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López-Galán E, Montoya-Pedrón A, Barrio-Deler R, Sánchez-Hechavarría ME, Muñoz-Bustos ME, Muñoz-Bustos GA. Reactive Hyperemia and Cardiovascular Autonomic Neuropathy in Type 2 Diabetic Patients: A Systematic Review of Randomized and Nonrandomized Clinical Trials. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040770. [PMID: 37109728 PMCID: PMC10141598 DOI: 10.3390/medicina59040770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023]
Abstract
Objective: This work aimed to determine the relationship between the autonomic nervous system and reactive hyperemia (RH) in type 2 diabetes patients with and without cardiovascular autonomic neuropathy (CAN). Methodology: A systematic review of randomized and nonrandomized clinical studies characterizing reactive hyperemia and autonomic activity in type 2 diabetes patients with and without CAN was performed. Results: Five articles showed differences in RH between healthy subjects and diabetic patients with and/or without neuropathy, while one study did not show such differences between healthy subjects and diabetic patients, but patients with diabetic ulcers had lower RH index values compared to healthy controls. Another study found no significant difference in blood flow after a muscle strain that induced reactive hyperemia between normal subjects and non-smoking diabetic patients. Four studies measured reactive hyperemia using peripheral arterial tonometry (PAT); only two found a significantly lower endothelial-function-derived measure of PAT in diabetic patients than in those without CAN. Four studies measured reactive hyperemia using flow-mediated dilation (FMD), but no significant differences were reported between diabetic patients with and without CAN. Two studies measured RH using laser Doppler techniques; one of them found significant differences in the blood flow of calf skin after stretching between diabetic non-smokers and smokers. The diabetic smokers had neurogenic activity at baseline that was significantly lower than that of the normal subjects. The greatest evidence revealed that the differences in RH between diabetic patients with and without CAN may depend on both the method used to measure hyperemia and that applied for the ANS examination as well as the type of autonomic deficit present in the patients. Conclusions: In diabetic patients, there is a deterioration in the vasodilator response to the reactive hyperemia maneuver compared to healthy subjects, which depends in part on endothelial and autonomic dysfunction. Blood flow alterations in diabetic patients during RH are mainly mediated by sympathetic dysfunction. The greatest evidence suggests a relationship between ANS and RH; however, there are no significant differences in RH between diabetic patients with and without CAN, as measured using FMD. When the flow of the microvascular territory is measured, the differences between diabetics with and without CAN become evident. Therefore, RH measured using PAT may reflect diabetic neuropathic changes with greater sensitivity compared to FMD.
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Affiliation(s)
- Erislandis López-Galán
- Facultad de Medicina 2, Universidad de Ciencias Médicas de Santiago de Cuba, Santiago de Cuba 90100, Cuba
| | - Arquímedes Montoya-Pedrón
- Departamento de Neurofisiología Clínica, Hospital Clínico Quirúrgico Juan Brunos Zayas Alfonso, Universidad de Ciencias Médicas de Santiago de Cuba, Santiago de Cuba 90100, Cuba
| | - Rafael Barrio-Deler
- Hospital Infantil Norte Juan de la Cruz Martínez Maceira, Universidad de Ciencias Médicas de Santiago de Cuba, Santiago de Cuba 90100, Cuba
| | - Miguel Enrique Sánchez-Hechavarría
- Departamento de Ciencias Clínicas y Preclínicas, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile
- Núcleo Científico de Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Adventista de Chile, Chillán 3780000, Chile
| | - Mario Eugenio Muñoz-Bustos
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Concepción, Concepción 4030000, Chile
| | - Gustavo Alejandro Muñoz-Bustos
- Escuela de Kinesiología, Facultad de Salud y Ciencias Sociales, Campus El Boldal, Sede Concepción, Universidad de las Américas, Concepcion 4030000, Chile
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Chen JJ, Wu HT, Haryadi B. Reactive Hyperemia-Triggered Wrist Pulse Analysis for Early Monitoring of Young Men with High Atherosclerotic Risk. Diagnostics (Basel) 2021; 11:1918. [PMID: 34679616 PMCID: PMC8535088 DOI: 10.3390/diagnostics11101918] [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: 09/19/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022] Open
