Ni Zhao
- Department of Electronic Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Dingchang Zheng
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5RW, United Kingdom
| | - Tingting Zhu
- Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ, United Kingdom
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11
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Park S, Lee S, Park E, Lee J, Kim IY. Quantitative analysis of pulse arrival time and PPG morphological features based cuffless blood pressure estimation: a comparative study between diabetic and non-diabetic groups. Biomed Eng Lett 2023; 13:625-636. [PMID: 37872987 PMCID: PMC10590356 DOI: 10.1007/s13534-023-00284-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 10/25/2023] Open
Abstract
Pulse arrival time (PAT) and PPG morphological features have attracted much interest in cuffless blood pressure (BP) estimation, but their effects are not clearly understood when vascular characteristics are affected by diseases such as diabetes. This work quantitatively analyzes the effect of diabetic disease on the PAT and PPG morphological features-based BP estimation. We selected 112 diabetic patients and 308 non-diabetic subjects from VitalDB, and extracted 16 features including PAT, PPG morphological features, and heart rate. BP estimation performance was statistically compared between groups using linear regression models with several feature sets, and the relative importance of each feature in the optimal feature set was extracted. As a result, the standard deviation of the error and mean absolute error of PAT-based BP estimation were significantly higher in the diabetic group than in the non-diabetic group (p < 0.01). A feature set containing PAT and PPG morphological features achieved the best performance in both groups. However, the relative importance of each feature for BP estimation differed notably between groups. The results indicate that different features are important depending on the vascular characteristics, which could help to construct different models to accommodate specific diseases.
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Affiliation(s)
- Seongryul Park
- Department of Electronic Engineering, Hanyang University, Seoul, 04763 South Korea
| | | | - Eunkyoung Park
- Department of Biomedical Engineering, Soonchunhyang University, Asan, 31538 South Korea
| | - Jongshill Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, 04763 South Korea
| | - In Young Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, 04763 South Korea
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12
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Nuryani N, Pambudi Utomo T, Wiyono N, Sutomo AD, Ling S. Cuffless Hypertension Detection using Swarm Support Vector Machine Utilizing Photoplethysmogram and Electrocardiogram. J Biomed Phys Eng 2023; 13:477-488. [PMID: 37868942 PMCID: PMC10589690 DOI: 10.31661/jbpe.v0i0.2206-1504] [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: 06/13/2022] [Accepted: 01/11/2023] [Indexed: 10/24/2023]
Abstract
Background Hypertension is associated with severe complications, and its detection is important to provide early information about a hypertension event, which is essential to prevent further complications. Objective This study aimed to investigate a strategy for hypertension detection without a cuff using parameters of bioelectric signals, i.e., Electrocardiogram (ECG), Photoplethysmogram (PPG,) and an algorithm of Swarm-based Support Vector Machine (SSVM). Material and Methods This experimental study was conducted to develop a hypertension detection system. ECG and PPG bioelectrical records were collected from the Medical Information Mart for Intensive Care (MIMIC) from normal and hypertension participants and processed to find the parameters, used for the inputs of SSVM and comprised Pulse Arrival Time (PAT) and the characteristics of PPG signal derivatives. The SSVM was n Support Vector Machine (SVM) algorithm optimized using particle swarm optimization with Quantum Delta-potential-well (QDPSO). The SSVMs with different inputs were investigated to find the optimal detection performance. Results The proposed strategy was performed at 96% in terms of F1-score, accuracy, sensitivity, and specificity with better performance than the other methods tested and methods and also could develop a cuff-free hypertension monitoring system. Conclusion Hypertension using SSVM, ECG, and PPG parameters is acceptably performed. The hypertension detection had lower performance utilizing only PPG than both ECG and PPG.
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Affiliation(s)
- Nuryani Nuryani
- Department of Physics, University of Sebelas Maret Jl. Ir. Sutami 36A Kentingan Jebres Surakarta 57126, Indonesia
| | - Trio Pambudi Utomo
- Department of Physics, University of Sebelas Maret Jl. Ir. Sutami 36A Kentingan Jebres Surakarta 57126, Indonesia
| | - Nanang Wiyono
- Faculty of Medicine, University of Sebelas Maret Jl. Ir. Sutami 36A Kentingan Jebres Surakarta 57126, Indonesia
| | - Artono Dwijo Sutomo
- Department of Physics, Graduate Program, University of Sebelas Maret Jl. Ir. Sutami 36A Kentingan Jebres Surakarta 57126, Indonesia
| | - Steve Ling
- Centre for Health Technologies, University of Technology Sydney, Broadway NSW 2007, Australia
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13
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Yoon YH, Kim J, Lee KJ, Cho D, Oh JK, Kim M, Roh JH, Park HW, Lee JH. Blood Pressure Measurement Based on the Camera and Inertial Measurement Unit of a Smartphone: Instrument Validation Study. JMIR Mhealth Uhealth 2023; 11:e44147. [PMID: 37694382 PMCID: PMC10503482 DOI: 10.2196/44147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/13/2023] [Accepted: 07/21/2023] [Indexed: 09/12/2023] Open
Abstract
Background Even though several mobile apps that can measure blood pressure have been developed, the data about the accuracy of these apps are limited. Objective We assessed the accuracy of AlwaysBP (test) in blood pressure measurement compared with the standard, cuff-based, manual method of brachial blood pressure measurement (reference). Methods AlwaysBP is a smartphone software that estimates systolic blood pressure (SBP) and diastolic blood pressure (DBP) based on pulse transit time (PTT). PTT was calculated with a finger photoplethysmogram and seismocardiogram using, respectively, the camera and inertial measurement unit sensor of a commercially available smartphone. After calculating PTT, SBP and DBP were estimated via the Bramwell-Hill and Moens-Korteweg equations. A calibration process was carried out 3 times for each participant to determine the input parameters of the equations. This study was conducted from March to August 2021 at Chungnam National University Sejong Hospital with 87 participants aged between 19 and 70 years who met specific conditions. The primary analysis aimed to evaluate the accuracy of the test method compared with the reference method for the entire study population. The secondary analysis was performed to confirm the stability of the test method for up to 4 weeks in 15 participants. At enrollment, gender, arm circumference, and blood pressure distribution were considered according to current guidelines. Results Among the 87 study participants, 45 (52%) individuals were male, and the average age was 35.6 (SD 10.4) years. Hypertension was diagnosed in 14 (16%) participants before this study. The mean test and reference SBPs were 120.0 (SD 18.8) and 118.7 (SD 20.2) mm Hg, respectively (difference: mean 1.2, SD 7.1 mm Hg). The absolute differences between the test and reference SBPs were <5, <10, and <15 mm Hg in 57.5% (150/261), 84.3% (220/261 ), and 94.6% (247/261) of measurements. The mean test and reference DBPs were 80.1 (SD 12.6) and 81.1 (SD 14.4) mm Hg, respectively (difference: mean -1.0, SD 6.0 mm Hg). The absolute differences between the test and reference DBPs were <5, <10, and <15 mm Hg in 75.5% (197/261), 93.9% (245/261), and 97.3% (254/261) of measurements, respectively. The secondary analysis showed that after 4 weeks, the differences between SBP and DBP were 0.1 (SD 8.8) and -2.4 (SD 7.6) mm Hg, respectively. Conclusions AlwaysBP exhibited acceptable accuracy in SBP and DBP measurement compared with the standard measurement method, according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization protocol criteria. However, further validation studies with a specific validation protocol designed for cuffless blood pressure measuring devices are required to assess clinical accuracy. This technology can be easily applied in everyday life and may improve the general population's awareness of hypertension, thus helping to control it.
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Affiliation(s)
- Yong-Hoon Yoon
- Chungnam National University Sejong Hospital, Sejong-Si, Republic of Korea
| | - Jongin Kim
- Deepmedi Research Institute of Technology, Seoul, Republic of Korea
| | - Kwang Jin Lee
- Deepmedi Research Institute of Technology, Seoul, Republic of Korea
| | - Dongrae Cho
- Deepmedi Research Institute of Technology, Seoul, Republic of Korea
| | - Jin Kyung Oh
- Chungnam National University Sejong Hospital, Sejong-Si, Republic of Korea
| | - Minsu Kim
- Chungnam National University Sejong Hospital, Sejong-Si, Republic of Korea
| | - Jae-Hyung Roh
- Chungnam National University Sejong Hospital, Sejong-Si, Republic of Korea
| | - Hyun Woong Park
- Chungnam National University Sejong Hospital, Sejong-Si, Republic of Korea
| | - Jae-Hwan Lee
- Chungnam National University Sejong Hospital, Sejong-Si, Republic of Korea
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14
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Martinez J, Passage B, Mortazavi BJ, Jafari R. Hypothesis Scoring for Confidence-Aware Blood Pressure Estimation With Particle Filters. IEEE J Biomed Health Inform 2023; 27:4273-4284. [PMID: 37363851 PMCID: PMC10567135 DOI: 10.1109/jbhi.2023.3289192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
We propose our Confidence-Aware Particle Filter (CAPF) framework that analyzes a series of estimated changes in blood pressure (BP) to provide several true state hypotheses for a given instance. Particularly, our novel confidence-awareness mechanism assigns likelihood scores to each hypothesis in an effort to discard potentially erroneous measurements - based on the agreement amongst a series of estimated changes and the physiological plausibility when considering DBP/SBP pairs. The particle filter formulation (or sequential Monte Carlo method) can jointly consider the hypotheses and their probabilities over time to provide a stable trend of estimated BP measurements. In this study, we evaluate BP trend estimation from an emerging bio-impedance (Bio-Z) prototype wearable modality although it is applicable to all types of physiological modalities. Each subject in the evaluation cohort underwent a hand-gripper exercise, a cold pressor test, and a recovery state to increase the variation to the captured BP ranges. Experiments show that CAPF yields superior continuous pulse pressure (PP), diastolic blood pressure (DBP), and systolic blood pressure (SBP) estimation performance compared to ten baseline approaches. Furthermore, CAPF performs on track to comply with AAMI and BHS standards for achieving a performance classification of Grade A, with mean error accuracies of -0.16 ± 3.75 mmHg for PP (r = 0.81), 0.42 ± 4.39 mmHg for DBP (r = 0.92), and -0.09 ± 6.51 mmHg for SBP (r = 0.92) from more than test 3500 data points.
