1
|
El-Nashar H, Sabry M, Tseng YT, Francis N, Latif N, Parker KH, Moore JE, Yacoub MH. Multiscale structure and function of the aortic valve apparatus. Physiol Rev 2024; 104:1487-1532. [PMID: 37732828 DOI: 10.1152/physrev.00038.2022] [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: 12/07/2022] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
Whereas studying the aortic valve in isolation has facilitated the development of life-saving procedures and technologies, the dynamic interplay of the aortic valve and its surrounding structures is vital to preserving their function across the wide range of conditions encountered in an active lifestyle. Our view is that these structures should be viewed as an integrated functional unit, here referred to as the aortic valve apparatus (AVA). The coupling of the aortic valve and root, left ventricular outflow tract, and blood circulation is crucial for AVA's functions: unidirectional flow out of the left ventricle, coronary perfusion, reservoir function, and support of left ventricular function. In this review, we explore the multiscale biological and physical phenomena that underlie the simultaneous fulfillment of these functions. A brief overview of the tools used to investigate the AVA, such as medical imaging modalities, experimental methods, and computational modeling, specifically fluid-structure interaction (FSI) simulations, is included. Some pathologies affecting the AVA are explored, and insights are provided on treatments and interventions that aim to maintain quality of life. The concepts explained in this article support the idea of AVA being an integrated functional unit and help identify unanswered research questions. Incorporating phenomena through the molecular, micro, meso, and whole tissue scales is crucial for understanding the sophisticated normal functions and diseases of the AVA.
Collapse
Affiliation(s)
- Hussam El-Nashar
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Malak Sabry
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Yuan-Tsan Tseng
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nadine Francis
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Najma Latif
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - James E Moore
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Magdi H Yacoub
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| |
Collapse
|
2
|
Nishan A, M. Taslim Uddin Raju S, Hossain MI, Dipto SA, M. Tanvir Uddin S, Sijan A, Chowdhury MAS, Ahmad A, Mahamudul Hasan Khan M. A continuous cuffless blood pressure measurement from optimal PPG characteristic features using machine learning algorithms. Heliyon 2024; 10:e27779. [PMID: 38533045 PMCID: PMC10963242 DOI: 10.1016/j.heliyon.2024.e27779] [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: 01/30/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/28/2024] Open
Abstract
Background and objective Hypertension is a potentially dangerous health condition that can be detected by measuring blood pressure (BP). Blood pressure monitoring and measurement are essential for preventing and treating cardiovascular diseases. Cuff-based devices, on the other hand, are uncomfortable and prevent continuous BP measurement. Methods In this study, a new non-invasive and cuff-less method for estimating Systolic Blood Pressure (SBP), Mean Arterial Pressure (MAP), and Diastolic Blood Pressure (DBP) has been proposed using characteristic features of photoplethysmogram (PPG) signals and nonlinear regression algorithms. PPG signals were collected from 219 participants, which were then subjected to preprocessing and feature extraction steps. Analyzing PPG and its derivative signals, a total of 46 time, frequency, and time-frequency domain features were extracted. In addition, the age and gender of each subject were also included as features. Further, correlation-based feature selection (CFS) and Relief F feature selection (ReliefF) techniques were used to select the relevant features and reduce the possibility of over-fitting the models. Finally, support vector regression (SVR), K-nearest neighbour regression (KNR), decision tree regression (DTR), and random forest regression (RFR) were established to develop the BP estimation model. Regression models were trained and evaluated on all features as well as selected features. The best regression models for SBP, MAP, and DBP estimations were selected separately. Results The SVR model, along with the ReliefF-based feature selection algorithm, outperforms other algorithms in estimating the SBP, MAP, and DBP with the mean absolute error of 2.49, 1.62 and 1.43 mmHg, respectively. The proposed method meets the Advancement of Medical Instrumentation standard for BP estimations. Based on the British Hypertension Society standard, the results also fall within Grade A for SBP, MAP, and DBP. Conclusion The findings show that the method can be used to estimate blood pressure non-invasively, without using a cuff or calibration, and only by utilizing the PPG signal characteristic features.
