Athletic differences in the characteristics of the photoplethysmographic pulse shape: effect of maximal oxygen uptake and maximal muscular voluntary contraction

Recovery Responses of Central Hemodynamics in Basketball Athletes and Controls After the Bruce Test

Purpose

It is commonly believed that central hemodynamics is closely associated with the presence of cardiovascular events. However, controversial data exist on the acute response of competitive sports on central hemodynamics. Moreover, the central hemodynamic response to exercise is too transient to be investigated. Therefore, this study aimed to investigate the central hemodynamic response in young basketball athletes and controls after 1 h recovery after exercise.

Methods

Fifteen young basketball athletes and fifteen aged-matched controls were recruited to perform the Bruce test. Central hemodynamics were measured and calculated, including heart rate (HR), aortic systolic, diastolic, and pulse pressure (ASP, ADP, and APP), ejection duration (ED), sub-endocardial viability ratio (SEVR), central augmentation index (AIx), and AIx@HR75. Intra-group and inter-group differences were analyzed by two-way repeated measures ANOVA.

Results

ASP significantly decreased at 10 min after exercise in athletes, while it markedly declined at 15 min after exercise in controls (p < 0.01). Additionally, only in the athlete group, ADP significantly decreased at 50 min and at 1 h after exercise. AIx was also significantly reduced at 1-2, 20, 30, and 40 min after exercise (all p < 0.05). Moreover, there were significant differences in the changes of these parameters between the two groups at these measurement points (p < 0.05). SEVR significantly recovered to the baseline level after 30 min, while ED and HR returned to baseline levels at 40 min after exercise in both groups.

Conclusion

Sustained decrease of aortic BPs was sooner after the cessation of exercise in athletes than in controls, and changes of aortic stiffness were more evident in athletes than those in controls during the 1 h recovery period. Additionally, SEVR returned to the baseline sooner than ED and HR in athletes.

Characterization of Rat Cardiovascular System by Anacrotic/Dicrotic Notches in the Condition of Increase/Decrease of NO Bioavailability

We characterized modes of action of NO-donor S-nitrosoglutathione (GSNO) and NO-synthase inhibitor l-NAME derived from dicrotic (DiN) and anacrotic (AnN) notches of rat arterial pulse waveform (APW) in the condition of increased/decreased NO bioavailability. The cross-relationship patterns of DiN and AnN with 34 hemodynamic parameters (HPs) induced by GSNO and l-NAME are presented. After GSNO bolus administration, approximate non-hysteresis relationships were observed in the difference between DiN-AnN (mmHg) blood pressure (BP) and other 19 HPs, suggesting that these HPs, i.e., their signaling pathways, responding to NO concentration, are directly connected. Hysteresis relationships were observed between DiN-AnN (mmHg) and other 14 HPs, suggesting that signaling pathways of these HPs are indirectly connected. The hysteresis relationships were only observed between the time interval DiN-AnN (ms) and other 34 HPs, indicating no direct connection of signaling pathways. The cross-relationship patterns of DiN-AnN (mmHg), but not DiN-AnN (ms), induced by l-NAME were in accordance to the increased NO bioavailability induced by GSNO. In conclusion, we found the non-hysteresis/hysteresis cross-relationship "patterns" of DiN-AnN intervals to other HPs in the presence of GSNO that revealed their direct or indirect signaling pathways connections. This may contribute to our understanding of biological effects of natural substances that modulate NO production and/or NO signaling pathways.

Optical coherence tomography angiography measures blood pulsatile waveforms at variable tissue depths

Background

Photoplethysmography (PPG) is routinely used to detect the blood pulse signal from skin tissue beds in clinics. However, the origin of the PPG signal remains controversial. The purpose of this study is to explore optical coherence tomography angiography (OCTA) to indicate pulsatile waveforms in the papillary plexus and dermal plexus separately under different hand elevations.

Method

Optical microangiography (OMAG) algorithm was used to obtain a 3D OCTA signals, from which the depth-resolved pulsatile blood flow signals were extracted from different skin vascular plexus. The systolic amplitude, crest time, and delta T were measured from the OCTA pulsatile signals when the hand was placed at the positions of 50 cm below, 0 cm, and 50 cm above the heart level.