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15
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Liu ZD, Li Y, Zhang YT, Zeng J, Chen ZX, Cui ZW, Liu JK, Miao F. Cuffless Blood Pressure Measurement Using Smartwatches: A Large-Scale Validation Study. IEEE J Biomed Health Inform 2023; 27:4216-4227. [PMID: 37204948 DOI: 10.1109/jbhi.2023.3278168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This study aimed to evaluate the performance of cuffless blood pressure (BP) measurement techniques in a large and diverse cohort of participants. We enrolled 3077 participants (aged 18-75, 65.16% women, 35.91% hypertensive participants) and conducted followed-up for approximately 1 month. Electrocardiogram, pulse pressure wave, and multiwavelength photoplethysmogram signals were simultaneously recorded using smartwatches; dual-observer auscultation systolic BP (SBP) and diastolic BP (DBP) reference measurements were also obtained. Pulse transit time, traditional machine learning (TML), and deep learning (DL) models were evaluated with calibration and calibration-free strategy. TML models were developed using ridge regression, support vector machine, adaptive boosting, and random forest; while DL models using convolutional and recurrent neural networks. The best-performing calibration-based model yielded estimation errors of 1.33 ± 6.43 mmHg for DBP and 2.31 ± 9.57 mmHg for SBP in the overall population, with reduced SBP estimation errors in normotensive (1.97 ± 7.85 mmHg) and young (0.24 ± 6.61 mmHg) subpopulations. The best-performing calibration-free model had estimation errors of -0.29 ± 8.78 mmHg for DBP and -0.71 ± 13.04 mmHg for SBP. We conclude that smartwatches are effective for measuring DBP for all participants and SBP for normotensive and younger participants with calibration; performance degrades significantly for heterogeneous populations including older and hypertensive participants. The availability of cuffless BP measurement without calibration is limited in routine settings. Our study provides a large-scale benchmark for emerging investigations on cuffless BP measurement, highlighting the need to explore additional signals or principles to enhance the accuracy in large-scale heterogeneous populations.
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16
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Liao S, Liu H, Lin WH, Zheng D, Chen F. Filtering-induced changes of pulse transmit time across different ages: a neglected concern in photoplethysmography-based cuffless blood pressure measurement. Front Physiol 2023; 14:1172150. [PMID: 37560157 PMCID: PMC10407099 DOI: 10.3389/fphys.2023.1172150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023] Open
Abstract
Background: Pulse transit time (PTT) is a key parameter in cuffless blood pressure measurement based on photoplethysmography (PPG) signals. In wearable PPG sensors, raw PPG signals are filtered, which can change the timing of PPG waveform feature points, leading to inaccurate PTT estimation. There is a lack of comprehensive investigation of filtering-induced PTT changes in subjects with different ages. Objective: This study aimed to quantitatively investigate the effects of aging and PTT definition on the infinite impulse response (IIR) filtering-induced PTT changes. Methods: One hundred healthy subjects in five different ranges of age (i.e., 20-29, 30-39, 40-49, 50-59, and over 60 years old, 20 subjects in each) were recruited. Electrocardiogram (ECG) and PPG signals were recorded simultaneously for 120 s. PTT was calculated from the R wave of ECG and PPG waveform features. Eight PTT definitions were developed from different PPG waveform feature points. The raw PPG signals were preprocessed then further low-pass filtered. The difference between PTTs derived from preprocessed and filtered PPG signals, and the relative difference, were calculated and compared among five age groups and eight PTT definitions using the analysis of variance (ANOVA) or Scheirer-Ray-Hare test with post hoc analysis. Linear regression analysis was used to investigate the relationship between age and filtering-induced PTT changes. Results: Filtering-induced PTT difference and the relative difference were significantly influenced by age and PTT definition (p < 0.001 for both). Aging effect on filtering-induced PTT changes was consecutive with a monotonous trend under all PTT definitions. The age groups with maximum and minimum filtering-induced PTT changes depended on the definition. In all subjects, the PTT defined by maximum peak of PPG had the minimum filtering-induced PTT changes (mean: 16.16 ms and 5.65% for PTT difference and relative difference). The changes of PTT defined by maximum first PPG derivative had the strongest linear relationship with age (R-squared: 0.47 and 0.46 for PTT difference relative difference). Conclusion: The filtering-induced PTT changes are significantly influenced by age and PTT definition. These factors deserve further consideration to improve the accuracy of PPG-based cuffless blood pressure measurement using wearable sensors.
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Affiliation(s)
- Shangdi Liao
- Department of Electronic and Electrical Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Wan-Hua Lin
- Chinese Academy of Sciences Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institute of Advanced Technology, Shenzhen, China
| | - Dingchang Zheng
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Fei Chen
- Department of Electronic and Electrical Engineering, Southern University of Science and Technology, Shenzhen, China
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17
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Alawieh H, Weiss N. A Novel Form Factor For PPG-based Blood Pressure Monitoring. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-6. [PMID: 38083075 DOI: 10.1109/embc40787.2023.10341192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Blood pressure (BP) is one of the four main vital signs in medicine and may be a useful signal for wellness tracking and for user-aware interfaces in human-computer interaction. The current standard for BP measurement uses cuff-based devices that block an artery temporarily to get a single, discrete measurement of BP. Recently, there have been significant efforts to measure correlates of BP continuously and non-invasively from relevant signals like photoplethysmography (PPG), which responds to volumetric changes in arteries due to blood pulsations. In this paper, we explore a novel setup with two points of instrumentation, one on the head and a second on the wrist, for recording PPG and estimating the pulse wave velocity, which is a major correlate of BP, along with other waveform-related features. We prospectively tested the device on 10 subjects who followed a protocol for the deliberate variation of BP while ground truth measurements were taken using a reference cuff-device. Generic absolute BP models, which use the collected data for leave-one-subject-out cross-validation, yielded an error of -0.14 ± 7.3 mmHg for systolic BP (SBP) and -0.21±6.7 mmHg for diastolic BP (DBP), which are within the regulatory limits of 5 ± 8 mmHg. Notably, the correlation between the predicted BPs and the ground truth BPs was higher for SBP (r = 0.74, p < 0.001) than for DBP (r = 0.34, p < 0.001). The results show that the proposed form factor can extract BP-related features that could be used for continuous, cuff-less BP monitoring.
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18
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Manga S, Muthavarapu N, Redij R, Baraskar B, Kaur A, Gaddam S, Gopalakrishnan K, Shinde R, Rajagopal A, Samaddar P, Damani DN, Shivaram S, Dey S, Mitra D, Roy S, Kulkarni K, Arunachalam SP. Estimation of Physiologic Pressures: Invasive and Non-Invasive Techniques, AI Models, and Future Perspectives. SENSORS (BASEL, SWITZERLAND) 2023; 23:5744. [PMID: 37420919 DOI: 10.3390/s23125744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/25/2023] [Accepted: 06/12/2023] [Indexed: 07/09/2023]
Abstract
The measurement of physiologic pressure helps diagnose and prevent associated health complications. From typical conventional methods to more complicated modalities, such as the estimation of intracranial pressures, numerous invasive and noninvasive tools that provide us with insight into daily physiology and aid in understanding pathology are within our grasp. Currently, our standards for estimating vital pressures, including continuous BP measurements, pulmonary capillary wedge pressures, and hepatic portal gradients, involve the use of invasive modalities. As an emerging field in medical technology, artificial intelligence (AI) has been incorporated into analyzing and predicting patterns of physiologic pressures. AI has been used to construct models that have clinical applicability both in hospital settings and at-home settings for ease of use for patients. Studies applying AI to each of these compartmental pressures were searched and shortlisted for thorough assessment and review. There are several AI-based innovations in noninvasive blood pressure estimation based on imaging, auscultation, oscillometry and wearable technology employing biosignals. The purpose of this review is to provide an in-depth assessment of the involved physiologies, prevailing methodologies and emerging technologies incorporating AI in clinical practice for each type of compartmental pressure measurement. We also bring to the forefront AI-based noninvasive estimation techniques for physiologic pressure based on microwave systems that have promising potential for clinical practice.
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Affiliation(s)
- Sharanya Manga
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Neha Muthavarapu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Renisha Redij
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Avneet Kaur
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sunil Gaddam
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Keerthy Gopalakrishnan
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Rutuja Shinde
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Poulami Samaddar
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Devanshi N Damani
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX 79995, USA
| | - Suganti Shivaram
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Shuvashis Dey
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Electrical and Computer Engineering, North Dakota State University, Fargo, ND 58105, USA
| | - Dipankar Mitra
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Computer Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Sayan Roy
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Electrical Engineering and Computer Science, South Dakota Mines, Rapid City, SD 57701, USA
| | - Kanchan Kulkarni
- Centre de Recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, U1045, 33000 Bordeaux, France
- IHU Liryc, Heart Rhythm Disease Institute, Fondation Bordeaux Université, Bordeaux, 33600 Pessac, France
| | - Shivaram P Arunachalam
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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19
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Sel K, Mohammadi A, Pettigrew RI, Jafari R. Physics-informed neural networks for modeling physiological time series for cuffless blood pressure estimation. NPJ Digit Med 2023; 6:110. [PMID: 37296218 PMCID: PMC10256762 DOI: 10.1038/s41746-023-00853-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
The bold vision of AI-driven pervasive physiological monitoring, through the proliferation of off-the-shelf wearables that began a decade ago, has created immense opportunities to extract actionable information for precision medicine. These AI algorithms model input-output relationships of a system that, in many cases, exhibits complex nature and personalization requirements. A particular example is cuffless blood pressure estimation using wearable bioimpedance. However, these algorithms need training over significant amount of ground truth data. In the context of biomedical applications, collecting ground truth data, particularly at the personalized level is challenging, burdensome, and in some cases infeasible. Our objective is to establish physics-informed neural network (PINN) models for physiological time series data that would use minimal ground truth information to extract complex cardiovascular information. We achieve this by building Taylor's approximation for gradually changing known cardiovascular relationships between input and output (e.g., sensor measurements to blood pressure) and incorporating this approximation into our proposed neural network training. The effectiveness of the framework is demonstrated through a case study: continuous cuffless BP estimation from time series bioimpedance data. We show that by using PINNs over the state-of-the-art time series models tested on the same datasets, we retain high correlations (systolic: 0.90, diastolic: 0.89) and low error (systolic: 1.3 ± 7.6 mmHg, diastolic: 0.6 ± 6.4 mmHg) while reducing the amount of ground truth training data on average by a factor of 15. This could be helpful in developing future AI algorithms to help interpret pervasive physiologic data using minimal amount of training data.
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Affiliation(s)
- Kaan Sel
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Amirmohammad Mohammadi
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX, USA
| | | | - Roozbeh Jafari
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA.
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX, USA.
- School of Engineering Medicine, Texas A&M University, Houston, TX, USA.