Collapse
Affiliation(s)
- Araf Nishan
- Department of Computer Science and Engineering, Khulna University of Engineering & Technology, Khulna - 9203, Bangladesh
| | - S. M. Taslim Uddin Raju
- Department of Computer Science and Engineering, Khulna University of Engineering & Technology, Khulna - 9203, Bangladesh
| | - Md Imran Hossain
- Department of Computer Science and Engineering, Khulna University of Engineering & Technology, Khulna - 9203, Bangladesh
| | - Safin Ahmed Dipto
- Department of Computer Science and Engineering, Khulna University of Engineering & Technology, Khulna - 9203, Bangladesh
| | - S. M. Tanvir Uddin
- Department of Electrical and Electronic Engineering, Dhaka University of Engineering & Technology, Gazipur, Bangladesh
| | - Asif Sijan
- Department of Software Engineering, American International University, Dhaka, Bangladesh
| | - Md Abu Shahid Chowdhury
- Department of Biomedical Engineering, Khulna University of Engineering & Technology, Khulna - 9203, Bangladesh
| | - Ashfaq Ahmad
- Department of Computer Science and Engineering, Khulna University of Engineering & Technology, Khulna - 9203, Bangladesh
| | - Md Mahamudul Hasan Khan
- Department of Computer Science and Engineering, Khulna University of Engineering & Technology, Khulna - 9203, Bangladesh
| |
Collapse
|
3
|
Ignatov PN, Neykova KK, Yordanova-Ignatova T. Diastolic deceleration area in the fetal MCA: a new Doppler parameter. J Matern Fetal Neonatal Med 2023; 36:2206939. [PMID: 37121906 DOI: 10.1080/14767058.2023.2206939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Objective: Doppler velocimetry has been widely used throughout the years as a valuable tool in the follow-up and prognosis of various pregnancy complications. Numerous Doppler indices have been introduced to qualitatively describe fetal blood flow. Currently, the Pulsatility index (PI) is the most widely used index for this purpose. In current clinical practice, middle cerebral artery (MCA) PI measurement is commonly used to assess fetal well-being, especially in late-onset fetal growth restriction (FGR). However, existing evidence suggests that MCA PI alone is inferior to the ratio between MCA and umbilical artery (UA) pulsatility indices in predicting adverse perinatal and neonatal outcomes. When comparing normal and abnormal MCA Doppler waveforms, it is evident that most changes appear in the diastolic part of the heart cycle. Therefore, the PI, which contains elements from both systole (peak systolic velocity-PSV) and diastole (end-diastolic velocity), may not be the most effective tool for quantifying fetal brain sparing (BS).Methods: We hypothesize that another measurement modality that focuses predominantly on the diastole could be more efficient for evaluating the amount of vasodilatation. In ultrasound velocimetry of larger blood vessels, there is a well-known phenomenon called "dicrotic notch" (DN), which appears on the declining part of each Doppler waveform and can be used to precisely pinpoint the end of systole and the start of diastole. We hypothesized that the extent of cerebral vasodilation can be more accurately assessed by measuring the area between the dicrotic notch (DN) and the end-diastolic velocity (which we refer to as the "diastolic deceleration area-DDA"). In this study, we introduced a new Doppler parameter along with a rationale for DDA measurement in the fetal MCA. We also defined third-trimester nomograms and provided a preliminary assessment of the correlation between DDA and fetal oxygen deficiency.Results: Our findings suggest that the DDA may serve as an independent instrument for identifying hypoxia during late pregnancy, either on its own or in conjunction with other Doppler and cardiotocography modalities.Conclusion: However, before incorporating DDA into clinical practice, it is crucial to conduct further research and validation studies with larger sample sizes and more diverse populations. This would help assess the generalizability of the results and establish optimal cutoff points for DDA in various clinical settings. It is also important to prospectively study the role of DDA in early- and late-onset fetal growth restriction (FGR), Rh-isoimmunization/anemia, preeclampsia, gestational diabetes, and other pregnancy complications. In fact, we believe that the concept of measuring specific areas in arterial Doppler velocimetry indices could have significant implications not only in fetal medicine and obstetrics, but also in other areas of human and veterinary medicine.
