Pulse transit times to the capillary bed evaluated by laser Doppler flowmetry

Assessing pulse transit time to the skeletal muscle microcirculation using near-infrared spectroscopy

Pulse transit time (PTT) is the time it takes for pressure waves to propagate through the arterial system. Arterial stiffness assessed via PTT has been extensively examined in the conduit arteries; however, limited information is available about PTT to the skeletal muscle microcirculation. Therefore, the purpose of this study was to assess PTT to the skeletal muscle microcirculation (PTTm) with near-infrared spectroscopy (NIRS) and to determine whether PTTm provides unique information about vascular function that PTT assessed in the conduit arteries (PTTc) cannot provide. This pilot study was conducted with 10 (male = 5; female = 5) individuals of similar age (21.5 ± 1.2 yr). The feasibility of using the intersecting tangents method to derive PTTm with NIRS was assessed during reactive hyperemia with the cross-correlation of PTTm produced by the intersecting tangents method and a different algorithm that used signal spectral properties. To determine whether PTTm was distinct from PTTc, the cross-correlation of PTTm and PTTc during reactive hyperemia was assessed. Cross-correlation indicated agreement between PTTm derived from both algorithms (r2 = 0.77, P < 0.01) and a lack of agreement between PTTm and PTTc during reactive hyperemia (r2 = 0.07, P < 0.01). Therefore, we conclude that it is feasible to assess PTTm using NIRS, and PTTm provides unique information about vascular function, including skeletal muscle microvascular elasticity, which cannot be achieved with traditional PTTc. PTTm with NIRS may provide a comprehensive and noninvasive assessment of vascular function and health.NEW & NOTEWORTHY Pulse transit time to the skeletal muscle microcirculation can be assessed using near-infrared spectroscopy and the intersecting tangents method. Pulse transit analysis to the microcirculation provides a comprehensive assessment of the vascular response to postocclusive reactive hyperemia that pulse transit analysis in the conduit arteries cannot provide. Pulse transit time to the skeletal muscle microcirculation using near-infrared spectroscopy provides unique information about microvascular elasticity in the skeletal muscle. These findings indicate that the combination of near-infrared spectroscopy and pulse transit analysis may be a useful method for assessing the skeletal muscle microcirculation.

Skin inhomogeneity as a source of error in remote PPG-imaging

Remote photoplethysmography (rPPG) imaging is an optical technique to remotely assess the local cutaneous microcirculation. Despite its potential for enabling health-related applications, the current understanding of the outcome images/maps remains incomplete. In this paper, we present a model and supporting experiments confirming the contribution of skin inhomogeneity to the morphology of PPG waveforms. Since rPPG imagers rely on the complex inner-product operator and may combine multiple wavelengths, the derived phase measurements reflect morphological heterogeneity of PPG signals to a larger extent than propagation-related phase differences. The influence of light penetration depth on PPG was observed and modeled on the green and red wavelengths at the hand region. We further show how our work contributes to understanding reproducibility issues in recent papers on pulse wave velocity (PWV) estimation.

Analysis of the microcirculatory pulse wave: age-related alterations

Morphological analysis of the pulse wave of central blood pressure signal is commonly used for the study of cardiac and vascular properties, but very few attempts were performed for analyzing the peripheral pulse wave of blood flow. In this work, we analyzed this waveform using classical methods, based on the application of FFT, followed by principal components analysis, for assessing the properties of the blood flow. As a sample problem, we evaluated the capability of the proposed method of assessing the alterations correlated with the aging of the vascular system. Results show a good discrimination between the different age groups, confirming the validity of the approach.

Measurement of brachial artery endothelial function using a standard blood pressure cuff