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20
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Sel K, Osman D, Huerta N, Edgar A, Pettigrew RI, Jafari R. Continuous cuffless blood pressure monitoring with a wearable ring bioimpedance device. NPJ Digit Med 2023; 6:59. [PMID: 36997608 PMCID: PMC10063561 DOI: 10.1038/s41746-023-00796-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/10/2023] [Indexed: 04/01/2023] Open
Abstract
Smart rings provide unique opportunities for continuous physiological measurement. They are easy to wear, provide little burden in comparison to other smart wearables, are suitable for nocturnal settings, and can be sized to provide ideal contact between the sensors and the skin at all times. Continuous measuring of blood pressure (BP) provides essential diagnostic and prognostic value for cardiovascular health management. However, conventional ambulatory BP measurement devices operate using an inflating cuff that is bulky, intrusive, and impractical for frequent or continuous measurements. We introduce ring-shaped bioimpedance sensors leveraging the deep tissue sensing ability of bioimpedance while introducing no sensitivity to skin tones, unlike optical modalities. We integrate unique human finger finite element model with exhaustive experimental data from participants and derive optimum design parameters for electrode placement and sizes that yields highest sensitivity to arterial volumetric changes, with no discrimination against varying skin tones. BP is constructed using machine learning algorithms. The ring sensors are used to estimate arterial BP showing peak correlations of 0.81, and low error (systolic BP: 0.11 ± 5.27 mmHg, diastolic BP: 0.11 ± 3.87 mmHg) for >2000 data points and wide BP ranges (systolic: 89-213 mmHg and diastolic: 42-122 mmHg), highlighting the significant potential use of bioimpedance ring for accurate and continuous estimation of BP.
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Affiliation(s)
- Kaan Sel
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Deen Osman
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Noah Huerta
- Department of Mechanical Engineering, Texas A&M University, College Station, TX, USA
| | - Arabella Edgar
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | | | - Roozbeh Jafari
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA.
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA.
- School of Engineering Medicine, Texas A&M University, Houston, TX, USA.
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX, USA.
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21
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Zhou ZB, Cui TR, Li D, Jian JM, Li Z, Ji SR, Li X, Xu JD, Liu HF, Yang Y, Ren TL. Wearable Continuous Blood Pressure Monitoring Devices Based on Pulse Wave Transit Time and Pulse Arrival Time: A Review. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16062133. [PMID: 36984013 PMCID: PMC10057755 DOI: 10.3390/ma16062133] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 06/12/2023]
Abstract
Continuous blood pressure (BP) monitoring is of great significance for the real-time monitoring and early prevention of cardiovascular diseases. Recently, wearable BP monitoring devices have made great progress in the development of daily BP monitoring because they adapt to long-term and high-comfort wear requirements. However, the research and development of wearable continuous BP monitoring devices still face great challenges such as obvious motion noise and slow dynamic response speeds. The pulse wave transit time method which is combined with photoplethysmography (PPG) waves and electrocardiogram (ECG) waves for continuous BP monitoring has received wide attention due to its advantages in terms of excellent dynamic response characteristics and high accuracy. Here, we review the recent state-of-art wearable continuous BP monitoring devices and related technology based on the pulse wave transit time; their measuring principles, design methods, preparation processes, and properties are analyzed in detail. In addition, the potential development directions and challenges of wearable continuous BP monitoring devices based on the pulse wave transit time method are discussed.
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Affiliation(s)
- Zi-Bo Zhou
- School of Integrated Circuit, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
- School of Mechanical, Electrical and Information Engineering, Shandong University, Weihai 264209, China
| | - Tian-Rui Cui
- School of Integrated Circuit, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Ding Li
- School of Integrated Circuit, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Jin-Ming Jian
- School of Integrated Circuit, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Zhen Li
- School of Integrated Circuit, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Shou-Rui Ji
- School of Integrated Circuit, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Xin Li
- School of Integrated Circuit, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Jian-Dong Xu
- School of Integrated Circuit, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Hou-Fang Liu
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Yi Yang
- School of Integrated Circuit, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Tian-Ling Ren
- School of Integrated Circuit, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, China
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22
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Liu SH, Wu YR, Chen W, Su CH, Chin CL. Using Ballistocardiogram and Impedance Plethysmogram for Minimal Contact Measurement of Blood Pressure Based on a Body Weight-Fat Scale. SENSORS (BASEL, SWITZERLAND) 2023; 23:2318. [PMID: 36850917 PMCID: PMC9966183 DOI: 10.3390/s23042318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Electronic health (eHealth) is a strategy to improve the physical and mental condition of a human, collecting daily physiological data and information from digital apparatuses. Body weight and blood pressure (BP) are the most popular and important physiological data. The goal of this study is to develop a minimal contact BP measurement method based on a commercial body weight-fat scale, capturing biometrics when users stand on it. The pulse transit time (PTT) is extracted from the ballistocardiogram (BCG) and impedance plethysmogram (IPG), measured by four strain gauges and four footpads of a commercial body weight-fat scale. Cuffless BP measurement using the electrocardiogram (ECG) and photoplethysmogram (PPG) serves as the reference method. The BP measured by a commercial BP monitor is considered the ground truth. Twenty subjects participated in this study. By the proposed model, the root-mean-square errors and correlation coefficients (r2s) of estimated systolic blood pressure and diastolic blood pressure are 7.3 ± 2.1 mmHg and 4.5 ± 1.8 mmHg, and 0.570 ± 0.205 and 0.284 ± 0.166, respectively. This accuracy level achieves the C grade of the corresponding IEEE standard. Thus, the proposed method has the potential benefit for eHealth monitoring in daily application.
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Affiliation(s)
- Shing-Hong Liu
- Department of Computer Science and Information Engineering, Chaoyang University of Technology, Taichung City 41349, Taiwan
| | - Yan-Rong Wu
- Department of Computer Science and Information Engineering, Chaoyang University of Technology, Taichung City 41349, Taiwan
| | - Wenxi Chen
- Biomedical Information Engineering Laboratory, The University of Aizu, Aizu-Wakamatsu City 965-8580, Japan
| | - Chun-Hung Su
- Institute of Medicine, School of Medicine, Chung-Shan Medical University, Taichung City 40201, Taiwan
- Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung City 40201, Taiwan
| | - Chiun-Li Chin
- Department of Medical Informatics, Chung-Shan Medical University, Taichung City 40201, Taiwan
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23
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Sel K, Mohammadi A, Pettigrew RI, Jafari R. Physics-Informed Neural Networks for Modeling Physiological Time Series: A Case Study with Continuous Blood Pressure. RESEARCH SQUARE 2023:rs.3.rs-2423200. [PMID: 36711741 PMCID: PMC9882661 DOI: 10.21203/rs.3.rs-2423200/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The bold vision of AI-driven pervasive physiological monitoring, through the proliferation of off-the-shelf wearables that began a decade ago, has created immense opportunities to extract actionable information for precision medicine. These AI algorithms model the input-output relationships of a system that, in many cases, exhibits complex nature and personalization requirements. A particular example is cuffless blood pressure estimation using wearable bioimpedance. However, these algorithms need to be trained with a significant amount of ground truth data. In the context of biomedical applications, collecting ground truth data, particularly at the personalized level is challenging, burdensome, and in some cases infeasible. Our objective is to establish physics-informed neural network (PINN) models for physiological time series data that would reduce reliance on ground truth information. We achieve this by building Taylor's approximation for the gradually changing known cardiovascular relationships between input and output (e.g., sensor measurements to blood pressure) and incorporating this approximation into our proposed neural network training. The effectiveness of the framework is demonstrated through a case study: continuous cuffless BP estimation from time series bioimpedance data. We show that by using PINNs over the state-of-the-art time series regression models tested on the same datasets, we retain a high correlation (systolic: 0.90, diastolic: 0.89) and low error (systolic: 1.3 ± 7.6 mmHg, diastolic: 0.6 ± 6.4 mmHg) while reducing the amount of ground truth training data on average by a factor of 15. This could be helpful in developing future AI algorithms to help interpret pervasive physiologic data using minimal amount of training data.
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Affiliation(s)
- Kaan Sel
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Amirmohammad Mohammadi
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX, USA
| | | | - Roozbeh Jafari
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX, USA
- School of Engineering Medicine, Texas A&M University, Houston, TX, USA
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
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24
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Herranz Olazabal J, Wieringa F, Hermeling E, Van Hoof C. Comparing Remote Speckle Plethysmography and Finger-Clip Photoplethysmography with Non-Invasive Finger Arterial Pressure Pulse Waves, Regarding Morphology and Arrival Time. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010101. [PMID: 36671673 PMCID: PMC9854800 DOI: 10.3390/bioengineering10010101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/04/2023] [Accepted: 01/08/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The goal was to compare Speckle plethysmography (SPG) and Photoplethysmography (PPG) with non-invasive finger Arterial Pressure (fiAP) regarding Pulse Wave Morphology (PWM) and Pulse Arrival Time (PAT). METHODS Healthy volunteers (n = 8) were connected to a Non-Invasive Blood Pressure (NIBP) monitor providing fiAP pulse wave and PPG from a clinical transmission-mode SpO2 finger clip. Biopac recorded 3-lead ECG. A camera placed at a 25 cm distance recorded a video stream (100 fps) of a finger illuminated by a laser diode at 639 nm. A chest belt (Polar) monitored respiration. All signals were recorded simultaneously during episodes of spontaneous breathing and paced breathing. ANALYSIS Post-processing was performed in Matlab to obtain SPG and analyze the SPG, PPG and fiAP mean absolute deviations (MADs) on PWM, plus PAT modulation. RESULTS Across 2599 beats, the average fiAP MAD with PPG was 0.17 (0-1) and with SPG 0.09 (0-1). PAT derived from ECG-fiAP correlated as follows: 0.65 for ECG-SPG and 0.67 for ECG-PPG. CONCLUSION Compared to the clinical NIBP monitor fiAP reference, PWM from an experimental camera-derived non-contact reflective-mode SPG setup resembled fiAP significantly better than PPG from a simultaneously recorded clinical transmission-mode finger clip. For PAT values, no significant difference was found between ECG-SPG and ECG-PPG compared to ECG-fiAP.