Collapse
Affiliation(s)
- P N Ignatov
- Department of Public Health, Medical University of Sofia, Sofia, Bulgaria
- Department of Fetal Medicine, Orthogyn Medical Center, Sofia, Bulgaria
| | - K K Neykova
- Department of High-Risk Pregnancy, State University Hospital "Maichin dom", Sofia, Bulgaria
| | - T Yordanova-Ignatova
- Department of Fetal Medicine, Orthogyn Medical Center, Sofia, Bulgaria
- Department of Social Medicine, Medical University of Sofia, Sofia, Bulgaria
| |
Collapse
|
4
|
Abushouk A, Kansara T, Abdelfattah O, Badwan O, Hariri E, Chaudhury P, Kapadia SR. The Dicrotic Notch: Mechanisms, Characteristics, and Clinical Correlations. Curr Cardiol Rep 2023; 25:807-816. [PMID: 37493873 DOI: 10.1007/s11886-023-01901-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE OF REVIEW The dicrotic notch (DN) has long been considered a marker of arterial stiffness and compliance. Herein, we explored the recent developments in vascular medicine research in an attempt to assess the DN utility in clinical cardiovascular medicine. RECENT FINDINGS Since its discovery, several studies have attempted to measure the changes in different parameters of the DN in physiological and pathological states. Despite the significance of their findings, the clinical role of the DN remained limited. This may have been related to the difficulty of measuring the DN via indwelling arterial catheters in the past. However, over the past two decades, several non-invasive methods have been developed, which may re-ignite interest in DN research. The DN may have broader applications in clinical cardiovascular medicine. Further research is needed to establish the accuracy of DN non-invasive measurement methods and compare its prognostic value to other circulatory parameters.
Collapse
Affiliation(s)
- Abdelrahman Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tikal Kansara
- Department of Hospital Medicine, Union Hospital, Cleveland Clinic Foundation, Dover, OH, USA
| | - Omar Abdelfattah
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
- Division of Cardiovascular Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Pulkit Chaudhury
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA.
| |
Collapse
|
5
|
Lemes L, Armentano RL, Farro I, Chatterjee P, Scarponi G, Cymberknop LJ. Different Types of Training Lead to Different Levels of Cardiovascular Energy Dissipation: Young Soccer Players Versus Ballet Dancers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082775 DOI: 10.1109/embc40787.2023.10340019] [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
INTRODUCTION Arterial wall viscosity is a source of energy dissipation that takes place during mechanical transduction. In our previous studies, a "global" damping effect in endurance training athletes was introduced, verifying that endurance-athletes dissipate greater pulsatile energy in the circulation compared with healthy untrained subjects. OBJECTIVE To investigate the wall energy dissipation in the vascular bed for each beat and within the conceptual framework of ventricular-arterial coupling, in order to elucidate if different types of training could lead to differentiated levels of cardiovascular energy dissipation. MATERIALS AND METHODS Data from subjects with different kinds of training (soccer players and ballet dancers) have been collected noninvasively and compared with a control group of untrained individuals to analyse the differentiating characteristics of the subjects, especially in terms of Stroke Work Dissipation (WDIS). RESULTS In the endurance-trained individuals, an enhanced WDIS has been observed compared to the untrained individuals (p<0.05). However, non-significant differences were found regarding ballet-dancers group. CONCLUSION Changes in wall energy dissipation are developed under high intensity endurance training routines.
Collapse
|
6
|
Jaffe AT, Zubajlo RE, Daniel L, Anthony BW. Automated Force-Coupled Ultrasound Method for Calibration-Free Carotid Artery Blood Pressure Estimation. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1806-1821. [PMID: 35811237 DOI: 10.1016/j.ultrasmedbio.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
We develop, automate and evaluate a calibration-free technique to estimate human carotid artery blood pressure from force-coupled ultrasound images. After acquiring images and force, we use peak detection to align the raw force signal with an optical flow signal derived from the images. A trained convolutional neural network selects a seed point within the carotid in a single image. We then employ a region-growing algorithm to segment and track the carotid in subsequent images. A finite-element deformation model is fit to the observed segmentation and force via a two-stage iterative non-linear optimization. The first-stage optimization estimates carotid artery wall stiffness parameters along with systolic and diastolic carotid pressures. The second-stage optimization takes the output parameters from the first optimization and estimates the carotid blood pressure waveform. Diastolic and systolic measurements are compared with those of an oscillometric brachial blood pressure cuff. In 20 participants, average absolute diastolic and systolic errors are 6.2 and 5.6 mm Hg, respectively, and correlation coefficients are r = 0.7 and r = 0.8, respectively. Force-coupled ultrasound imaging represents an automated, standalone ultrasound-based technique for carotid blood pressure estimation, which motivates its further development and expansion of its applications.