The integrity of endothelial function in major arteries (EFMA) is a powerful independent predictor of heart attack and stroke. Existing ultrasound-based non-invasive assessment methods are technically challenging and suitable only for laboratory settings. EFMA, like blood pressure (BP), is both acutely and chronically affected by factors such as lifestyle and medication. Consequently, laboratory-based measurements cannot fully gauge the effects of medical interventions on EFMA. EFMA and BP have, arguably, comparable (but complementary) value in the assessment of cardiovascular health. Widespread deployment of EFMA assessment is thus a desirable clinical goal. To this end, we propose a device based on modifying the measurement protocol of a standard electronic sphygmomanometer. The protocol involves inflating the cuff to sub-diastolic levels to enable recording of the pulse waveform before and after vasodilatory stimulus. The mechanical unloading of the arterial wall provided by the cuff amplifies the distension that occurs with each pulse, which is measured as a pressure variation in the cuff. We show that the height of the rising edge of each pulse is proportional to the change in lumen area between diastole and systole. This allows the effect of vasodilatory stimuli on the artery to be measured with high sensitivity. We compare the proposed cuff flow-mediated dilation (cFMD) method to ultrasound flow-mediated dilation (uFMD). We find significant correlation (r = 0.55, p = 0.003, N = 27) between cFMD- and uFMD-based metrics obtained when the release of a 5 min cuff occlusion is employed to induce endothelial stimulus via reactive hyperemia. cFMD is approximately proportional to the square of uFMD, representing a typical increase in sensitivity to vasodilation of 300-600%. This study illustrates the potential for an individual to conveniently measure his/her EFMA by using a low-cost reprogrammed home sphygmomanometer.

Shape analysis of the microcirculatory flow wave

The cardiovascular system and its alterations are a crucial aspect of physiology and medicine. Non-invasive assessment of the functional properties of circulation is of considerable interest to clinicians and physiologists. In this work we investigate the possibility of detecting alterations of the flow waveform in microcirculation, using non-invasive measurements based on a laser Doppler flowmeter. As a test case, we focus on the effect of ageing. Skin is warmed up to a fixed temperature (44 °C) during measurement, to increase blood flow. The shape of the perfusion waveform during each heart beat after the flow was stabilized was used to estimate dynamic parameters of the microcirculatory system. Both the wave rise time, defined as the delay between the diastolic minimum and the following systolic maximum, and the oscillation fraction, defined as the normalized difference between the maximum and minimum flow, present significant variation with age.

Ballistocardiogram as Proximal Timing Reference for Pulse Transit Time Measurement: Potential for Cuffless Blood Pressure Monitoring

GOAL

We tested the hypothesis that the ballistocardiogram (BCG) waveform could yield a viable proximal timing reference for measuring pulse transit time (PTT).

METHODS

From 15 healthy volunteers, we measured PTT as the time interval between BCG and a noninvasively measured finger blood pressure (BP) waveform. To evaluate the efficacy of the BCG-based PTT in estimating BP, we likewise measured pulse arrival time (PAT) using the electrocardiogram (ECG) as proximal timing reference and compared their correlations to BP.

RESULTS

BCG-based PTT was correlated with BP reasonably well: the mean correlation coefficient (r ) was 0.62 for diastolic (DP), 0.65 for mean (MP), and 0.66 for systolic (SP) pressures when the intersecting tangent method was used as distal timing reference. Comparing four distal timing references (intersecting tangent, maximum second derivative, diastolic minimum, and systolic maximum), PTT exhibited the best correlation with BP when the systolic maximum method was used (mean r value was 0.66 for DP, 0.67 for MP, and 0.70 for SP). PTT was more strongly correlated with DP than PAT regardless of the distal timing reference: mean r value was 0.62 versus 0.51 (p = 0.07) for intersecting tangent, 0.54 versus 0.49 (p = 0.17) for maximum second derivative, 0.58 versus 0.52 (p = 0.37) for diastolic minimum, and 0.66 versus 0.60 (p = 0.10) for systolic maximum methods. The difference between PTT and PAT in estimating DP was significant (p = 0.01) when the r values associated with all the distal timing references were compared altogether. However, PAT appeared to outperform PTT in estimating SP ( p = 0.31 when the r values associated with all the distal timing references were compared altogether).

CONCLUSION

We conclude that BCG is an adequate proximal timing reference in deriving PTT, and that BCG-based PTT may be superior to ECG-based PAT in estimating DP.

SIGNIFICANCE

PTT with BCG as proximal timing reference has potential to enable convenient and ubiquitous cuffless BP monitoring.

