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Hamilton LD, Binns S, McFann K, Nudell N, Dunn JA. A Direct Assessment of Noninvasive Continuous Blood Pressure Monitoring in the Emergency Department and Intensive Care Unit. J Emerg Nurs 2024; 50:503-515. [PMID: 38639694 DOI: 10.1016/j.jen.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Noninvasive continuous blood pressure monitoring has the potential to improve patient treatment in the hospital setting. Such noninvasive devices can be applied earlier in the treatment process to empower nurses and clinicians to react more quickly to patient deterioration with the added benefit of eliminating the risks associated with invasive monitoring. However, emerging technologies must be capable of reproducing current clinical measures for medical decision making. METHODS This study aimed to determine the usability and willingness of nurses to implement a noninvasive continuous blood pressure monitoring device. The secondary aim directly compared the systolic blood pressure, diastolic blood pressure, and mean arterial pressure values recorded by the device (VitalStream; CareTaker Medical LLC, Charlottesville, VA) with the "gold standard" brachial cuff and arterial line measures recorded in the emergency department and intensive care unit settings. RESULTS VitalStream was similarly received by nurses in the emergency department and intensive care setting, but ultimately had greater promotion from emergency nurses. Despite some statistical similarity between measurement methodologies, all direct comparisons were found to not meet the Association for the Advancement of Medical Instrumentation 2008 and Association for the Advancement of Medical Instrumentation / European Society of Hypertension / International Organization for Standardization 2019 consensus statement criteria for acceptable blood pressure measure differences between the VitalStream and "gold standard" clinical measures. In all instances, the standard deviation of the Bland-Altman bias exceeded 8 mm Hg with less than 85% of paired differences falling within 10 mm Hg of the "gold standard." DISCUSSION Taken together, the tested device requires additional postprocessing for medical decision making in trauma or emergent care.
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Gore P, Liu H, Bohringer C. Can Currently Available Non-invasive Continuous Blood Pressure Monitors Replace Invasive Measurement With an Arterial Catheter? Cureus 2024; 16:e54707. [PMID: 38529464 PMCID: PMC10961923 DOI: 10.7759/cureus.54707] [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] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
Deviations from normal blood pressure (BP) during general anesthesia have been clearly linked to several adverse outcomes. Measuring BP accurately is therefore critically important for producing excellent outcomes in health care. Normal BP does not necessarily guarantee adequate organ perfusion however and adverse events have occurred even when BP seemed adequate. Invasive blood pressure monitoring has recently evolved beyond merely measuring BP. Arterial line-derived pulse contour analysis is used now to assess both cardiac output and stroke volume variation as indices of adequate intravascular volume. Confirmation of acceptable cardiac output with data derived from invasive intra-arterial catheters has become very important when managing high-risk patients. Newer devices that measure BP continuously and non-invasively in the digital arteries via a finger cuff have also become available. Many clinicians contemplate now if these new devices are ready to replace invasive monitoring with an arterial catheter. Unlike non-invasive devices, intra-arterial catheters allow frequent blood sampling. This makes it possible to assess vital parameters like pH, hemoglobin concentration, ionized calcium, potassium, glucose, and arterial partial pressure of oxygen and carbon dioxide frequently. Non-invasive continuous BP measurement has been found to be unreliable in critically ill patients, the elderly, and patients with calcified arteries. Pulse contour-derived estimates of cardiac output and stroke volume variation have been validated better with data derived from arterial lines than that from the newer finger cuff monitors. Significant advances have been recently made with non-invasive continuous BP monitors. Invasive monitoring with an arterial line however remains the gold standard for measuring BP and assessing pulse contour analysis-derived hemodynamic variables in critically ill patients. In the future, non-invasive continuous BP monitors will likely replace intermittent oscillometers in the operating room and the postoperative period. They will however not eliminate the need for arterial catheterization in critically ill patients.