Abstract
The high prevalence of cardiovascular disease in young adults has raised significant concern regarding the early identification of risk factors to allow for timely intervention. This study aimed to identify young males at risk of atherosclerosis using a noninvasive instrument and an initial application percussion entropy analysis of the wrist pressure pulse (WPP). In total, 49 young males aged 18 to 28, without any known history of vascular disease, were recruited. Blood samples were obtained whereby a TC/HDL cutoff value of 4 was used to divide the young men into low-risk (Group 1, TC/HDL < 4, N = 32) and high-risk (Group 2, TC/HDL ≥ 4, N = 17) groups regarding atherosclerosis. The reactive hyperemia-triggered WPPs were measured using a modified air-pressure-sensing system (MAPSS). The dilation index (DI) of the endothelial function and percussion entropy index (PEI) of the heart rate variability (HRV) assessments, calculated using pragmatic signal-processing techniques, were compared between the two groups. The nonparametric Mann-Whitney U test showed that the DI and PEI of the two groups showed statistical differences (both p < 0.05). Not only could the MAPSS assess endothelial function and HRV in young males, but the results also showed that waist circumference and PEI may serve as indicators for the early identification of young males at risk of atherosclerosis.
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Affiliation(s)
- Jian-Jung Chen
- Taichung Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taichung 42743, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97002, Taiwan
| | - Hsien-Tsai Wu
- Department of Electrical Engineering, Dong Hwa University, No. 1, Sec. 2, Da Hsueh Rd., Hualien 97401, Taiwan; (H.-T.W.); (B.H.)
| | - Bagus Haryadi
- Department of Electrical Engineering, Dong Hwa University, No. 1, Sec. 2, Da Hsueh Rd., Hualien 97401, Taiwan; (H.-T.W.); (B.H.)
- Department of Physics, Universitas Ahmad Dahlan, Jendral A. Yani Street, Kragilan, Tamanan, Kec. Banguntapan, Bantul, Yogyakarta 55191, Indonesia
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Mejía-Mejía E, May JM, Torres R, Kyriacou PA. Pulse rate variability in cardiovascular health: a review on its applications and relationship with heart rate variability. Physiol Meas 2020; 41:07TR01. [DOI: 10.1088/1361-6579/ab998c] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Haryadi B, Liou JJ, Wei HC, Xiao MX, Wu HT, Sun CK. Application of multiscale Poincaré short-time computation versus multiscale entropy in analyzing fingertip photoplethysmogram amplitudes to differentiate diabetic from non-diabetic subjects. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 166:115-121. [PMID: 30415711 DOI: 10.1016/j.cmpb.2018.10.001] [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: 04/13/2018] [Revised: 09/03/2018] [Accepted: 10/01/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Multiscale Poincaré (MSP) plots have recently been introduced to facilitate the visualization of time series of physiological signals. This study aimed at investigating the feasibility of MSP application in distinguishing subjects with and without diabetes. METHODS Using photoplethysmogram (PPG) waveform amplitudes acquired from unilateral fingertip of non-diabetic (n = 34) and diabetic (n = 30) subjects, MSP indices (MSPI) of the two groups were compared using 1000, 500, 250, 100 data points. Data from Poincaré index (short-term variability/long-term variability [i.e. SD1/SD2] ratio, SSR) and multiscale entropy (MSE) were also obtained with the four corresponding data points for comparison. RESULTS SSR and MSPI were both negatively related to glycated hemoglobin (HbA1c) and fasting blood sugar levels. Significant negative correlation was also noted between MSPI and pulse pressure. When only 500 and 250 data points were included, significant elevations in the non-diabetic group were only noted in MSPI (both p < 0.01). Furthermore, MSPI was significantly higher in non-diabetic than that in diabetic subjects on all scales (i.e., 1-10) but not using MSE when utilizing 1000 data points. CONCLUSIONS The results demonstrated enhanced sensitivity of MSP in differentiating between non-diabetic and diabetic subjects compared to SSR and MSE, highlighting the feasibility of MSP application in biomedical data analysis to reduce computational time and enhance sensitivity.