P(VDF-TrFE) polymer-based thin films deposited on stainless steel substrates treated using water dissociation for flexible tactile sensor development

In this work, deionized (DI) water dissociation was used to treat and change the contact angle of the surface of stainless steel substrates followed by the spin coating of P(VDF-TrFE) material for the fabrication of tactile sensors. The contact angle of the stainless steel surface decreased 14° at −30 V treatment; thus, the adhesion strength between the P(VDF-TrFE) thin film and the stainless steel substrate increased by 90%. Although the adhesion strength was increased at negative voltage treatment, it is observed that the crystallinity value of the P(VDF-TrFE) thin film declined to 37% at −60 V. In addition, the remanent polarization value of the P(VDF-TrFE) thin film declined from 5.6 μC/cm² to 4.61 μC/cm² for treatment voltages between −5 V and −60 V. A maximum value of approximately 1000 KV/cm of the coercive field value was obtained with the treatment at −15 V. The d33 value was approximately −10.7 pC/N for the substrate treated at 0 V and reached a minimum of −5 pC/N for treatment at −60 V. By using the P(VDF-TrFE) thin-film as the sensing material for tactile sensors, human pulse measurements were obtained from areas including the carotid, brachial, ankle, radial artery, and apical regions. In addition, the tactile sensor is suitable for monitoring the Cun, Guan, and Chi acupoints located at the radial artery region in Traditional Chinese Medicine (TCM). Waveform measurements of the Cun, Guan, and Chi acupoints are crucial because, in TCM, the various waveforms provided information regarding the health conditions of organs.

Finger microvascular responses to deep inspiratory gasp assessed and quantified using wavelet analysis

The physiological changes following a deep inspiratory gasp (DIG) manoeuvre have been described in the literature. However, the lack of a reliable signal processing technique to visualize and quantify these physiological changes has so far limited the applicability of the test to the clinical setting. The main aim of this study was to assess the feasibility of using wavelet analysis to quantify the pulse arrival time (PAT) and its changes during the DIG manoeuvre. Vascular responses were extracted from cardiac (electrocardiogram, ECG) and peripheral pulse (photoplethysmography, PPG) waveforms. Wavelet analysis characterized their cardiovascular responses in healthy adult subjects in the time-frequency space, and for the ECG-PPG inter-relationship in terms of the PAT. PAT showed a characteristic biphasic response to gasp, with an increase of 59 ± 59 ms (p = 0.001) compared to the maximum value reached during quiet breathing, and a decrease of -38 ± 55 ms (p < 0.01) compared to the minimum value during quiet breathing. The response measures were repeatable. This pilot study has successfully shown the feasibility of using wavelet analysis to characterize the cardiovascular waveforms and quantify their changes with DIG.

Flexible PZT thin film tactile sensor for biomedical monitoring

This paper presents the development of tactile sensors using the sol-gel process to deposit a PZT thin-film from 250 nm to 1 μm on a flexible stainless steel substrate. The PZT thin-film tactile sensor can be used to measure human pulses from several areas, including carotid, brachial, finger, ankle, radial artery, and the apical region. Flexible PZT tactile sensors can overcome the diverse topology of various human regions and sense the corresponding signals from human bodies. The measured arterial pulse waveform can be used to diagnose hypertension and cardiac failure in patients. The proposed sensors have several advantages, such as flexibility, reliability, high strain, low cost, simple fabrication, and low temperature processing. The PZT thin-film deposition process includes a pyrolysis process at 150 °C/500 °C for 10/5 min, followed by an annealing process at 650 °C for 10 min. Finally, the consistent pulse wave velocity (PWV) was demonstrated based on human pulse measurements from apical to radial, brachial to radial, and radial to ankle. It is characterized that the sensitivity of our PZT-based tactile sensor was approximately 0.798 mV/g.

Comparison of bilateral pulse arrival time before and after induced vasodilation by axillary block

The propagation time of arterial pulse waves provides information about arterial stiffness. Pulse arrival time (PAT) is calculated as the time between the R-wave (ECG) and three reference points on photoplethysmographic (PPG) pulse waves: foot, first derivative and peak. Because large variation in PAT-values between patients exists, measurements of the contra-lateral arm as reference could be a solution. However, anatomical differences between arteries of the arms could introduce an offset of PAT. Furthermore, when arterial stiffness decreases (e.g. after axillary blockade (AxB)) and pulse wave amplitude increases (vasodilation), the pulse waveform can change. The aim of this study was to investigate whether there is a difference between the PAT of both arms and to evaluate the effect of vasodilation after AxB on PAT. ECG and PPG was measured on both hands in 34 patients, starting 2 min before the injection of local anaesthetic of an AxB and continuing for a period of 30 min after block placement. PAT of the baseline and after AxB were calculated and compared. The mean-PAT of both arms were not significantly different for the three reference points. After AxB, PAT significantly increased for all reference points. PAT can be used for intra-subject comparison.