Results

The pulse signal integrated from all the depths has a similar waveform to that of the PPG and showed the same morphological change at different hand elevations. The pulsatile patterns from the papillary plexus and dermal plexus showed distinct morphological changes at different local blood pressure. Less amplitude difference was found from papillary plexus comparing to that of the dermal plexus. Crest time was found in an increasing trend in the OCTA pulsatile waveform from both plexuses when the arm was raised from the position below to above the heart level. In contrast, a decreasing trend of Delta T was detected in the dermal pulsatile but was not observed from that of the papillary plexus, indicating that vascular resistance associated with the arm elevations does not necessarily have the same effect on the two plexuses.

Conclusions

OCTA can provide depth-resolved pulsatile waveforms within different microvascular plexus within tissue skin beds. This technique could open doors to understanding the mechanisms of how blood flow changes at different skin circulatory plexus.

Quantitative Comparison of Photoplethysmographic Waveform Characteristics: Effect of Measurement Site

Introduction: Photoplethysmography (PPG) has been widely used to assess cardiovascular function. However, few studies have comprehensively investigated the effect of measurement site on PPG waveform characteristics. This study aimed to provide a quantitative comparison on this. Methods: Thirty six healthy subjects participated in this study. For each subject, PPG signals were sequentially recorded for 1 min from six different body sites (finger, wrist under (anatomically volar), wrist upper (dorsal), arm, earlobe, and forehead) under both normal and deep breathing patterns. For each body site under a certain breathing pattern, the mean amplitude was firstly derived from recorded PPG waveform which was then normalized to derive several waveform characteristics including the pulse peak time (Tp), dicrotic notch time (Tn), and the reflection index (RI). The effects of breathing pattern and measurement site on the waveform characteristics were finally investigated by the analysis of variance (ANOVA) with post hoc multiple comparisons. Results: Under both breathing patterns, the PPG measurements from the finger achieved the highest percentage of analyzable waveforms for extracting waveform characteristics. There were significant effects of breathing pattern on Tn and RI (larger Tn and smaller RI with deep breathing on average, both p < 0.03). The effects of measurement site on mean amplitude, Tp, Tn, and RI were significant (all p < 0.001). The key results were that, under both breathing patterns, the mean amplitude from finger PPG was significantly larger and its Tp and RI were significantly smaller than those from the other five sites (all p < 0.001, except p = 0.04 for the Tp of "wrist under"), and Tn was only significantly larger than that from the earlobe (both p < 0.05). Conclusion: This study has quantitatively confirmed the effect of PPG measurement site on PPG waveform characteristics (including mean amplitude, Tp, Tn, and RI), providing scientific evidence for a better understanding of the PPG waveform variations between different body sites.

Changes of Arterial Pulse Waveform Characteristics with Gestational Age during Normal Pregnancy

Arterial pulse waveform analysis has been widely used to reflect physiological changes in the cardiovascular system. This study aimed to comprehensively investigate the changes of waveform characteristics of both photoplethysmographic (PPG) and radial pulses with gestational age during normal pregnancy. PPG and radial pulses were simultaneously recorded from 130 healthy pregnant women at seven gestational time points. After normalizing the arterial pulse waveforms, the abscissa of notch point, the total pulse area and the reflection index were extracted and compared between different measurement points and between the PPG and radial pulses using post-hoc multiple comparisons with Bonferrioni correction. The results showed that the effect of gestational age on all the three waveform characteristics was significant (all p < 0.001) after adjusting for maternal age, heart rate and blood pressures. All the three waveform characteristics demonstrated similar changing trends with gestational age, and they were all significantly different between the measurements from gestational week 12–15 and the others (all p < 0.05, except for the PPG total pulse area between the first and second measurement points). In conclusion, this study has comprehensively quantified similar changes of both PPG and radial pulse waveform characteristics with gestational age.