Collapse
Affiliation(s)
- Alex T Jaffe
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Rebecca E Zubajlo
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Luca Daniel
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Brian W Anthony
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
| |
Collapse
|
7
|
Leppänen T, Kainulainen S, Korkalainen H, Sillanmäki S, Kulkas A, Töyräs J, Nikkonen S. Pulse Oximetry: The Working Principle, Signal Formation, and Applications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:205-218. [PMID: 36217086 DOI: 10.1007/978-3-031-06413-5_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulse oximeters are routinely used in various medical-grade and consumer-grade applications. They can be used to estimate, for example, blood oxygen saturation, autonomic nervous system activity and cardiac function, blood pressure, sleep quality, and recovery through the recording of photoplethysmography signal. Medical-grade devices often record red and infra-red light-based photoplethysmography signals while smartwatches and other consumer-grade devices usually rely on a green light. At its simplest, a pulse oximeter can consist of one or two photodiodes and a photodetector attached, for example, a fingertip or earlobe. These sensors are used to record light absorption in a medium as a function of time. This time-varying absorption information is used to form a photoplethysmography signal. In this chapter, we discuss the working principles of pulse oximeters and the formation of the photoplethysmography signal. We will further discuss the advantages and disadvantages of pulse oximeters, which kind of applications exist in the medical field, and how pulse oximeters are utilized in daily health monitoring.
Collapse
Affiliation(s)
- Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
| | - Samu Kainulainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Henri Korkalainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Saara Sillanmäki
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Kulkas
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Sami Nikkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
8
|
Abdallah HM, El-Bassossy HM, El-Halawany AM, Ahmed TA, Mohamed GA, Malebari AM, Hassan NA. Self-Nanoemulsifying Drug Delivery System Loaded with Psiadia punctulata Major Metabolites for Hypertensive Emergencies: Effect on Hemodynamics and Cardiac Conductance. Front Pharmacol 2021; 12:681070. [PMID: 34177590 PMCID: PMC8222910 DOI: 10.3389/fphar.2021.681070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022] Open
Abstract
Vasodilators are an important class of antihypertensive agents. However, they have limited clinical use due to the reflex tachycardia associated with their use which masks most of its antihypertensive effect and raises cardiac risk. Chemical investigation of Psiadia punctulata afforded five major methoxylated flavonoids (1–5) three of which (1, 4, and 5) showed vasodilator activity. Linoleic acid-based self-nanoemulsifying drug delivery system (SNEDDS) was utilized to develop intravenous (IV) formulations that contain compounds 1, 4, or 5. The antihypertensive effect of the prepared SNEDDS formulations, loaded with each of the vasodilator compounds, was tested in the angiotensin-induced rat model of hypertension. Rats were subjected to real-time recording of blood hemodynamics and surface Electrocardiogram (ECG) while the pharmaceutical formulations were individually slowly injected in cumulative doses. Among the tested formulations, only that contains umuhengerin (1) and 5,3′-dihydroxy-6,7,4′,5′-tetramethoxyflavone (5) showed potent antihypertensive effects. Low IV doses, from the prepared SNEDDS, containing either compound 1 or 5 showed a marked reduction in the elevated systolic blood pressure by 10 mmHg at 12 μg/kg and by more than 20 mmHg at 36 μg/kg. The developed SNEDDS formulation containing either compound 1 or 5 significantly reduced the elevated diastolic, pulse pressure, dicrotic notch pressure, and the systolic–dicrotic notch pressure difference. Moreover, both formulations decreased the ejection duration and increased the non-ejection duration while they did not affect the time to peak. Both formulations did not affect the AV conduction as appear from the lack of effect on p duration and PR intervals. Similarly, they did not affect the ventricular repolarization as no effect on QTc or JT interval. Both formulations decreased the R wave amplitude but increased the T wave amplitude. In conclusion, the careful selection of linoleic acid for the development of SNEDDS formulation rescues the vasodilating effect of P. punctulata compounds from being masked by the reflex tachycardia that is commonly associated with the decrease in peripheral resistance by most vasodilators. The prepared SNEDDS formulation could be suggested as an effective medication in the treatment of hypertensive emergencies, after clinical evaluation.
