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Almarshad MA, Islam MS, Al-Ahmadi S, BaHammam AS. Diagnostic Features and Potential Applications of PPG Signal in Healthcare: A Systematic Review. Healthcare (Basel) 2022; 10:547. [PMID: 35327025 PMCID: PMC8950880 DOI: 10.3390/healthcare10030547] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023] Open
Abstract
Recent research indicates that Photoplethysmography (PPG) signals carry more information than oxygen saturation level (SpO2) and can be utilized for affordable, fast, and noninvasive healthcare applications. All these encourage the researchers to estimate its feasibility as an alternative to many expansive, time-wasting, and invasive methods. This systematic review discusses the current literature on diagnostic features of PPG signal and their applications that might present a potential venue to be adapted into many health and fitness aspects of human life. The research methodology is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020. To this aim, papers from 1981 to date are reviewed and categorized in terms of the healthcare application domain. Along with consolidated research areas, recent topics that are growing in popularity are also discovered. We also highlight the potential impact of using PPG signals on an individual's quality of life and public health. The state-of-the-art studies suggest that in the years to come PPG wearables will become pervasive in many fields of medical practices, and the main domains include cardiology, respiratory, neurology, and fitness. Main operation challenges, including performance and robustness obstacles, are identified.
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Affiliation(s)
- Malak Abdullah Almarshad
- Computer Science Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia; (M.S.I.); (S.A.-A.)
- Computer Science Department, College of Computer and Information Sciences, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
| | - Md Saiful Islam
- Computer Science Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia; (M.S.I.); (S.A.-A.)
| | - Saad Al-Ahmadi
- Computer Science Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia; (M.S.I.); (S.A.-A.)
| | - Ahmed S. BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11324, Saudi Arabia;
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Kotidis C, Wertheim D, Weindling M, Rabe H, Turner MA. Assessing patent ductus arteriosus in preterm infants from standard neonatal intensive care monitoring. Eur J Pediatr 2022; 181:1117-1124. [PMID: 34748081 PMCID: PMC8897357 DOI: 10.1007/s00431-021-04311-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Abstract
Monitoring patent ductus arteriosus (PDA) in premature infants is currently performed intermittently using echocardiography which requires considerable expertise. The aim of this pilot study was to investigate whether PDA status could be assessed from standard neonatal intensive care monitoring. Electrocardiography (ECG) and blood pressure (BP) waveforms were acquired from extremely preterm infants using standard neonatal monitors. We developed software using MATLAB to analyse ECG and BP waveforms and their interrelationships in terms of pulse transit time (PTT) and pulse wave velocity (PWV). The times from peak systolic BP to diastolic trough (BPFt) and from the diastolic trough to peak systolic BP (BPRt) were also calculated. PTT, BPFt and BPRt were normalised for heart rate (HR) termed NPTT, NBPFt and NBPRt, respectively. ECG, invasive aortic BP monitoring and echocardiography were performed in 14 preterm infants < 29 weeks' gestation in the first 3 days after birth. The median (range) birth weight of the infants was 0.90 (0.48-1.31) kg, gestation 26.6 (24.0-28.7) weeks, PDA diameter 1.6 (0.8-3.6) mm and mean BP 32 (16-40) mmHg. We found a significant positive correlation between PDA diameter and NPTT (r = 0.69, P = 0.007) as well as NBPFt (r = 0.65, P = 0.012) and NBPRt (r = 0.71, P = 0.005). No relationship was found between PDA diameter and pulse pressure.Conclusions: Interrelationships between ECG and BP traces as well as BP waveform time analysis are straightforward to measure and associated with PDA diameter. The results of this pilot study suggest that this approach may help provide biomarkers for continuous monitoring PDA diameter and function. What is Known: • Patent ductus arteriosus (PDA) in premature infants is associated with increased risk of developing chronic lung disease, necrotising enterocolitis and cerebral injury. • Currently PDA is assessed intermittently using echocardiography which requires considerable expertise and sometimes is not well tolerated by critically ill preterm infants. What is New: • Blood pressure (BP) and ECG waveform interrelation and BP trace time analysis, taking account of heart rate, relate to PDA diameter. • ECG and BP waveform phase difference as well as BP waveform time analysis may be useful in the continuous assessment of PDA function.