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Affiliation(s)
- Jorge Herranz Olazabal
- IMEC, 3000 Leuven, Belgium
- Faculty of Engineering Science, Katholieke Universiteit Leuven (KUL), 3000 Leuven, Belgium
- IMEC NL, 5656 AE Eindhoven, The Netherlands
| | - Fokko Wieringa
- IMEC NL, 5656 AE Eindhoven, The Netherlands
- Division of Internal Medicine, Department of Nephrology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | | | - Chris Van Hoof
- IMEC, 3000 Leuven, Belgium
- Faculty of Engineering Science, Katholieke Universiteit Leuven (KUL), 3000 Leuven, Belgium
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25
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Wang X, Feng Z, Li P, Wang L, Chen L, Wu Y, Yang J. A Flexible Pressure Sensor with a Mesh Structure Formed by Lost Hair for Human Epidermal Pulse Wave Monitoring. SENSORS (BASEL, SWITZERLAND) 2022; 23:45. [PMID: 36616646 PMCID: PMC9823516 DOI: 10.3390/s23010045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/11/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
Flexible pressure sensors with the capability of monitoring human vital signs show broad application prospects in personalized healthcare. In this work, a hair-based flexible pressure sensor (HBPS) consisting of lost hair and polymer films was proposed for the continuous monitoring of the human epidermal arterial pulse waveform. A macroscale mesh structure formed by lost hair provides a simplified spacer that endows the triboelectric-based flexible pressure sensor with sufficient contact-separation space. Based on this mesh structure design, the hair-based flexible pressure sensor can respond to the slight pressure change caused by an object with 5 mg weight and hold a stable output voltage under 1-30 Hz external pressure excitation. Additionally, the hair-based flexible pressure sensor showed great sensitivity (0.9 V/kPa) and decent stability after 4500 cycles of operation. Given these compelling features, the HBPS can successfully measure the human epidermal arterial pulses with obvious details at different arteries. The proposed HBPS can also be used to monitor the pulse signals of different subjects. Furthermore, the three different pulse wave transmission time (PTT) values (PTT-foot, PTT-middle, and PTT-peak) can be obtained by simultaneously monitoring human pulse and electrocardiogram signals, which has enormous application potential for assessing cardiovascular system health.
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Affiliation(s)
- Xue Wang
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems Ministry of Education, Chongqing University, Chongqing 400044, China
- Department of Optoelectronic Engineering, Chongqing Key Laboratory of Laser Control & Precision Measurement, Chongqing University, Chongqing 400044, China
| | - Zhiping Feng
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems Ministry of Education, Chongqing University, Chongqing 400044, China
- Department of Optoelectronic Engineering, Chongqing Key Laboratory of Laser Control & Precision Measurement, Chongqing University, Chongqing 400044, China
| | - Peng Li
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems Ministry of Education, Chongqing University, Chongqing 400044, China
- Department of Optoelectronic Engineering, Chongqing Key Laboratory of Laser Control & Precision Measurement, Chongqing University, Chongqing 400044, China
| | - Luna Wang
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems Ministry of Education, Chongqing University, Chongqing 400044, China
- Department of Optoelectronic Engineering, Chongqing Key Laboratory of Laser Control & Precision Measurement, Chongqing University, Chongqing 400044, China
| | - Liang Chen
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems Ministry of Education, Chongqing University, Chongqing 400044, China
- Department of Optoelectronic Engineering, Chongqing Key Laboratory of Laser Control & Precision Measurement, Chongqing University, Chongqing 400044, China
| | - Yufen Wu
- College of Physics and Electronic Engineering, Chongqing Normal University, Chongqing 401331, China
| | - Jin Yang
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems Ministry of Education, Chongqing University, Chongqing 400044, China
- Department of Optoelectronic Engineering, Chongqing Key Laboratory of Laser Control & Precision Measurement, Chongqing University, Chongqing 400044, China
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Khodabakhshi MB, Eslamyeh N, Sadredini SZ, Ghamari M. Cuffless blood pressure estimation using chaotic features of photoplethysmograms and parallel convolutional neural network. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107131. [PMID: 36137326 DOI: 10.1016/j.cmpb.2022.107131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/26/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE As a nonlinear framework in dynamical system analysis, chaotic approaches are mainly applied to evolve the complexity of biological systems. Due to the chaotic nature of the cardiovascular systems, the nonlinear features can intuitively provide a reliable framework in blood pressure (BP) estimation. Cuffless BP estimation is usually carried out by establishing deep neural network models estimating the BP values through machine-learned features of photoplethysmogram (PPG) signals. METHODS In this study, a novel parallel deep architecture is proposed to handle the machine-learned and chaotic features of PPG signals in estimating the actual BP values. The chaotic handcrafted features were the signal properties associated with the Poincare sections in the phase space and the recurrence plot-based measures called recurrence quantification analysis (RQA). Moreover, the measures quantifying the nonlinear properties of the temporal sequences such as correlation dimension, fractal dimension, Lyapunov exponent, and entropy-based quantities were also employed. The parallel architecture not only embedded the chaotic nature of PPG signals but also provided a facility to include the pseudo-periodic variations of PPGs by utilizing a concatenating layer. RESULTS Our framework was examined on the public dataset, namely, Multi-Parameter Intelligent in Intensive Care II contained the recording of PPG, ECG and arterial blood pressure. The performance of the employed handcrafted features in distinguishing between the levels of BP values was investigated based on Spearman's statistics. In addition, our proposed scheme is evaluated in terms of Pearson's correlation coefficient (R), root mean square error (RMSE), and mean absolute error (MAE). The best performance was achieved when the employed handcrafted features accompanied by PPG sequences were applied to the parallel deep network. In particular, the values of R, RMSE, and MAE were obtained 0.9529, 2.76 mmHg, and 1.73 mmHg for diastolic BP, and 0.9444, 6.18 mmHg, and 3.8 mmHg for systolic BP, respectively. Moreover, based on the requirements of the standards set by the British Hypertension Society (BHS), the proposed scheme achieved a grade of A. CONCLUSIONS Our proposed scheme outperformed the state-of-the-art BP estimation methods. In addition, the results confirmed that the concatenation of the PPG-related machine-learned and nonlinear handcrafted features can be properly applied in continuous BP monitoring.
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Affiliation(s)
- Mohammad Bagher Khodabakhshi
- Department of Biomedical Engineering, Hamedan University of Technology, Mardom St, Shahid Fahmideh Blvd, Hamedan 6516913733, Iran.
| | - Naeem Eslamyeh
- Department of Biomedical Engineering, Hamedan University of Technology, Mardom St, Shahid Fahmideh Blvd, Hamedan 6516913733, Iran
| | - Seyede Zohreh Sadredini
- Department of Biomedical Engineering, Hamedan University of Technology, Mardom St, Shahid Fahmideh Blvd, Hamedan 6516913733, Iran
| | - Mohammad Ghamari
- Department of Computer Engineering, Hamedan University of Technology, Hamedan 6516913733, Iran
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27
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Ku CJ, Wang Y, Chang CY, Wu MT, Dai ST, Liao LD. Noninvasive blood oxygen, heartbeat rate, and blood pressure parameter monitoring by photoplethysmography signals. Heliyon 2022; 8:e11698. [DOI: 10.1016/j.heliyon.2022.e11698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/02/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
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28
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Liu Z, Zhou C, Wang H, He Y. Blood pressure monitoring techniques in the natural state of multi-scenes: A review. Front Med (Lausanne) 2022; 9:851172. [PMID: 36091712 PMCID: PMC9462511 DOI: 10.3389/fmed.2022.851172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Blood pressure is one of the basic physiological parameters of human physiology. Frequent and repeated measurement of blood pressure along with recording of environmental or other physiological parameters when measuring blood pressure may reveal important cardiovascular risk factors that can predict occurrence of cardiovascular events. Currently, wearable non-invasive blood pressure measurement technology has attracted much research attention. Several different technical routes have been proposed to solve the challenge between portability or continuity of measurement methods and medical level accuracy of measurement results. The accuracy of blood pressure measurement technology based on auscultation and oscillography has been clinically verified, while majority of other technical routes are being explored at laboratory or multi-center clinical demonstration stage. Normally, Blood pressure measurement based on oscillographic method outside the hospital can only be measured at intervals. There is a need to develop techniques for frequent and high-precision blood pressure measurement under natural conditions outside the hospital. In this paper, we discussed the current status of blood pressure measurement technology and development trends of blood pressure measurement technology in different scenarios. We focuses on the key technical challenges and the latest advances in the study of miniaturization devices based on oscillographic method at wrist and PTT related method at finger positions as well as technology processes. This study is of great significance to the application of high frequency blood pressure measurement technology.
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Affiliation(s)
- Ziyi Liu
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
- Guangdong Transtek Medical Electronics Co., Ltd., Zhongshan, China
| | - Congcong Zhou
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Hongwei Wang
- Tongde Hospital of Zhejiang Province, Hangzhou, China
- *Correspondence: Hongwei Wang,
| | - Yong He
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
- Yong He,
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29
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Liu SH, Zhang BH, Chen W, Su CH, Chin CL. Cuffless and Touchless Measurement of Blood Pressure from Ballistocardiogram Based on a Body Weight Scale. Nutrients 2022; 14:2552. [PMID: 35745282 PMCID: PMC9229996 DOI: 10.3390/nu14122552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
Abstract
Currently, in terms of reducing the infection risk of the COVID-19 virus spreading all over the world, the development of touchless blood pressure (BP) measurement has potential benefits. The pulse transit time (PTT) has a high relation with BP, which can be measured by electrocardiogram (ECG) and photoplethysmogram (PPG). The ballistocardiogram (BCG) reflects the mechanical vibration (or displacement) caused by the heart contraction/relaxation (or heart beating), which can be measured from multiple degrees of the body. The goal of this study is to develop a cuffless and touchless BP-measurement method based on a commercial weight scale combined with a PPG sensor when measuring body weight. The proposed method was that the PTTBCG-PPGT was extracted from the BCG signal measured by a weight scale, and the PPG signal was measured from the PPG probe placed at the toe. Four PTT models were used to estimate BP. The reference method was the PTTECG-PPGF extracted from the ECG signal and PPG signal measured from the PPG probe placed at the finger. The standard BP was measured by an electronic blood pressure monitor. Twenty subjects were recruited in this study. By the proposed method, the root-mean-square error (ERMS) of estimated systolic blood pressure (SBP) and diastolic blood pressure (DBP) are 6.7 ± 1.60 mmHg and 4.8 ± 1.47 mmHg, respectively. The correlation coefficients, r2, of the proposed model for the SBP and DBP are 0.606 ± 0.142 and 0.284 ± 0.166, respectively. The results show that the proposed method can serve for cuffless and touchless BP measurement.