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Affiliation(s)
- Payton Gore
- Anesthesiology, University of California Davis Medical Center, Sacramento, USA
| | - Hong Liu
- Anesthesiology, University of California Davis Medical Center, Sacramento, USA
| | - Christian Bohringer
- Anesthesiology, University of California Davis Medical Center, Sacramento, USA
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Charlton PH, Allen J, Bailón R, Baker S, Behar JA, Chen F, Clifford GD, Clifton DA, Davies HJ, Ding C, Ding X, Dunn J, Elgendi M, Ferdoushi M, Franklin D, Gil E, Hassan MF, Hernesniemi J, Hu X, Ji N, Khan Y, Kontaxis S, Korhonen I, Kyriacou PA, Laguna P, Lázaro J, Lee C, Levy J, Li Y, Liu C, Liu J, Lu L, Mandic DP, Marozas V, Mejía-Mejía E, Mukkamala R, Nitzan M, Pereira T, Poon CCY, Ramella-Roman JC, Saarinen H, Shandhi MMH, Shin H, Stansby G, Tamura T, Vehkaoja A, Wang WK, Zhang YT, Zhao N, Zheng D, Zhu T. The 2023 wearable photoplethysmography roadmap. Physiol Meas 2023; 44:111001. [PMID: 37494945 PMCID: PMC10686289 DOI: 10.1088/1361-6579/acead2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/04/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023]
Abstract
Photoplethysmography is a key sensing technology which is used in wearable devices such as smartwatches and fitness trackers. Currently, photoplethysmography sensors are used to monitor physiological parameters including heart rate and heart rhythm, and to track activities like sleep and exercise. Yet, wearable photoplethysmography has potential to provide much more information on health and wellbeing, which could inform clinical decision making. This Roadmap outlines directions for research and development to realise the full potential of wearable photoplethysmography. Experts discuss key topics within the areas of sensor design, signal processing, clinical applications, and research directions. Their perspectives provide valuable guidance to researchers developing wearable photoplethysmography technology.
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Affiliation(s)
- Peter H Charlton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, United Kingdom
- Research Centre for Biomedical Engineering, City, University of London, London, EC1V 0HB, United Kingdom
| | - John Allen
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5RW, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Raquel Bailón
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Stephanie Baker
- College of Science and Engineering, James Cook University, Cairns, 4878 Queensland, Australia
| | - Joachim A Behar
- Faculty of Biomedical Engineering, Technion Israel Institute of Technology, Haifa, 3200003, Israel
| | - Fei Chen
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, 518055 Guandong, People’s Republic of China
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, United States of America
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
| | - David A Clifton
- Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ, United Kingdom
| | - Harry J Davies
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Cheng Ding
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
- Department of Biomedical Engineering, Emory University, Atlanta, GA 30322, United States of America
| | - Xiaorong Ding
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China
| | - Jessilyn Dunn
- Department of Biomedical Engineering, Duke University, Durham, NC 27708-0187, United States of America
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC 27708-0187, United States of America
- Duke Clinical Research Institute, Durham, NC 27705-3976, United States of America
| | - Mohamed Elgendi
- Biomedical and Mobile Health Technology Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, 8008, Switzerland
| | - Munia Ferdoushi
- Department of Electrical and Computer Engineering, University of Southern California, 90089, Los Angeles, California, United States of America
- The Institute for Technology and Medical Systems (ITEMS), Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Daniel Franklin
- Institute of Biomedical Engineering, Translational Biology & Engineering Program, Ted Rogers Centre for Heart Research, University of Toronto, Toronto, M5G 1M1, Canada
| | - Eduardo Gil
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Md Farhad Hassan
- Department of Electrical and Computer Engineering, University of Southern California, 90089, Los Angeles, California, United States of America
- The Institute for Technology and Medical Systems (ITEMS), Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Jussi Hernesniemi
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, 33720, Finland
- Tampere Heart Hospital, Wellbeing Services County of Pirkanmaa, Tampere, 33520, Finland
| | - Xiao Hu
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, 30322, Georgia, United States of America
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, 30322, Georgia, United States of America
- Department of Computer Sciences, College of Arts and Sciences, Emory University, Atlanta, GA 30322, United States of America
| | - Nan Ji
- Hong Kong Center for Cerebrocardiovascular Health Engineering (COCHE), Hong Kong Science and Technology Park, Hong Kong, 999077, People’s Republic of China
| | - Yasser Khan