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Affiliation(s)
- Bagus Haryadi
- Department of Electrical Engineering, National Dong-Hwa University, Hualien 974701, Taiwan; Department of Physics, Universitas Ahmad Dahlan, Yogyakarta, Indonesia.
| | - Juin J Liou
- School of Electrical and Information Engineering, North Minzu University, Yinchuan 750021, China
| | - Hai-Cheng Wei
- School of Electrical and Information Engineering, North Minzu University, Yinchuan 750021, China.
| | - Ming-Xia Xiao
- School of Electrical and Information Engineering, North Minzu University, Yinchuan 750021, China
| | - Hsien-Tsai Wu
- Department of Electrical Engineering, National Dong-Hwa University, Hualien 974701, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University School of Medicine for International students, Kaohsiung, Taiwan.
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Effects of Combined Far-Infrared Radiation and Acupuncture at ST36 on Peripheral Blood Perfusion and Autonomic Activities. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:1947315. [PMID: 28883882 PMCID: PMC5572608 DOI: 10.1155/2017/1947315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/24/2022]
Abstract
Using four-channel photoplethysmography (PPG) for acquiring peripheral arterial waveforms, this study investigated vascular and autonomic impacts of combined acupuncture-far infrared radiation (FIR) in improving peripheral circulation. Twenty healthy young adults aged 25.5 ± 4.6 were enrolled for 30-minute measurement. Each subject underwent four treatment strategies, including acupuncture at ST36 (Zusanli), pseudoacupuncture, FIR, and combined acupuncture-FIR at different time points. Response was assessed at 5-minute intervals. Area under arterial waveform at baseline was defined as AreaBaseline, whereas AreaStim referred to area at each 5-minute substage during and after treatment. AreaStim/AreaBaseline was compared at different stages and among different strategies. Autonomic activity at different stages was assessed using low-to-high frequency power ratio (LHR). The results demonstrated increased perfusion for each therapeutic strategy from stage 1 to stage 2 (all p < 0.02). Elevated perfusion was noted for all treatment strategies at stage 3 compared to stage 1 except pseudoacupuncture. Increased LHR was noted only in subjects undergoing pseudoacupuncture at stage 3 compared to stage 1 (p = 0.045). Reduced LHR at stage 2 compared to stage 1 was found only in combined treatment group (p = 0.041). In conclusion, the results support clinical benefits of combined acupuncture-FIR treatment in enhancing peripheral perfusion and parasympathetic activity.
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Nardelli M, Greco A, Bolea J, Valenza G, Scilingo EP, Bailon R. Reliability of Lagged Poincaré Plot Parameters in Ultrashort Heart Rate Variability Series: Application on Affective Sounds. IEEE J Biomed Health Inform 2017; 22:741-749. [PMID: 28436907 DOI: 10.1109/jbhi.2017.2694999] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The number of studies about ultrashort cardiovascular time series is increasing because of the demand for mobile applications in telemedicine and e-health monitoring. However, the current literature still needs a proper validation of heartbeat nonlinear dynamics assessment from ultrashort time series. This paper reports on the reliability of the Lagged Poincaré Plot (LPP) parameters-calculated from ultrashort cardiovascular time series. Reliability is studied on simulated as well as on real RR series. Simulated RR series are generated and LPP parameters estimated for ultrashort time series (from 15 to 60 s) are compared to those estimated from 1 h. All LPP parameters estimated from time series longer than 35 s presented a Spearman's correlation coefficient higher than 0.99. RR series acquired from 32 healthy subjects during 5-min resting state sessions are used to test the LPP approach in experimental data. The usefulness of ultrashort term parameters in real data is accomplished also studying their ability to discriminate positive and negative valence of auditory stimuli taken from the International Affective Digitized Sound System (IADS) dataset. The achieved accuracies in the recognition of elicitation along the valence dimension, using only the LPP parameters, were of 77.78% for 1 min 28 s series, and of 79.17% for 35 s series.