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Affiliation(s)
- Shing-Hong Liu
- Department of Computer Science and Information Engineering, Chaoyang University of Technology, Taichung City 41349, Taiwan; (S.-H.L.); (B.-H.Z.)
| | - Bing-Hao Zhang
- Department of Computer Science and Information Engineering, Chaoyang University of Technology, Taichung City 41349, Taiwan; (S.-H.L.); (B.-H.Z.)
| | - Wenxi Chen
- Biomedical Information Engineering Laboratory, The University of Aizu, Aizu-Wakamatsu City 965-8580, Fukushima, Japan;
| | - Chun-Hung Su
- Institute of Medicine, School of Medicine, Chung-Shan Medical University, Taichung City 40201, Taiwan;
- Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung City 40201, Taiwan
| | - Chiun-Li Chin
- Department of Medical Informatics, Chung-Shan Medical University, Taichung City 40201, Taiwan
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Wearable Blood Pressure Sensing Based on Transmission Coefficient Scattering for Microstrip Patch Antennas. SENSORS 2022; 22:s22113996. [PMID: 35684617 PMCID: PMC9183053 DOI: 10.3390/s22113996] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/18/2022] [Accepted: 05/22/2022] [Indexed: 02/04/2023]
Abstract
Painless, cuffless and continuous blood pressure monitoring sensors provide a more dynamic measure of blood pressure for critical diagnosis or continuous monitoring of hypertensive patients compared to current cuff-based options. To this end, a novel flexible, wearable and miniaturized microstrip patch antenna topology is proposed to measure dynamic blood pressure (BP). The methodology was implemented on a simulated five-layer human tissue arm model created and designed in High-Frequency Simulation Software “HFSS”. The electrical properties of the five-layer human tissue were set at the frequency range (2−3) GHz to comply with clinical/engineering standards. The fabricated patch incorporated on a 0.4 mm epoxy substrate achieved consistency between the simulated and measured reflection coefficient results at flat and bent conditions over the frequency range of 2.3−2.6 GHz. Simulations for a 10 g average specific absorption rate (SAR) based on IEEE-Standard for a human arm at different input powers were also carried out. The safest input power was 50 mW with an acceptable SAR value of 3.89 W/Kg < 4W/Kg. This study also explored a novel method to obtain the pulse transit time (PTT) as an option to measure BP. Pulse transmit time is based on obtaining the time difference between the transmission coefficient scattering waveforms measured between the two pairs of metallic sensors underlying the assumption that brachial arterial geometries are dynamic. Consequently, the proposed model is validated by comparing it to the standard nonlinear Moens and Korteweg model over different artery thickness-radius ratios, showing excellent correlation between 0.76 ± 0.03 and 0.81 ± 0.03 with the systolic and diastolic BP results. The absolute risk of arterial blood pressure increased with the increase in brachial artery thickness-radius ratio. The results of both methods successfully demonstrate how the radius estimates, PTT and pulse wave velocity (PWV), along with electromagnetic (EM) antenna transmission propagation characteristics, can be used to estimate continuous BP non-invasively.
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Malayeri AB, Khodabakhshi MB. Concatenated convolutional neural network model for cuffless blood pressure estimation using fuzzy recurrence properties of photoplethysmogram signals. Sci Rep 2022; 12:6633. [PMID: 35459260 PMCID: PMC9033848 DOI: 10.1038/s41598-022-10244-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/31/2022] [Indexed: 11/09/2022] Open
Abstract
Due to the importance of continuous monitoring of blood pressure (BP) in controlling hypertension, the topic of cuffless BP estimation has been widely studied in recent years. A most important approach is to explore the nonlinear mapping between the recorded peripheral signals and the BP values which is usually conducted by deep neural networks. Because of the sequence-based pseudo periodic nature of peripheral signals such as photoplethysmogram (PPG), a proper estimation model needed to be equipped with the 1-dimensional (1-D) and recurrent layers. This, in turn, limits the usage of 2-dimensional (2-D) layers adopted in convolutional neural networks (CNN) for embedding spatial information in the model. In this study, considering the advantage of chaotic approaches, the recurrence characterization of peripheral signals was taken into account by a visual 2-D representation of PPG in phase space through fuzzy recurrence plot (FRP). FRP not only provides a beneficial framework for capturing the spatial properties of input signals but also creates a reliable approach for embedding the pseudo periodic properties to the neural models without using recurrent layers. Moreover, this study proposes a novel deep neural network architecture that combines the morphological features extracted simultaneously from two upgraded 1-D and 2-D CNNs capturing the temporal and spatial dependencies of PPGs in systolic and diastolic BP estimation. The model has been fed with the 1-D PPG sequences and the corresponding 2-D FRPs from two separate routes. The performance of the proposed framework was examined on the well-known public dataset, namely, multi-parameter intelligent in Intensive Care II. Our scheme is analyzed and compared with the literature in terms of the requirements of the standards set by the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI). The proposed model met the AAMI requirements, and it achieved a grade of A as stated by the BHS standard. In addition, its mean absolute errors and standard deviation for both systolic and diastolic blood pressure estimations were considerably low, 3.05 ± 5.26 mmHg and 1.58 ± 2.6 mmHg, in turn.
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Affiliation(s)
- Ali Bahari Malayeri
- Department of Electrical Engineering, Shahid Beheshti University, 1983969411, Tehran, Iran
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Yi Z, Liu Z, Li W, Ruan T, Chen X, Liu J, Yang B, Zhang W. Piezoelectric Dynamics of Arterial Pulse for Wearable Continuous Blood Pressure Monitoring. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2110291. [PMID: 35285098 DOI: 10.1002/adma.202110291] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/09/2022] [Indexed: 06/14/2023]
Abstract
Piezoelectric arterial pulse wave dynamics are traditionally considered to be similar to those of typical blood pressure waves. However, achieving accurate continuous blood pressure wave monitoring based on arterial pulse waves remains challenging, because the correlation between piezoelectric pulse waves and their related blood pressure waves is unclear. To address this, the correlation between piezoelectric pulse waves and blood pressure waves is first elucidated via theoretical, simulation, and experimental analysis of these dynamics. Based on this correlation, the authors develop a wireless wearable continuous blood pressure monitoring system, with better portability than conventional systems that are based on the pulse wave velocity between multiple sensors. They explore the feasibility of achieving wearable continuous blood pressure monitoring without motion artifacts, using a single piezoelectric sensor. These findings eliminate the controversy over the arterial pulse wave piezoelectric response, and can potentially be used to develop a portable wearable continuous blood pressure monitoring device for the early prevention and daily control of hypertension.
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Affiliation(s)
- Zhiran Yi
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Zhaoxu Liu
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Wenbo Li
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Tao Ruan
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Xiang Chen
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jingquan Liu
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Bin Yang
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Wenming Zhang
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
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33
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Miao F, Zhou B, Liu Z, Wen B, Li Y, Tang M. Using noninvasive adjusted pulse transit time for tracking beat-to-beat systolic blood pressure during ventricular arrhythmia. Hypertens Res 2022; 45:424-435. [PMID: 34931020 DOI: 10.1038/s41440-021-00795-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/26/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022]
Abstract
Tracking beat-to-beat blood pressure noninvasively during ventricular arrhythmia (VA) is of great importance but rarely reported. The goal of our study was to investigate the potential utility of the adjusted pulse transit time (APTT) to track beat-to-beat femoral systolic blood pressure (SBP) during VA. Patients who underwent radiofrequency ablation for arrhythmias at Fuwai Hospital were enrolled. Electrocardiograms (ECGs), finger photoplethysmograms, and femoral arterial blood pressure were recorded simultaneously during VA. The APTT was calculated as the ratio between the square of the conventional pulse transit time (cPTT) and the RR interval of the ECG waveform. Forty-five patients were enrolled in our study, and 22,849 beats were collected during their VA. The inverse of the APTT showed a good correlation with femoral SBP during VA (r = 0.70 ± 0.18). The APTT-derived SBP demonstrated acceptable accuracy in terms of the mean difference ± standard deviation (-0.01 ± 10.54 mmHg) from the invasive femoral SBP. The area under the receiver operating characteristic (ROC) curve for the ability of the APTT to detect ≥30% decreases in femoral SBP was 0.903 (95% confidential interval, 0.895-0.911). In addition, the APTT performed better than the cPTT and RR interval in the above analysis (all P < 0.05). Therefore, the APTT has acceptable accuracy in tracking beat-to-beat femoral SBP and could detect substantially decreased femoral SBP. These findings indicate that the APTT may be a promising noninvasive surrogate for invasive femoral SBP during VA. A multiparameter model combining APTT and other parameters is needed to further improve the accuracy.
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Affiliation(s)
- Fen Miao
- Key Laboratory for Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bin Zhou
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Fuwai Hospital, National Center for Cardiovascular Disease, State Key Lab of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zengding Liu
- Key Laboratory for Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bo Wen
- Key Laboratory for Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Ye Li
- Key Laboratory for Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Joint Engineering Research Center for Health Big Data Intelligent Analysis Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Min Tang
- Fuwai Hospital, National Center for Cardiovascular Disease, State Key Lab of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Instrumental Evaluation of COVID-19 Related Dysautonomia in Non-Critically-Ill Patients: An Observational, Cross-Sectional Study. J Clin Med 2021; 10:jcm10245861. [PMID: 34945155 PMCID: PMC8703676 DOI: 10.3390/jcm10245861] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease-19 (COVID-19) is a predominantly respiratory syndrome. Growing reports about a SARS-CoV-2 neurological involvement, including autonomic dysfunction (AD), have been reported, mostly in critically-ill patients, or in the long-COVID syndrome. In this observational, cross-sectional study, we investigated the prevalence of AD in 20 non-critically-ill COVID-19 patients (COVID+ group) in the acute phase of the disease through a composite instrumental evaluation consisting of Sudoscan, automated pupillometry, heart rate variability (HRV), and pulse transit time (PTT). All the parameters were compared to a control group of 20 healthy volunteers (COVID− group). COVID+ group presented higher values of pupillary dilatation velocities, and baseline pupil diameter than COVID− subjects. Moreover, COVID+ patients presented a higher incidence of feet sudomotor dysfunction than COVID− group. No significant differences emerged in HRV and PTT parameters between groups. In this study we observed the occurrence of autonomic dysfunction in the early stage of the disease.