- Department of Electrical and Computer Engineering, University of Southern California, 90089, Los Angeles, California, United States of America
- The Institute for Technology and Medical Systems (ITEMS), Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Spyridon Kontaxis
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Ilkka Korhonen
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, 33720, Finland
| | - Panicos A Kyriacou
- Research Centre for Biomedical Engineering, City, University of London, London, EC1V 0HB, United Kingdom
| | - Pablo Laguna
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Jesús Lázaro
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Chungkeun Lee
- Digital Health Devices Division, Medical Device Evaluation Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju, 28159, Republic of Korea
| | - Jeremy Levy
- Faculty of Biomedical Engineering, Technion Israel Institute of Technology, Haifa, 3200003, Israel
- Faculty of Electrical and Computer Engineering, Technion Institute of Technology, Haifa, 3200003, Israel
| | - Yumin Li
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, People’s Republic of China
| | - Chengyu Liu
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, People’s Republic of China
| | - Jing Liu
- Analog Devices Inc, San Jose, CA 95124, United States of America
| | - Lei Lu
- Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ, United Kingdom
| | - Danilo P Mandic
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Vaidotas Marozas
- Department of Electronics Engineering, Kaunas University of Technology, 44249 Kaunas, Lithuania
- Biomedical Engineering Institute, Kaunas University of Technology, 44249 Kaunas, Lithuania
| | - Elisa Mejía-Mejía
- Research Centre for Biomedical Engineering, City, University of London, London, EC1V 0HB, United Kingdom
| | - Ramakrishna Mukkamala
- Department of Bioengineering and Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Meir Nitzan
- Department of Physics/Electro-Optic Engineering, Lev Academic Center, 91160 Jerusalem, Israel
| | - Tania Pereira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, Porto, 4200-465, Portugal
- Faculty of Engineering, University of Porto, Porto, 4200-465, Portugal
| | | | - Jessica C Ramella-Roman
- Department of Biomedical Engineering and Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33174, United States of America
| | - Harri Saarinen
- Tampere Heart Hospital, Wellbeing Services County of Pirkanmaa, Tampere, 33520, Finland
| | - Md Mobashir Hasan Shandhi
- Department of Biomedical Engineering, Duke University, Durham, NC 27708-0187, United States of America
| | - Hangsik Shin
- Department of Digital Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Gerard Stansby
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
- Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, United Kingdom
| | - Toshiyo Tamura
- Future Robotics Organization, Waseda University, Tokyo, 1698050, Japan
| | - Antti Vehkaoja
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, 33720, Finland
- PulseOn Ltd, Espoo, 02150, Finland
| | - Will Ke Wang
- Department of Biomedical Engineering, Duke University, Durham, NC 27708-0187, United States of America
| | - Yuan-Ting Zhang
- Hong Kong Center for Cerebrocardiovascular Health Engineering (COCHE), Hong Kong Science and Technology Park, Hong Kong, 999077, People’s Republic of China
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, 999077, People’s Republic of China
| | - Ni Zhao
- Department of Electronic Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Dingchang Zheng
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5RW, United Kingdom
| | - Tingting Zhu
- Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ, United Kingdom
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Hu JR, Park DY, Agarwal N, Herzig M, Ormseth G, Kaushik M, Giao DM, Turkson-Ocran RAN, Juraschek SP. The Promise and Illusion of Continuous, Cuffless Blood Pressure Monitoring. Curr Cardiol Rep 2023; 25:1139-1149. [PMID: 37688763 PMCID: PMC10842120 DOI: 10.1007/s11886-023-01932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE OF REVIEW Blood pressure (BP) fluctuations outside of clinic are increasingly recognized for their role in the development of cardiovascular disease, syncope, and premature death and as a promising target for tailored hypertension treatment. However, current cuff-based BP devices, including home and ambulatory devices, are unable to capture the breadth of BP variability across human activities, experiences, and contexts. RECENT FINDINGS Cuffless, wearable BP devices offer the promise of beat-to-beat, continuous, noninvasive measurement of BP during both awake and sleep periods with minimal patient inconvenience. Importantly, cuffless BP devices can characterize BP variability, allowing for the identification of patient-specific triggers of BP surges in the home environment. Unfortunately, the pace of evidence, regulation, and validation testing has lagged behind the pace of innovation and direct consumer marketing. We provide an overview of the available technologies and devices for cuffless BP monitoring, considerations for the calibration and validation of these devices, and the promise and pitfalls of the cuffless BP paradigm.