Collapse
Affiliation(s)
- Hossam M Abdallah
- Department of Natural Products and Alternative Medicine, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Hany M El-Bassossy
- Department of Pharmacology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Ali M El-Halawany
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Tarek A Ahmed
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Gamal A Mohamed
- Department of Natural Products and Alternative Medicine, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Pharmacognosy, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, Egypt
| | - Azizah M Malebari
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Noura A Hassan
- Department of Pharmacology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| |
Collapse
|
9
|
Liu J, Pahlevan NM. The underlying mechanism of intersite discrepancies in ejection time measurements from arterial waveforms and its validation in the Framingham Heart Study. Am J Physiol Heart Circ Physiol 2021; 321:H135-H148. [PMID: 34018849 DOI: 10.1152/ajpheart.00096.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Radial applanation tonometry is a well-established method for clinical hemodynamic assessment and is also becoming popular in wrist-worn fitness trackers. The time difference between the foot and the dicrotic notch of the arterial pressure waveform is a well-accepted approximation for the left ventricular ejection time (ET). However, several clinical studies have shown that ET measured from the radial pressure waveform deviates from that measured centrally. In this work, we consider the systolic wave and the dicrotic wave as two independent traveling waves and hypothesize that their wave speed difference leads to the intersite differences of measured ET (ΔET). Accordingly, we derived a mathematical dicrotic wave decomposition model and identified the most influential factors on ΔET via global sensitivity analysis. In our clinical validation on a heterogeneous cohort (N = 5,742) from the Framingham Heart Study (FHS), the local sensitivity analysis results resembled the sensitivity variation patterns of ΔET from model simulations. A regression analysis on FHS data, using morphological features of radial pressure waveforms to estimate the carotid ET, produced a root mean square error of 3.76 ms and R2 of 0.91. The proposed dicrotic wave decomposition model can explain the intersite ET measurement discrepancies observed in the clinical data of FHS and can facilitate the precise identification of ET with radial pressure waveforms. Therefore, the proposed model will improve various physics-based pulse wave analysis methods as well as prospective artificial intelligence methods for tackling the subsequent big data produced from widespread wearable radial pressure monitoring.NEW & NOTEWORTHY Based on a new understanding of pressure wave propagation, we propose a novel dicrotic wave decomposition model considering the dicrotic wave as an independent traveling component. The proposed model can explain the mechanism underlying the intersite discrepancies in ejection time measurement from arterial waveforms and then, in principle, enhance the accuracy of both classical physics-based as well as more contemporary artificial intelligence-based pulse wave analysis methods in clinical and wearable radial blood pressure monitoring applications.
Collapse
Affiliation(s)
- Jing Liu
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, California
| | - Niema M Pahlevan
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, California.,Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
10
|
Wiegerinck AIP, Thomsen A, Hisdal J, Kalvøy H, Tronstad C. Electrical Impedance Plethysmography Versus Tonometry To Measure the Pulse Wave Velocity in Peripheral Arteries in Young Healthy Volunteers: a Pilot Study. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2021; 12:169-177. [PMID: 35111272 PMCID: PMC8776312 DOI: 10.2478/joeb-2021-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Indexed: 06/14/2023]
Abstract
The leading cause of health loss and deaths worldwide are cardiovascular diseases. A predictor of cardiovascular diseases and events is the arterial stiffness. The pulse wave velocity (PWV) can be used to estimate arterial stiffness non-invasively. The tonometer is considered as the gold standard for measuring PWV. This approach requires manual probe fixation above the artery and depends on the skills of the operator. Electrical impedance plethysmography (IPG) is an interesting alternative using skin surface sensing electrodes, that is miniaturizable, cost-effective and allows measurement of deeper arteries. The aim of this pilot study was to explore if IPG can be a suitable technique to measure pulse wave velocity in legs as an alternative for the tonometer technique. The PWV was estimated by differences in the ECG-gated pulse arrival times (PAT) at the a. femoralis, a. popliteal, a. tibialis dorsalis and a. dorsalis pedis in nine healthy young adults using IPG and the SphygmoCor tonometer as a reference. The estimated PWV results from bioimpedance and the tonometer were fairly in agreement, and the beat-to-beat variability in PAT was similar. This pilot study indicates that the use of IPG may be a good alternative for estimating PWV in the legs.
Collapse
Affiliation(s)
- A. I. P. Wiegerinck
- Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - A. Thomsen
- Department of Physics, University of Oslo, Oslo, Norway
| | - J. Hisdal
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - H. Kalvøy
- Department of Clinical & Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - C. Tronstad
- Department of Clinical & Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
11
|
Khir AW, Segers P. Physiological fluid mechanics: A special Issue with a taster of forefront research. Proc Inst Mech Eng H 2020; 234:1183-1186. [PMID: 33040681 DOI: 10.1177/0954411920959955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|