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Zienkiewicz A, Favre M, Ferdinando H, Iring S, Serrador J, Myllylä T. Blood pressure wave propagation - a multisensor setup for cerebral autoregulation studies. Physiol Meas 2021; 42. [PMID: 34731844 DOI: 10.1088/1361-6579/ac3629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/03/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Cerebral autoregulation is critically important to maintain proper brain perfusion and supply the brain with oxygenated blood. Non-invasive measures of blood pressure (BP) are critical in assessing cerebral autoregulation. Wave propogation velocity may be a useful technique to estimate BP but the effect of the location of the sensors on the readings has not been thoroughly examined. In this paper, we were interested to study if propagation velocity of the pressure wave in the direction from the heart to the brain may differ compared with propagation from the heart to the periphery, as well as across different physiological tasks and/or health conditions. Using non-invasive sensors simultaneously placed on different locations of the human body allow for the study of how propagation velocity of the pressure wave, based on pulse transit time (PTT), varies across different directions. APPROACH We present multi-sensor BP wave propagation measurement setup aimed for cerebral autoregulation studies. The presented sensor setup consists of three sensors, one each placed on the neck, chest and finger, allowing simultaneous measurement of changes in BP propagation velocity towards the brain and to the periphery. We show how commonly tested physiological tasks affect the relative changes of PTT and correlations with BP. MAIN RESULTS We observed that during maximal blow, valsalva and breath hold breathing tasks, the relative changes of PTT were higher when PTT was measured in the direction from the heart to the brain than from the heart to the peripherals. In contrast, during a deep breathing task, the relative change in PTT from the heart to the brain was lower. In addition, we present a short literature review of PTT methods used in brain research. SIGNIFICANCE These preliminary data suggest that physiological task and direction of PTT measurement may affect relative PTT changes. Presented three-sensor setup provides an easy and neuroimaging compatible method for cerebral autoregulation studies by allowing to measure BP wave propagation velocity towards the brain vs. towards the periphery.
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Affiliation(s)
- Aleksandra Zienkiewicz
- Optoelectronics and Measurement Techniques Research Unit, University of Oulu, Oulu, FINLAND
| | - Michelle Favre
- Department of Pharmacology, Physiology & Neuroscience, Rutgers The State University of New Jersey, Newark, New Jersey, UNITED STATES
| | - Hany Ferdinando
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Pohjois-Pohjanmaa, FINLAND
| | - Stephanie Iring
- Department of Pharmacology, Physiology & Neuroscience, Rutgers The State University of New Jersey, Newark, New Jersey, UNITED STATES
| | - Jorge Serrador
- Department of Pharmacology, Physiology & Neuroscience, Rutgers The State University of New Jersey, Newark, New Jersey, UNITED STATES
| | - Teemu Myllylä
- Optoelectronics and Measurement Techniques Research Unit, University of Oulu, Oulu, FINLAND
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Ding X, Wang W, Chen Y, Yang Y, Zhao Y, Kong D. Feasibility Study of Pulse Width at Half Amplitude of Camera PPG for Contactless Blood Pressure Estimation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:365-368. [PMID: 34891310 DOI: 10.1109/embc46164.2021.9630964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Non-contact blood pressure (BP) estimation with imaging photoplethysmogram (PPG) that can be acquired by camera is a promising alternative to cuff-based technology because of its nature of pervasive, low-cost, and being continuous. Most of the non-contact BP estimation methods are based on the principle of pulse transit time (PTT) as being used for wearable cuffless BP measurement. However, PTT-based method on the one hand requires simultaneous capture of images of multiple skin sites with the sites being at a distance from each other; and on the other hand, it can only partially reflect BP changes according to previous studies. In this paper, we propose to use a different camera PPG feature that has not yet been fully studied - pulse width at half amplitude (PWHA) for the evaluation of BP in a non-contact way. PWHA can be obtained from a single-site camera PPG, and it can indicate BP changes. The relationship of PWHA and BP was analyzed on 16 healthy subjects with BP changes induced by deep breathing and stepping exercise. The results showed that beat-to-beat PWHA can well track dynamic BP changes, and it is inversely related to BP across the sampled population and within each individual with about 80% individuals having high correlations. The findings suggest that PWHA can reflect the dynamic changes in cardiovascular characteristics and thereby BP changes, demonstrating the feasibility of imaging PWHA for non-contact BP estimation beyond the PTT method.Clinical Relevance- This provides a potential new method for non-contact BP, which allows BP monitoring at home, clinical setting, and public places in a pervasive manner. It reduces contacts between persons during a pandemic and offers an ever-present way to monitor BP.
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Di Rienzo M, Avolio A, Rizzo G, Zeybek ZMI, Cucugliato L. Multi-site Pulse Transit Times, Beat-to-Beat Blood Pressure, and Isovolumic Contraction Time at Rest and Under Stressors. IEEE J Biomed Health Inform 2021; 26:561-571. [PMID: 34347613 DOI: 10.1109/jbhi.2021.3101976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study investigates the beat-to-beat relationships among Pulse Transit Times (PTTs) and Pulse Arrival Times (PATs) concomitantly measured from the heart to finger, ear and forehead vascular districts, and their correlations with continuous finger blood pressure. These aspects were explored in 22 young volunteers at rest and during cold pressure test (CPT, thermal stress), handgrip (HG, isometric exercise) and cyclo-ergometer pedalling (CYC, dynamic exercise). The starting point of the PTT measures was the opening of the aortic valve detected by the seismocardiogram. Results indicate that PTTs measured at the ear, forehead and finger districts are uncorrelated each other at rest, and during CPT and HG. The stressors produced district-dependent changes in the PTT variability. Only the dynamic exercise was able to induce significant changes with respect to rest in the PTTs mean values (-40%, -36% and -17%, respectively for PTTear, PTTfore, PTTfinger,), and synchronize their modulations. Similar trends were observed in the PATs. The isovolumic contraction time decreased during the stressors application with a minimum at CYC (-25%) reflecting an augmented heart contractility. The increase in blood pressure (BP) at CPT was greater than that at CYC (137 vs. 128 mmHg), but the correlations between beat-to-beat transit times and BP were maximal at CYC (PAT showed a higher correlation than PTT; correlations were greater for systolic than for diastolic BP). This suggests that pulse transit times do not always depend directly on the beat-to-beat BP values but, under specific conditions, on other factors and mechanisms that concomitantly also influence BP.
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Ganti V, Carek AM, Jung H, Srivatsa AV, Cherry D, Johnson LN, Inan OT. Enabling Wearable Pulse Transit Time-Based Blood Pressure Estimation for Medically Underserved Areas and Health Equity: Comprehensive Evaluation Study. JMIR Mhealth Uhealth 2021; 9:e27466. [PMID: 34338646 PMCID: PMC8369375 DOI: 10.2196/27466] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/10/2021] [Accepted: 05/10/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Noninvasive and cuffless approaches to monitor blood pressure (BP), in light of their convenience and accuracy, have paved the way toward remote screening and management of hypertension. However, existing noninvasive methodologies, which operate on mechanical, electrical, and optical sensing modalities, have not been thoroughly evaluated in demographically and racially diverse populations. Thus, the potential accuracy of these technologies in populations where they could have the greatest impact has not been sufficiently addressed. This presents challenges in clinical translation due to concerns about perpetuating existing health disparities. OBJECTIVE In this paper, we aim to present findings on the feasibility of a cuffless, wrist-worn, pulse transit time (PTT)-based device for monitoring BP in a diverse population. METHODS We recruited a diverse population through a collaborative effort with a nonprofit organization working with medically underserved areas in Georgia. We used our custom, multimodal, wrist-worn device to measure the PTT through seismocardiography, as the proximal timing reference, and photoplethysmography, as the distal timing reference. In addition, we created a novel data-driven beat-selection algorithm to reduce noise and improve the robustness of the method. We compared the wearable PTT measurements with those from a finger-cuff continuous BP device over the course of several perturbations used to modulate BP. RESULTS Our PTT-based wrist-worn device accurately monitored diastolic blood pressure (DBP) and mean arterial pressure (MAP) in a diverse population (N=44 participants) with a mean absolute difference of 2.90 mm Hg and 3.39 mm Hg for DBP and MAP, respectively, after calibration. Meanwhile, the mean absolute difference of our systolic BP estimation was 5.36 mm Hg, a grade B classification based on the Institute for Electronics and Electrical Engineers standard. We have further demonstrated the ability of our device to capture the commonly observed demographic differences in underlying arterial stiffness. CONCLUSIONS Accurate DBP and MAP estimation, along with grade B systolic BP estimation, using a convenient wearable device can empower users and facilitate remote BP monitoring in medically underserved areas, thus providing widespread hypertension screening and management for health equity.
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Affiliation(s)
- Venu Ganti
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Andrew M Carek
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Hewon Jung
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Adith V Srivatsa
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | | | | | - Omer T Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
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Zhang Y, Zhou C, Huang Z, Ye X. Study of cuffless blood pressure estimation method based on multiple physiological parameters. Physiol Meas 2021; 42. [PMID: 33857923 DOI: 10.1088/1361-6579/abf889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/15/2021] [Indexed: 11/11/2022]
Abstract
Objective.Noninvasive blood pressure (BP) measurement technologies have been widely studied, but they still have the disadvantages of low accuracy, the requirement for frequent calibration and limited subjects. This work considers the regulation of vascular activity by the sympathetic nervous system and proposes a method for estimating BP using multiple physiological parameters.Approach.The parameters used in the model consist of heart rate variability (HRV), pulse transit time (PTT) and pulse wave morphology features extracted from electrocardiogram (ECG) and photoplethysmogram (PPG) signals. Through four classic machine learning algorithms, a hybrid data set of 3337 subjects from two databases is evaluated to verify the ability of cross-database migration. We also recommend an individual calibration procedure to further improve the accuracy of the method.Main results.The mean absolute error (MAE) and the root mean square error (RMSE) of the proposed algorithm is 10.03 and 14.55 mmHg for systolic BP (SBP), and 5.42 and 8.19 mmHg for diastolic BP (DBP). With individual calibration, the MAE and standard deviation (SD) is -0.16 ± 7.96 (SBP) and -0.13 ± 4.50 (DBP) mmHg, which satisfied the Advancement of Medical Instrumentation (AAMI) standard. In addition, the models are used to test single databases to evaluate their performance on different data sources. The overall performance of the Adaboost algorithm is better on the Multi-parameter Intelligent Monitoring in Intensive Care Unit (MIMIC) database; the MAE between its predicted value and true value reaches 6.6mmHg (SBP) and 3.12mmHg (DBP), respectively.Significance.The proposed method considers the regulation of blood vessels and the heart by the autonomic nervous system, and verifies its effectiveness and robustness across data sources, which is promising for improving the accuracy of continuous and cuffless BP estimation.