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Affiliation(s)
- Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Nikita Agarwal
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthew Herzig
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - George Ormseth
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Milan Kaushik
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Ruth-Alma N Turkson-Ocran
- Section for Research, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stephen P Juraschek
- Section for Research, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- , 330 Brookline Avenue, CO-1309, #204, MA, 02215, USA.
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Bellovary BN, Wells AD, Fennel ZJ, Ducharme JB, Houck JM, Mayschak TJ, Gibson AL, Drum SN, Mermier CM. Could Orthostatic Stress Responses Predict Acute Mountain Sickness Susceptibility Prior to High Altitude Travel? A Pilot Study. High Alt Med Biol 2023; 24:19-26. [PMID: 36473199 DOI: 10.1089/ham.2021.0177] [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: 12/12/2022] Open
Abstract
Bellovary, Bryanne N., Andrew D. Wells, Zachary J. Fennel, Jeremy B. Ducharme, Jonathan M. Houck, Trevor J. Mayschak, Ann L. Gibson, Scott N. Drum, and Christine M. Mermier. Could orthostatic stress responses predict acute mountain sickness susceptibility before high altitude travel? A pilot study. High Alt Med Biol. 24:19-26, 2023. Purpose: This study assessed head-up tilt (HUT) responses in relation to acute mountain sickness (AMS)-susceptibility during hypoxic exposure. Materials and Methods: Fifteen participants completed three lab visits: (1) protocol familiarization and cycle maximal oxygen consumption (VO2max) test; (2) HUT test consisting of supine rest for 20 minutes followed by 70° tilting for ≤40 minutes; and (3) 6 hours of hypobaric hypoxic exposure (4,572 m) where participants performed two 30-minute cycling bouts separated by 1 hour at a 50% VO2max workload within the first 3 hours and rested when not exercising. During HUT, systolic blood pressure (SBP), diastolic blood pressure, heart rate (HR), and variability (blood pressure variability [BPV] and HR variability [HRV]) were measured continuously. The AMS scores were determined after 6 hours of exposure. Correlations determined relationships between HUT cardiovascular responses and AMS scores. Repeated-measures analysis of variance (ANOVA) assessed differences between those with and without AMS symptoms during HUT. Results: Higher AMS scores correlated with greater change in SBP variability (r = 0.52, p = 0.048) and blunted changes in HRV (root mean square of successive differences between normal heartbeats r = 0.81, p = 0.001, percentage of adjacent normal sinus intervals that differ by more than 50 milliseconds [pNN50] r = 0.87, p < 0.001) during HUT. A pNN50 interaction (p = 0.02) suggested elevated cardiac sympathetic activity at baseline and a blunted increase in cardiac sympathetic influence throughout HUT in those with AMS (pNN50 baseline: AMS = 26.2% ± 15.3%, no AMS = 51.0% ± 13.5%; first 3 minutes into HUT: AMS = 17.2% ± 19.1%, no AMS = 17.1% ± 10.9%; end of HUT: AMS = 6.2% ± 9.1%, no AMS 11.0% ± 10.0%). Conclusions: The results suggest autonomic responses via HUT differ in AMS-susceptible individuals. Changes in HRV and BPV during HUT may be a promising predictive measurement for AMS-susceptibility, but further research is needed for confirmation.