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Affiliation(s)
- Charalampos Kotidis
- Department of Women's and Children's Health, University of Liverpool, Liverpool Health Partners, Liverpool, UK. .,University of Liverpool, Liverpool Womens Hospital, Crown Street, L8 7SS, Liverpool, UK.
| | - David Wertheim
- grid.15538.3a0000 0001 0536 3773Faculty of Science, Engineering and Computing, Kingston University, Surrey, UK
| | - Michael Weindling
- grid.10025.360000 0004 1936 8470Department of Women’s and Children’s Health, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - Heike Rabe
- grid.12082.390000 0004 1936 7590Academic Department of Paediatrics, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Mark A. Turner
- grid.10025.360000 0004 1936 8470Department of Women’s and Children’s Health, University of Liverpool, Liverpool Health Partners, Liverpool, UK
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Sorensen MW, Sadiq I, Clifford GD, Maher KO, Oster ME. Using pulse oximetry waveforms to detect coarctation of the aorta. Biomed Eng Online 2020; 19:31. [PMID: 32408879 PMCID: PMC7227302 DOI: 10.1186/s12938-020-00775-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background Coarctation of the aorta is a common form of critical congenital heart disease that remains challenging to diagnose prior to clinical deterioration. Despite current screening methods, infants with coarctation may present with life-threatening cardiogenic shock requiring urgent hospitalization and intervention. We sought to improve critical congenital heart disease screening by using a novel pulse oximetry waveform analysis, specifically focused on detection of coarctation of the aorta. Methods and results Over a 2-year period, we obtained pulse oximetry waveform data on 18 neonates with coarctation of the aorta and 18 age-matched controls hospitalized in the cardiac intensive care unit at Children’s Healthcare of Atlanta. Patients with coarctation were receiving prostaglandin E1 and had a patent ductus arteriosus. By analyzing discrete features in the waveforms, we identified statistically significant differences in the maximum rate of fall between patients with and without coarctation. This was accentuated when comparing the difference between the upper and lower extremities, with the lower extremities having a shallow slope angle when a coarctation was present (p-value 0.001). Postoperatively, there were still differences in the maximum rate of fall between the repaired coarctation patients and controls; however, these differences normalized when compared with the same individual’s upper vs. lower extremities. Coarctation patients compared to themselves (preoperatively and postoperatively), demonstrated waveform differences between upper and lower extremities that were significantly reduced after successful surgery (p-value 0.028). This screening algorithm had an accuracy of detection of 72% with 0.61 sensitivity and 0.94 specificity. Conclusions We were able to identify specific features in pulse oximetry waveforms that were able to accurately identify patients with coarctation and further demonstrated that these changes normalized after surgical repair. Pulse oximetry screening for congenital heart disease in neonates may thus be improved by including waveform analysis, aiming to identify coarctation of the aorta prior to critical illness. Further large-scale testing is required to validate this screening model among patients in a newborn nursery setting who are low risk for having coarctation.
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Affiliation(s)
- Matthew W Sorensen
- Division of Cardiology, Pediatric Cardiology, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA. .,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Ismail Sadiq
- Department of Biomedical Informatics, Emory University School of Medicine, Woodruff Memorial Research Building, 101 Woodruff Circle, 4th Floor East, Atlanta, GA, 30322, USA.,Department of Electrical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Woodruff Memorial Research Building, 101 Woodruff Circle, 4th Floor East, Atlanta, GA, 30322, USA.,Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Kevin O Maher
- Division of Cardiology, Pediatric Cardiology, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew E Oster
- Division of Cardiology, Pediatric Cardiology, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Bennis FC, van Pul C, van den Bogaart JJL, Andriessen P, Kramer BW, Delhaas T. Artifacts in pulse transit time measurements using standard patient monitoring equipment. PLoS One 2019; 14:e0218784. [PMID: 31226142 PMCID: PMC6588249 DOI: 10.1371/journal.pone.0218784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/11/2019] [Indexed: 12/02/2022] Open
Abstract
Objective Pulse transit time (PTT) refers to the time it takes a pulse wave to travel between two arterial sites. PTT can be estimated, amongst others, using the electrocardiogram (ECG) and photoplethysmogram (PPG). Because we observed a sawtooth artifact in the PTT while using standard patient monitoring equipment for ECG and PPG, we explored the reasons for this artifact. Methods PPG and ECG were simulated at a heartrate of both 100 and 160 beats per minute while using a Masimo PPG post-processing module and a Philips patient monitor setup at the neonatal intensive care unit. Two different post-processing modules were used. PTT was defined as the difference between the R-peak in the ECG and the point of 50% increase in the PPG. Results A sawtooth artifact was seen in all simulations. Both length (59.2 to 72.4 s) and amplitude (30.8 to 36.0 ms) of the sawtooth were dependent on the post-processing module used. Furthermore, the absolute PTT value differed up to 250 ms depending on post-processing module and heart rate. The sawtooth occurred because the PPG wave continuously showed a minimal prolongation during the length of the sawtooth, followed by a sudden shortening. Both artifacts were generated in the post-processing module containing Masimo algorithms. Conclusion Post-processing of the PPG signal in the Masimo module of the Philips patient monitor introduces a sawtooth in PPG and derived PTT. This sawtooth, together with a large module-dependent absolute difference in PTT, renders the thus-derived PTT insufficient for clinical purposes.
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Affiliation(s)
- Frank C. Bennis
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
- MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Carola van Pul
- Department of Clinical Physics, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Peter Andriessen
- Department of Pediatrics, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Boris W. Kramer
- MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, MD, Maastricht, the Netherlands
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