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Affiliation(s)
- Yiming Zhang
- Department of Biomedical Engineering, Key Laboratory for Biomedical Engineering of Education Ministry, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Congcong Zhou
- Department of Biomedical Engineering, Key Laboratory for Biomedical Engineering of Education Ministry, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Zhongyi Huang
- Department of Biomedical Engineering, Key Laboratory for Biomedical Engineering of Education Ministry, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Xuesong Ye
- Department of Biomedical Engineering, Key Laboratory for Biomedical Engineering of Education Ministry, Zhejiang University, Hangzhou 310027, People's Republic of China.,Cyrus Tang Center for Sensor Materials and Applications, Zhejiang University, Hangzhou 310058, People's Republic of China
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Luo J, Yan Z, Guo S, Chen W. Recent Advances in Atherosclerotic Disease Screening Using Pervasive Healthcare. IEEE Rev Biomed Eng 2021; 15:293-308. [PMID: 34003754 DOI: 10.1109/rbme.2021.3081180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Atherosclerosis screening helps the medical model transform from therapeutic medicine to preventive medicine by assessing degree of atherosclerosis prior to the occurrence of fatal vascular events. Pervasive screening emphasizes atherosclerotic monitoring with easy access, quick process, and advanced computing. In this work, we introduced five cutting-edge pervasive technologies including imaging photoplethysmography (iPPG), laser Doppler, radio frequency (RF), thermal imaging (TI), optical fiber sensing and piezoelectric sensor. IPPG measures physiological parameters by using video images that record the subtle skin color changes consistent with cardiac-synchronous blood volume changes in subcutaneous arteries and capillaries. Laser Doppler obtained the information on blood flow by analyzing the spectral components of backscattered light from the illuminated tissues surface. RF is based on Doppler shift caused by the periodic movement of the chest wall induced by respiration and heartbeat. TI measures vital signs by detecting electromagnetic radiation emitted by blood flow. The working principle of optical fiber sensor is to detect the change of light properties caused by the interaction between the measured physiological parameter and the entering light. Piezoelectric sensors are based on the piezoelectric effect of dielectrics. All these pervasive technologies are noninvasive, mobile, and can detect physiological parameters related to atherosclerosis screening.
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Yang S, Sohn J, Lee S, Lee J, Kim HC. Estimation and Validation of Arterial Blood Pressure Using Photoplethysmogram Morphology Features in Conjunction With Pulse Arrival Time in Large Open Databases. IEEE J Biomed Health Inform 2021; 25:1018-1030. [PMID: 32750963 DOI: 10.1109/jbhi.2020.3009658] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although various predictors and methods for BP estimation have been proposed, differences in study designs have led to difficulties in determining the optimal method. This study presents analyses of BP estimation methods using 2.4 million cardiac cycles of two commonly used non-invasive biosignals, electrocardiogram (ECG) and photoplethysmogram (PPG), from 1376 surgical patients. Feature selection methods were used to determine the best subset of predictors from a total of 42 including PAT, heart rate (HR), and various PPG morphology features, and BP estimation models constructed using linear regression (LR), random forest (RF), artificial neural network (ANN), and recurrent neural network (RNN) were evaluated. 28 features out of 42 were determined as suitable for BP estimation, in particular two PPG morphology features outperformed PAT, which has been conventionally seen as the best non-invasive indicator of BP. By modelling the low frequency component of BP using ANN and the high frequency component using RNN with the selected predictors, mean errors of 0.05 ± 6.92 mmHg for systolic BP, and -0.05 ± 3.99 mmHg for diastolic BP were achieved. External validation of the model using another biosignal database consisting of 334 intensive care unit patients led to similar results, satisfying three standards for accuracy of BP monitors. The results indicate that the proposed method can contribute to the realization of ubiquitous non-invasive continuous BP monitoring.
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42
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Hejjel L, Béres S. Comment on 'Pulse rate variability in cardiovascular health: a review on its applications and relationship with heart rate variability'. Physiol Meas 2021; 42:018001. [PMID: 33554875 DOI: 10.1088/1361-6579/abd332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Precise beat-to-beat fiducial point detection in the photoplethysmogram signal is essential for reliable pulse rate variability (PRV) analysis, which is considered an integral part of health monitoring devices in the evolving era of mobile health. Several studies have aimed to compare PRV to the well-investigated, gold standard heart rate variability (HRV) analysis, to see if they are interchangeable. The agreement between PRV and HRV is not unequivocal, as we learn from the commented metaanalysis. Technical factors like low sampling rate of photoplethysmography (PPG) or imprecise fiducial point detection are more important in this difference than physiological factors corresponding to pulse arrival time. Standardization of the PPG acquisition and reference point detection is necessary for comparable studies and correct measurement.
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Affiliation(s)
- László Hejjel
- Heart Institute, Medical Faculty, University of Pécs, Ifjúság str. 13. Pécs, H-7624, Hungary
| | - Szabolcs Béres
- Heart Institute, Medical Faculty, University of Pécs, Ifjúság str. 13. Pécs, H-7624, Hungary
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43
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Lee D, Kwon H, Son D, Eom H, Park C, Lim Y, Seo C, Park K. Beat-to-Beat Continuous Blood Pressure Estimation Using Bidirectional Long Short-Term Memory Network. SENSORS 2020; 21:s21010096. [PMID: 33375722 PMCID: PMC7795062 DOI: 10.3390/s21010096] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Abstract
Continuous blood pressure (BP) monitoring is important for patients with hypertension. However, BP measurement with a cuff may be cumbersome for the patient. To overcome this limitation, various studies have suggested cuffless BP estimation models using deep learning algorithms. A generalized model should be considered to decrease the training time, and the model reproducibility should be taken into account in multi-day scenarios. In this study, a BP estimation model with a bidirectional long short-term memory network is proposed. The features are extracted from the electrocardiogram, photoplethysmogram, and ballistocardiogram. The leave-one-subject-out (LOSO) method is incorporated to generalize the model and fine-tuning is applied. The model was evaluated using one-day and multi-day tests. The proposed model achieved a mean absolute error (MAE) of 2.56 and 2.05 mmHg for the systolic and diastolic BP (SBP and DBP), respectively, in the one-day test. Moreover, the results demonstrated that the LOSO method with fine-tuning was more compatible in the multi-day test. The MAE values of the model were 5.82 and 5.24 mmHg for the SBP and DBP, respectively.
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Affiliation(s)
- Dongseok Lee
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 03080, Korea; (D.L.); (H.K.); (D.S.)
| | - Hyunbin Kwon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 03080, Korea; (D.L.); (H.K.); (D.S.)
- Medical Research Center, Institute of Medical and Biological Engineering, Seoul National University, Seoul 03080, Korea
| | - Dongyeon Son
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 03080, Korea; (D.L.); (H.K.); (D.S.)
| | - Heesang Eom
- Department of Computer Engineering, Kwangwoon University, Seoul 01897, Korea; (H.E.); (C.P.)
| | - Cheolsoo Park
- Department of Computer Engineering, Kwangwoon University, Seoul 01897, Korea; (H.E.); (C.P.)
| | - Yonggyu Lim
- Department of Oriental Biomedical Engineering, Sangji University, Wonju 26339, Korea;
| | - Chulhun Seo
- School of Electronic Engineering, Soongsil University, Seoul 06978, Korea;
| | - Kwangsuk Park
- Medical Research Center, Institute of Medical and Biological Engineering, Seoul National University, Seoul 03080, Korea
- Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul 03080, Korea
- Correspondence:
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44
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Schaanning SG, Skjaervold NK. Rapid declines in systolic blood pressure are associated with an increase in pulse transit time. PLoS One 2020; 15:e0240126. [PMID: 33031455 PMCID: PMC7544103 DOI: 10.1371/journal.pone.0240126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/20/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The correlation between pulse transit time and blood pressure has been proposed as a route to measure continuous non-invasive blood pressure. We investigated whether pulse transit time trends could model blood pressure trends during episodes of rapid declines in blood pressure. METHODS From the Medical Information Mart for Intensive Care waveform database we identified substantial blood pressure reductions. Pulse transit time was calculated from the R-peak of the electrocardiogram to the peak of the arterial pulse waveform. The time-series were processed with a moving average filter before comparison. Averaged, continuous heart rate was also analysed as a control. The intra-individual association between variables was assessed per subject using linear regression. RESULTS In the 511 patients included we found a median correlation coefficient between blood pressure and pulse transit time of -0.93 (IQR -0.98 to -0.76) with regression slopes of -1.23 mmHg/ms (IQR -1.73 to -0.81). The median correlation coefficient between blood pressure and heart rate was 0.46 (IQR -0.16 to 0.83). In supplementary analysis, results did not differ substantially when widening inclusion criteria, but the results were not always consistent within subjects across episodes of hypotension. CONCLUSIONS In a large cohort of critically ill patients experiencing episodes of rapid declines in systolic blood pressure, there was a moderate-strong intra-individual correlation between averaged systolic blood pressure and averaged pulse transit time. Our findings encourage further investigation into using the pulse transit time for non-invasive real-time detection of hypotension.
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Affiliation(s)
- Sebastian Grøvdal Schaanning
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nils Kristian Skjaervold
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, Trondheim University Hospital, Trondheim, Norway
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45
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Liu Z, Zhou B, Li Y, Tang M, Miao F. Continuous Blood Pressure Estimation From Electrocardiogram and Photoplethysmogram During Arrhythmias. Front Physiol 2020; 11:575407. [PMID: 33013491 PMCID: PMC7509183 DOI: 10.3389/fphys.2020.575407] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/13/2020] [Indexed: 12/02/2022] Open
Abstract
Objective Continuous blood pressure (BP) provides valuable information for the disease management of patients with arrhythmias. The traditional intra-arterial method is too invasive for routine healthcare settings, whereas cuff-based devices are inferior in reliability and comfortable for long-term BP monitoring during arrhythmias. The study aimed to investigate an indirect method for continuous and cuff-less BP estimation based on electrocardiogram (ECG) and photoplethysmogram (PPG) signals during arrhythmias and to test its reliability for the determination of BP using invasive BP (IBP) as reference. Methods Thirty-five clinically stable patients (15 with ventricular arrhythmias and 20 with supraventricular arrhythmias) who had undergone radiofrequency ablation were enrolled in this study. Their ECG, PPG, and femoral arterial IBP signals were simultaneously recorded with a multi-parameter monitoring system. Fifteen features that have the potential ability in indicating beat-to-beat BP changes during arrhythmias were extracted from the ECG and PPG signals. Four machine learning algorithms, decision tree regression (DTR), support vector machine regression (SVR), adaptive boosting regression (AdaboostR), and random forest regression (RFR), were then implemented to develop the BP models. Results The results showed that the mean value ± standard deviation of root mean square error for the estimated systolic BP (SBP), diastolic BP (DBP) with the RFR model against the reference in all patients were 5.87 ± 3.13 and 3.52 ± 1.38 mmHg, respectively, which achieved the best performance among all the models. Furthermore, the mean error ± standard deviation of error between the estimated SBP and DBP with the RFR model against the reference in all patients were −0.04 ± 6.11 and 0.11 ± 3.62 mmHg, respectively, which complied with the Association for the Advancement of Medical Instrumentation and the British Hypertension Society (Grade A) standards. Conclusion The results indicated that the utilization of ECG and PPG signals has the potential to enable cuff-less and continuous BP estimation in an indirect way for patients with arrhythmias.