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Affiliation(s)
- Bryanne N Bellovary
- Kinesiology Department, State University of New York at Cortland, Cortland, New York, USA
- Department of Health, Exercise, and Sport Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - Andrew D Wells
- Department of Health, Exercise, and Sport Sciences, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Zachary J Fennel
- Department of Health, Exercise, and Sport Sciences, University of New Mexico, Albuquerque, New Mexico, USA
- Molecular Medicine Program, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy B Ducharme
- Department of Health, Exercise, and Sport Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jonathan M Houck
- Department of Health, Exercise, and Sport Sciences, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Science, Husson University, Bangor, Maine, USA
| | - Trevor J Mayschak
- Department of Health, Exercise, and Sport Sciences, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Ann L Gibson
- Department of Health, Exercise, and Sport Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - Scott N Drum
- Department of Health Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Christine M Mermier
- Department of Health, Exercise, and Sport Sciences, University of New Mexico, Albuquerque, New Mexico, USA
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Long-term stability of over-the-counter cuffless blood pressure monitors: a proposal. HEALTH AND TECHNOLOGY 2023; 13:53-63. [PMID: 36713070 PMCID: PMC9870659 DOI: 10.1007/s12553-023-00726-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/17/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023]
Abstract
Blood pressure is an important cardiovascular parameter. Currently, the cuff-based sphygmomanometer is a popular, reliable, measurement method, but blood pressure monitors without cuffs have become popular and are now available without a prescription. Blood pressure monitors must be approved by regulatory authorities. Current cuffless blood pressure (CL-BP) monitors are not suitable for at-home management and prevention of hypertension. This paper proposes simple criteria for over-the-counter CL-BP monitoring. First, the history of the sphygmomanometer and current standard blood pressure protocol are reviewed. The main components of CL-BP monitoring are accuracy during the resting condition, accuracy during dynamic blood pressure changes, and long-term stability. In this proposal we recommend intermittent measurement to ensure that active measurement accuracy mirrors resting condition accuracy. A new experimental protocol is proposed to maintain long-term stability. A medically approved automated sphygmomanometer was used as the standard device in this study. The long-term accuracy of the test device is based on the definition of propagation error, i.e., for an oscillometric automated sphygmomanometer (5 ± 8 mmHg) ± the error for the test device static accuracy (-0.12 ± 5.49 mmHg for systolic blood pressure and - 1.17 ± 5.06 mmHg for diastolic blood pressure). Thus, the long-term stabilities were - 3.38 ± 7.1 mmHg and - 1.38 ± 5.4 mmHg, which satisfied propagation error. Further research and discussion are necessary to create standards for use by manufacturers; such standards should be readily evaluated and ensure high-quality evidence. Supplementary information The online version contains supplementary material available at 10.1007/s12553-023-00726-6.
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Sowho M, Jun J, Sgambati F, Potocki M, Schneider H, Smith P, Schwartz A, Dietz H, MacCarrick G, Neptune E. Assessment of pleural pressure during sleep in Marfan syndrome. J Clin Sleep Med 2022; 18:1583-1592. [PMID: 35152942 PMCID: PMC9163628 DOI: 10.5664/jcsm.9920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/03/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients with Marfan syndrome (MFS) have a high risk for aortic aneurysms. They are also susceptible to sleep-disordered breathing that may expose them to highly negative intrathoracic pressures known to increase aortic transmural pressure, which may accelerate aortic dilatation. Our objective was to quantify overnight intrathoracic pressure changes during sleep in snoring patients with MFS and the therapeutic effect of continuous positive airway pressure (CPAP). METHODS We used a questionnaire to identify self-reported snoring patients with MFS. In these patients, we monitored intrathoracic pressure using esophageal pressure (Pes) during overnight baseline and CPAP sleep studies. We defined a peak-inspiratory Pes (Pespeak-insp) < - 5 cm H2O as greater than normal and examined the distribution of Pespeak-insp during baseline and CPAP studies. RESULTS In our sample of 23 snorers with MFS, we found that 70% of sleep breaths exhibited Pespeak-insp < -5 cm H2O, with apnea/hypopneass accounting for only 12%, suggesting prevalent stable flow-limited breathing and snoring. In a subset (n = 12) with Pes monitoring during a CPAP night, CPAP lowered the mean proportion of breaths with Pespeak-insp < -5 cm H2O from 83.7% ± 14.9% to 3.6% ± 3.0% (P < .001). In addition, contemporaneous aortic root diameter was associated with the mean Pespeak-insp during inspiratory flow-limited breathing and apneas/hypopneas (β = -0.05, r = .675, P = .033). CONCLUSIONS The sleep state in MFS revealed prolonged exposure to exaggerated negative inspiratory Pes, which was reversible with CPAP. Since negative intrathoracic pressure can contribute to thoracic aortic stress and aortic dilatation, snoring may be a reversible risk factor for progression of aortic pathology in MFS. CITATION Sowho M, Jun J, Sgambati F, et al. Assessment of pleural pressure during sleep in Marfan syndrome. J Clin Sleep Med. 2022;18(6):1583-1592.