Postoperative Pain Assessment Indices Based on Photoplethysmography Waveform Analysis

The purpose of this study was to derive parameters that might reflect postoperative pain from photoplethysmography (PPG) and verify the derived parameters in postoperative pain assessment. We obtained preoperative and postoperative PPG and 100-mm visual analog scale (VAS) from 65 surgical patients and extracted a total of 51 PPG morphology-based parameters and their normalized parameters from these PPGs obtained. Pain discrimination performances of these derived parameters were assessed by statistical analyses, including Wilcoxon signed rank test with Bonferroni correction, classification accuracy based on logistic regression, and 4-fold cross validation. After comparing these parameters derived from PPG in pre- and post-operative conditions, statistically significant difference was found in 36 of the 51 parameters. Using logistic classification, dynamic between-pulse parameters such as normalized systolic amplitude variation and normalized diastolic amplitude variation showed better pain classification performance than the static within-pulse parameters. VAS score was 0 in every pre-operation condition, but >60 VAS was observed in the post-operative condition. Systolic peak amplitude variation normalized by PPG AC amplitude showed the best performance in classifying post-operative pain, with accuracy, sensitivity, specificity, and positive predictivity values of 79.5, 74.0, 86.0, and 84.5%, respectively. These results are superior to those of the surgical pleth index (SPI, GE Healthcare, Chicago, IL, United States) at 65.9, 65.9, 66.5, and 66.5%, respectively.

Quantification of radial arterial pulse characteristics change during exercise and recovery

It is physiologically important to understand the arterial pulse waveform characteristics change during exercise and recovery. However, there is a lack of a comprehensive investigation. This study aimed to provide scientific evidence on the arterial pulse characteristics change during exercise and recovery. Sixty-five healthy subjects were studied. The exercise loads were gradually increased from 0 to 125 W for female subjects and to 150 W for male subjects. Radial pulses were digitally recorded during exercise and 4-min recovery. Four parameters were extracted from the raw arterial pulse waveform, including the pulse amplitude, width, pulse peak and dicrotic notch time. Five parameters were extracted from the normalized radial pulse waveform, including the pulse peak and dicrotic notch position, pulse Area, Area₁ and Area₂ separated by notch point. With increasing loads during exercise, the raw pulse amplitude increased significantly with decreased pulse period, reduced peak and notch time. From the normalized pulses, the pulse Area, pulse Area₁ and Area₂ decreased, respectively, from 38 ± 4, 61 ± 5 and 23 ± 5 at rest to 34 ± 4, 52 ± 6 and 13 ± 5 at 150-W exercise load. During recovery, an opposite trend was observed. This study quantitatively demonstrated significant changes of radial pulse characteristics during different exercise loads and recovery phases.

Investigation of peripheral photoplethysmographic morphology changes induced during a hand-elevation study

A hand-elevation study was carried out in the laboratory in order to alter peripheral blood flow with the aim of increasing understanding of factors affecting the morphology of peripheral photoplethysmographic signals. Photoplethysmographic (PPG) signals were recorded from twenty healthy volunteer subjects during a hand-elevation study in which the right hand was raised and lowered relative to heart level, while the left hand remained static. Red and infrared (IR) PPG signals were obtained from the right and left index fingers using a custom-made PPG processing system. PPG features were identified using a feature-detection algorithm based on the first derivative of the PPG signal. The systolic PPG amplitude, the reflection index, crest time, pulse width at half height, and delta T were calculated from 20 s IR PPG signals from three positions of the right hand with respect to heart level (-50, 0, +50 cm) in 19 volunteers. PPG features were found to change with hand elevation. On lowering the hand to 50 cm below heart level, ac systolic PPG amplitudes from the finger decreased by 68.32 %, while raising the arm increased the systolic amplitude by 69.99 %. These changes in amplitude were attributed to changes in hydrostatic pressure and the veno-arterial reflex. Other morphological variables, such as crest time, were found to be statistically significantly different across hand positions, indicating increased vascular resistance on arm elevation than on dependency. It was hypothesized that these morphological PPG changes were influenced by changes in downstream venous resistance, rather than arterial, or arteriolar, resistance. Changes in hand position relative to heart level can significantly affect the morphology of the peripheral ac PPG waveform. These alterations are due to a combination of physical effects and physiological responses to changes in hand position, which alter vascular resistance. Care should be taken when interpreting morphological data derived from PPG signals and methods should be standardized to take these effects into account.