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Affiliation(s)
- ZengDing Liu
- Chinese Academy of Sciences Key Laboratory for Health Informatics, Shenzhen Institutes of Advanced Technology, Shenzhen, China.,Joint Engineering Research Center for Health Big Data Intelligent Analysis Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bin Zhou
- State Key Lab of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Li
- Chinese Academy of Sciences Key Laboratory for Health Informatics, Shenzhen Institutes of Advanced Technology, Shenzhen, China.,Joint Engineering Research Center for Health Big Data Intelligent Analysis Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Min Tang
- State Key Lab of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fen Miao
- Chinese Academy of Sciences Key Laboratory for Health Informatics, Shenzhen Institutes of Advanced Technology, Shenzhen, China.,Joint Engineering Research Center for Health Big Data Intelligent Analysis Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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46
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Draft Proposal of an Optical Cuffless Blood Pressure Device. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-020-00435-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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47
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Feasibility of a new free mobility procedure to evaluate the function of the autonomic nervous system in patients with syncope. Sci Rep 2020; 10:13994. [PMID: 32814782 PMCID: PMC7438529 DOI: 10.1038/s41598-020-70701-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/29/2020] [Indexed: 01/01/2023] Open
Abstract
To propose a new test to evaluate the autonomic nervous system in patients with syncope: Multimodal Monitoring for Diagnosis of Dysautonomia (MMDD). We included 21 patients with syncope (16 female, 6 male, mean age 43.5 years) and 21 with no-syncope subjects (15 female, 7 male, mean age 45.1 years) to perform a test of nine 2-min stages: four while resting and four during active testing of autonomic response. Transcranial-Doppler, electrocardiogram, and photoplethysmography blood pressure pulse-to-pulse monitoring, allow registering six variables from the Middle Cerebral Artery and four from the Cardiovascular System. We analyze each variable's mean differences in each stage and its change when they pass from one stage to another with the T and Z tests. To understand the significance of the change, we use a logistic regression model for a certain subgroup of variables. Since we have a small dataset, we use the bootstrap technique to infer the general behavior that characterizes a syncope. Our data confirm differences between syncope and non-syncope patients during MMDD stress stages 2, 4, 6 and 8. Bootstrap and multivariate logistic regression allow us to identify which sets of variables in each of these stages of the MMDD are sufficiently sensitive to recognizing syncope. MMDD protocol can recognize a syncope patient with some confidence by detecting subtle changes in the autonomic nervous system. This protocol encourages us to continue to study the effectiveness of MMDD protocol allowing a new approach to future research.
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Al-Qatatsheh A, Morsi Y, Zavabeti A, Zolfagharian A, Salim N, Z. Kouzani A, Mosadegh B, Gharaie S. Blood Pressure Sensors: Materials, Fabrication Methods, Performance Evaluations and Future Perspectives. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4484. [PMID: 32796604 PMCID: PMC7474433 DOI: 10.3390/s20164484] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022]
Abstract
Advancements in materials science and fabrication techniques have contributed to the significant growing attention to a wide variety of sensors for digital healthcare. While the progress in this area is tremendously impressive, few wearable sensors with the capability of real-time blood pressure monitoring are approved for clinical use. One of the key obstacles in the further development of wearable sensors for medical applications is the lack of comprehensive technical evaluation of sensor materials against the expected clinical performance. Here, we present an extensive review and critical analysis of various materials applied in the design and fabrication of wearable sensors. In our unique transdisciplinary approach, we studied the fundamentals of blood pressure and examined its measuring modalities while focusing on their clinical use and sensing principles to identify material functionalities. Then, we carefully reviewed various categories of functional materials utilized in sensor building blocks allowing for comparative analysis of the performance of a wide range of materials throughout the sensor operational-life cycle. Not only this provides essential data to enhance the materials' properties and optimize their performance, but also, it highlights new perspectives and provides suggestions to develop the next generation pressure sensors for clinical use.
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Affiliation(s)
- Ahmed Al-Qatatsheh
- Faculty of Science, Engineering, and Technology (FSET), Swinburne University of Technology, Melbourne VIC 3122, Australia; (Y.M.); (N.S.)
| | - Yosry Morsi
- Faculty of Science, Engineering, and Technology (FSET), Swinburne University of Technology, Melbourne VIC 3122, Australia; (Y.M.); (N.S.)
| | - Ali Zavabeti
- Department of Chemical Engineering, The University of Melbourne, Parkville VIC 3010, Australia;
| | - Ali Zolfagharian
- Faculty of Science, Engineering and Built Environment, School of Engineering, Deakin University, Waurn Ponds VIC 3216, Australia; (A.Z.); (A.Z.K.)
| | - Nisa Salim
- Faculty of Science, Engineering, and Technology (FSET), Swinburne University of Technology, Melbourne VIC 3122, Australia; (Y.M.); (N.S.)
| | - Abbas Z. Kouzani
- Faculty of Science, Engineering and Built Environment, School of Engineering, Deakin University, Waurn Ponds VIC 3216, Australia; (A.Z.); (A.Z.K.)
| | - Bobak Mosadegh
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, NY 10065, USA;
| | - Saleh Gharaie
- Faculty of Science, Engineering and Built Environment, School of Engineering, Deakin University, Waurn Ponds VIC 3216, Australia; (A.Z.); (A.Z.K.)
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Eom H, Lee D, Han S, Hariyani YS, Lim Y, Sohn I, Park K, Park C. End-to-End Deep Learning Architecture for Continuous Blood Pressure Estimation Using Attention Mechanism. SENSORS (BASEL, SWITZERLAND) 2020; 20:E2338. [PMID: 32325970 PMCID: PMC7219235 DOI: 10.3390/s20082338] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/13/2020] [Accepted: 04/17/2020] [Indexed: 11/16/2022]
Abstract
Blood pressure (BP) is a vital sign that provides fundamental health information regarding patients. Continuous BP monitoring is important for patients with hypertension. Various studies have proposed cuff-less BP monitoring methods using pulse transit time. We propose an end-to-end deep learning architecture using only raw signals without the process of extracting features to improve the BP estimation performance using the attention mechanism. The proposed model consisted of a convolutional neural network, a bidirectional gated recurrent unit, and an attention mechanism. The model was trained by a calibration-based method, using the data of each subject. The performance of the model was compared to the model that used each combination of the three signals, and the model with the attention mechanism showed better performance than other state-of-the-art methods, including conventional linear regression method using pulse transit time (PTT). A total of 15 subjects were recruited, and electrocardiogram, ballistocardiogram, and photoplethysmogram levels were measured. The 95% confidence interval of the reference BP was [86.34, 143.74] and [51.28, 88.74] for systolic BP (SBP) and diastolic BP (DBP), respectively. The R 2 values were 0.52 and 0.49, and the mean-absolute-error values were 4.06 ± 4.04 and 3.33 ± 3.42 for SBP and DBP, respectively. In addition, the results complied with global standards. The results show the applicability of the proposed model as an analytical metric for BP estimation.
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Affiliation(s)
- Heesang Eom
- Department of Computer Engineering, Kwangwoon University, Seoul 01897, Korea; (H.E.); (Y.S.H.)
| | - Dongseok Lee
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 03080, Korea;
| | - Seungwoo Han
- Department of Intelligent Information System and Embedded Software Engineering, Kwangwoon University, Seoul 01897, Korea;
| | - Yuli Sun Hariyani
- Department of Computer Engineering, Kwangwoon University, Seoul 01897, Korea; (H.E.); (Y.S.H.)
- School of Applied Science, Telkom University, Bandung 40257, Indonesia
| | - Yonggyu Lim
- Department of Oriental Biomedical Engineering, Sangji University, Wonju 26339, Korea;
| | - Illsoo Sohn
- Department of Computer Science and Engineering, Seoul National University of Science and Technology, Seoul 01811, Korea;
| | - Kwangsuk Park
- Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul 03080, Korea
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul 03080, Korea
| | - Cheolsoo Park
- Department of Computer Engineering, Kwangwoon University, Seoul 01897, Korea; (H.E.); (Y.S.H.)
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50
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Pulse transit time based respiratory rate estimation with singular spectrum analysis. Med Biol Eng Comput 2019; 58:257-266. [PMID: 31834610 DOI: 10.1007/s11517-019-02088-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
Respiratory rate (RR) is an important vital sign which can be difficult to measure accurately and unobtrusively in routine clinical practice. Pulse transit time (PTT), on the other hand, is unobtrusive to collect from electrocardiogram (ECG) and photoplethysmogram (PPG) signals. Using PTT is a novel method to estimate and monitor blood pressure (BP) and RR. This study aimed to estimate continuous RR using PTT with singular spectrum analysis to extract respiratory components. The performance of this method was validated on 17 subjects who carried out spontaneous breathing and controlled deep breathing conditions. Three types of estimated RR parameters (average RR by power spectral density (PSD) (RRPSD), number of breaths (RR#), and instantaneous RR (RRinst)) were compared with the corresponding reference RR. The reference RR was collected using a respiratory belt. Our findings demonstrate that the PTT signal reliably tracked respiratory variation with a root mean square error of 0.84, 1.11, and 0.74 breaths/min for RRPSD, RR#, and RRinst estimations, respectively. Overall, RR estimated by PTT was more accurate than heart/pulse rate interval, QRS area, and PPG amplitude, which were also extracted from ECG and PPG. The results suggest that it may be feasible to use PTT as an estimation of RR and that ECG and PPG may be relied upon for monitoring not only RR but also BP and heart rate. Graphical abstract The Pulse Transit Time (PTT) based Respiratory Rate (RR) estimation with Singular Spectrum Analysis (SSA) provides a superior performance than the method with other respiratory indicators extracted from Electrocardiogram (ECG) or Photoplethysmogram (PPG).
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