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Affiliation(s)
- Mudiaga Sowho
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jonathan Jun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Francis Sgambati
- Center for Interdisciplinary Sleep Research and Education, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mariah Potocki
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Hartmut Schneider
- American Sleep Clinic, Center for Sleep Medicine, Frankfurt, Germany
| | - Philip Smith
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alan Schwartz
- American Sleep Clinic, Center for Sleep Medicine, Frankfurt, Germany
| | - Harry Dietz
- McKusick‐Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gretchen MacCarrick
- McKusick‐Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Enid Neptune
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Sowho M, Schneider H, Jun J, MacCarrick G, Schwartz A, Pham L, Sgambati F, Lima J, Smith P, Polotsky V, Neptune E. D-dimer in Marfan syndrome: effect of obstructive sleep apnea induced blood pressure surges. Am J Physiol Heart Circ Physiol 2022; 322:H742-H748. [PMID: 35275761 PMCID: PMC8977140 DOI: 10.1152/ajpheart.00004.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/17/2022] [Accepted: 03/04/2022] [Indexed: 11/22/2022]
Abstract
Aortic dissection and rupture are the major causes of premature death in persons with Marfan syndrome (MFS), a rare genetic disorder featuring cardiovascular, skeletal, and ocular impairments. We and others have found that obstructive sleep apnea (OSA) confers significant vascular stress in this population and may accelerate aortic disease progression. We hypothesized that D-dimer, a diagnostic biomarker for several types of vascular injury that is also elevated in persons with MFS with aortic enlargement, may be sensitive to cardiovascular stresses caused by OSA. To test this concept, we recruited 16 persons with MFS without aortic dissection and randomized them to two nights of polysomnography, without (baseline) and with OSA treatment: continuous positive airway pressure (CPAP). In addition to scoring OSA by the apnea-hypopnea index (AHI), beat-by-beat systolic BP (SBP) and pulse-pressure (PP) fluctuations were quantified. Morning blood samples were also assayed for D-dimer levels. In this cohort (male:female, 10:6; age, 36 ± 13 yr; aortic diameter, 4 ± 1 cm), CPAP eliminated OSA (AHI: 20 ± 17 vs. 3 ± 2 events/h, P = 0.001) and decreased fluctuations in SBP (13 ± 4 vs. 9 ± 3 mmHg, P = 0.011) and PP (7 ± 2 vs. 5 ± 2 mmHg, P = 0.013). CPAP also reduced D-dimer levels from 1,108 ± 656 to 882 ± 532 ng/mL (P = 0.023). Linear regression revealed a positive association between the maximum PP during OSA and D-dimer in both the unadjusted (r = 0.523, P = 0.038) and a model adjusted for contemporaneous aortic root diameter (r = 0.733, P = 0.028). Our study revealed that overnight CPAP reduces D-dimer levels commensurate with the elimination of OSA and concomitant hemodynamic fluctuations. Morning D-dimer measurements together with OSA screening might serve as predictors of vascular injury in MFS.NEW & NOTEWORTHY What is New? Surges in blood pressure caused by obstructive sleep apnea during sleep increase vascular stress and D-dimer levels in Marfan syndrome. Elevations in D-dimer can be lowered with CPAP. What is Noteworthy? D-dimer levels might serve as a marker for determining the significance of obstructive sleep apnea in persons with Marfan syndrome. D-dimer or obstructive sleep apnea screening is a potential method to identify persons with Marfan syndrome at risk for adverse cardiovascular events.