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Yang CC, Wu HT, Chuang WY, Liu TC, Tsai IT, Chen JJ, Sun CK. Application of Short-Time MSE in Assessing Impact of Acupuncture on Peripheral Blood Flow and Autonomic Activities in Normal and Overweight Subjects. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0145-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Multiscale Entropy Analysis of Heart Rate Variability for Assessing the Severity of Sleep Disordered Breathing. ENTROPY 2015. [DOI: 10.3390/e17010231] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Liu AB, Wu HT, Liu CW, Liu CC, Tang CJ, Tsai IT, Sun CK. Application of multiscale entropy in arterial waveform contour analysis in healthy and diabetic subjects. Med Biol Eng Comput 2014; 53:89-98. [PMID: 25351478 DOI: 10.1007/s11517-014-1220-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 10/20/2014] [Indexed: 02/03/2023]
Abstract
We applied multiscale entropy (MSE) to assess variation in crest time (CT), a parameter in arterial waveform analysis, in diagnosing patients with diabetes. Data on digital volume pulse were obtained from 93 individuals in three groups [Healthy young (Group 1, 20 < age ≤ 40, n = 30), healthy upper-middle-aged (Group 2, age > 40, n = 30), and diabetic (Group 3, n = 33) subjects]. Crest time, normalized crest time, crest time ratio (CTR), small- and large-scale MSE on CT [MSESS(CT) and MSELS(CT), respectively] were computed and correlated with anthropometric (i.e., body weight/height, waist circumference), hemodynamic (i.e., blood pressure), and biochemical parameters (i.e., serum triglyceride, high-density lipoprotein, fasting blood sugar, and glycosylated hemoglobin). The results demonstrated higher variability in CT in healthy subjects (Groups 1 and 2) compared with that in diabetic patients (Group 3) as reflected in significantly elevated MSESS(CT) and MSELS(CT) in the former (p < 0.003 and p < 0.001, respectively). MSELS(CT) also showed significant association with waist circumference and fasting blood sugar (i.e., two diagnostic criteria of metabolic syndrome) as well as glycosylated hemoglobin concentration. In conclusion, using MSE analysis for assessing CT variation successfully distinguished diabetic patients from healthy subjects. MSESS(CT) and MSELS(CT) therefore may serve as noninvasive tools for identifying subjects with diabetes and those at risk.
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Affiliation(s)
- An-Bang Liu
- Department of Neurology, Buddhist Tzu Chi General Hospital, Buddhist Tzu Chi University, Hualien, Taiwan
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Effects of first-time overnight CPAP therapy for increasing the complexity of the patient's physiological system. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2014; 2014:652012. [PMID: 25140195 PMCID: PMC4129133 DOI: 10.1155/2014/652012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/15/2014] [Accepted: 06/16/2014] [Indexed: 11/18/2022]
Abstract
Studies regarding the effects of short-term continuous positive airway pressure (CPAP) therapy are not sufficient. A total of 35 patients with moderate to severe untreated OSA were divided into 2 groups. Group 1 comprised 22 patients who underwent polysomnography (PSG) for one night, and Group 2 comprised 13 patients who received PSG combined with CPAP therapy. To evaluate the influence of receiving CPAP therapy for one night, we measured 5 min wrist pulse signals before and after the experiment to assess heart rate variability, as well as novel short time multiscale entropy (sMSE) indicator that examines complexity in physiological signals. The results show that the participants in Group 1 exhibited significant changes in normalized low-frequency power/normalized high-frequency power (nLF/nHF) (0.72 ± 0.09 versus 1.11 ± 0.11, P = 0.006) values before and after the PSG study. By contrast, the participants in Group 2 showed no significant changes in the 3 indicators. Regarding the sMSE indicator, Group 2 patients exhibited significant increases in the sMSE. CPAP therapy administered for one night can reduce the sympathovagal imbalance in patients with moderate to severe untreated OSA and increase the complexity of the patient's physiological system, thereby reflecting their overall improved health.
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