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Affiliation(s)
- Mudiaga Sowho
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Hartmut Schneider
- American Sleep Clinic, Center for Sleep Medicine, Frankfurt, Germany
| | - Jonathan Jun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gretchen MacCarrick
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alan Schwartz
- Department of Otolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Luu Pham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Francis Sgambati
- Center for Interdisciplinary Sleep Research and Education, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joao Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Philip Smith
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Vsevolod Polotsky
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Enid Neptune
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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9
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Kwon Y, Baruch M, Stafford PL, Bonner H, Cho Y, Mazimba S, Logan JG, Shimbo D, Park SH, Lin GM, Azarbarzin A, Calhoun DA, Berry R, Carey RM. Elucidation of obstructive sleep apnoea related blood pressure surge using a novel continuous beat-to-beat blood pressure monitoring system. J Hypertens 2022; 40:520-527. [PMID: 34751170 PMCID: PMC8810587 DOI: 10.1097/hjh.0000000000003041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) episode related blood pressure (BP) surge may mediate the association of OSA with cardiovascular disease. However, BP is not measured during a clinical sleep study. METHOD We tested the feasibility of incorporating the Caretaker physiological monitor, which utilizes a novel continuous beat-to-beat (b-b) BP monitoring technology, into polysomnography (PSG) and aimed to characterize BP surges related to obstructive respiratory events. B-b BP was concurrently collected and merged with PSG data on a posthoc basis. We compared BP surge between mean respiratory (apnoea, hypopnea and desaturation-alone events) and nonrespiratory events (spontaneous or leg movement-related arousals). We examined the association of the degree of oxygen desaturation with BP surge in a given respiratory event combining all events. A total of 17 consecutive patients (12 men, mean 52 years old, nine diagnostic and eight split-night PSGs) undergoing clinically indicated PSG were included after excluding one patient with poor signal quality due to excessive movement. RESULTS Caretaker was well tolerated. Mean respiratory BP surge ranged from 5 to 19 mmHg [Median (IQR) = 13.9 (9.5--16.2)]. Mean BP surge between the respiratory and nonrespiratory events was similar [13.8 (4.5) vs. 14.9 (5.3) mmHg, P = 0.13]. Accounting for the count distribution of desaturation/BP surge data pair events, there was a linear correlation between the degree of oxygen desaturation and BP surge (R = 0.57, P < 0.001). In eight patients undergoing split-night sleep studies, the number of BP surge events (≥10 mmHg/h) decreased during continuous positive airway pressure in all but one patient. CONCLUSION We demonstrated highly variable OSA-related BP surge patterns using the Caretaker's b-b BP monitoring technology that has the potential to be integrated into sleep studies.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | - Heather Bonner
- Department of Medicine, University of Virginia, Charlottesville, VA
| | - Yeilim Cho
- Department of Medicine, University of Washington, Seattle, WA
| | - Sula Mazimba
- Department of Medicine, University of Virginia, Charlottesville, VA
| | | | - Daichi Shimbo
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Sung-Ha Park
- Division of Cardiology, Yonsei University, Seoul, Korea
| | - Gen-Min Lin
- Hualien Armed Forces General Hospital, Hualien, and Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ali Azarbarzin
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | | | - Richard Berry
- Division of Pulmonary, Critical Care and Sleep, Department of Medicine, University of Florida, Gainesville, FL
| | - Robert M. Carey
- Department of Medicine, University of Virginia, Charlottesville, VA
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10
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Blood Pressure Estimation by Photoplethysmogram Decomposition into Hyperbolic Secant Waves. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12041798] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Photoplethysmographic (PPG) pulses contain information about cardiovascular parameters. In particular, blood pressure can be estimated using PPG pulse decomposition analysis, which assumes that a PPG pulse is composed of the original heart ejection blood wave and its reflections in arterial branchings. Among pulse decomposition wave functions that have been studied in the literature, Gaussian waves are the most successful ones. However, a more adequate pulse decomposition function could be found to improve blood pressure estimates. In this paper, we propose pulse decomposition analysis using hyperbolic secant (sech) waves and compare results with corresponding Gaussian wave decomposition. We analyze how the parameters of each of the two types of decomposition waves correlate with blood pressure. For this analysis, continuous blood pressure data and PPG data were acquired from ten healthy volunteers. The blood pressure of volunteers was varied by asking them to hold their breath for up to 60 s. The results suggested sech wave decomposition had higher accuracy in estimating blood pressure than the Gaussian function. Thus, sech wave decomposition should be considered as a more robust alternative to Gaussian wave pulse decomposition for blood pressure estimation models.
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11
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Kwon Y, Stafford PL, Baruch MC, Kim SH, Cho Y, Mazimba S, Gimple LW. Tracking of the beat-to-beat blood pressure changes by the Caretaker physiological monitor against invasive central aortic measurement. Blood Press Monit 2022; 27:70-76. [PMID: 34569988 PMCID: PMC8741634 DOI: 10.1097/mbp.0000000000000568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There is an unmet need for noninvasive continuous blood pressure (BP) monitoring technologies in various clinical settings. Continuous and noninvasive central aortic BP monitoring is technically not feasible currently, but if realized, would provide more accurate and real-time global hemodynamic information than any form of peripheral arterial BP monitoring in an acute care setting. As part of our efforts to develop such, herein we examined the tracking correlation between noninvasively-derived peripheral arterial BP by Caretaker device against invasively measured central aortic BP. METHODS Beat-to-beat BP by Caretaker was recorded simultaneously with central aortic BP measured in patients undergoing cardiac catheterization. Pearson's correlation was also derived for SBP and DBP. A trend comparison analysis of the beat-to-beat BP change was performed using a four-quadrant plot analysis with the exclusion zones of 0.5 mmHg/s to determine concordance, (i.e. the direction of beat-to-beat changes in SBP and DBP). RESULTS A total of 47 patients were included in the study. A total of 31 369 beats representing an average of 17.3 min of recording were used for analysis. The trend analysis yielded concordances of 84.4 and 83.5% for SBP and DBP, respectively. Respective correlations (Pearson's r) for SBP and DBP trends were 0.87 and 0.86 (P < 0.01). Tracking of beat-to-beat BP by Caretaker showed excellent concordance and correlation in the direction and the degree of BP change with central aortic BP, respectively. CONCLUSION This study supports the satisfactory performance of the Caretaker device in continuous tracking of central aortic BP beat-to-beat BP and provides a basis to develop an algorithm for absolute central aortic BP estimation in the future.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Sung-Hoon Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeilim Cho
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Sula Mazimba
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Lawrence W. Gimple
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
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12
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Färber N, Manuel J, May M, Foadi N, Beissner F. The Central Inflammatory Network: A Hypothalamic fMRI Study of Experimental Endotoxemia in Humans. Neuroimmunomodulation 2022; 29:231-247. [PMID: 34610606 PMCID: PMC9254315 DOI: 10.1159/000519061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/25/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Inflammation is a mechanism of the immune system that is part of the reaction to pathogens or injury. The central nervous system closely regulates inflammation via neuroendocrine or direct neuroimmune mechanisms, but our current knowledge of the underlying circuitry is limited. Therefore, we aimed to identify hypothalamic centres involved in sensing or modulating inflammation and to study their association with known large-scale brain networks. METHODS Using high-resolution functional magnetic resonance imaging (fMRI), we recorded brain activity in healthy male subjects undergoing experimental inflammation from intravenous endotoxin. Four fMRI runs covered key phases of the developing inflammation: pre-inflammatory baseline, onset of endotoxemia, onset of pro-inflammatory cytokinemia, and peak of pro-inflammatory cytokinemia. Using masked independent component analysis, we identified functionally homogeneous subregions of the hypothalamus, which were further tested for changes in functional connectivity during inflammation and for temporal correlation with tumour necrosis factor and adrenocorticotropic hormone serum levels. We then studied the connection of these inflammation-associated hypothalamic subregions with known large-scale brain networks. RESULTS Our results show that there are at least 6 hypothalamic subregions associated with inflammation in humans including the paraventricular nucleus, supraoptic nucleus, dorsomedial hypothalamus, bed nucleus of the stria terminalis, lateral hypothalamic area, and supramammillary nucleus. They are functionally embedded in at least 3 different large-scale brain networks, namely a medial frontoparietal network, an occipital-pericentral network, and a midcingulo-insular network. CONCLUSION Measuring how the hypothalamus detects or modulates systemic inflammation is a first step to understand central nervous immunomodulation.
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Affiliation(s)
- Natalia Färber
- Somatosensory and Autonomic Therapy Research, Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
- *Natalia Färber,
| | - Jorge Manuel
- Somatosensory and Autonomic Therapy Research, Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Marcus May
- CRC Core Facility, Hannover Medical School, Hanover, Germany
| | - Nilufar Foadi
- Clinic for Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hanover, Germany
| | - Florian Beissner
- Somatosensory and Autonomic Therapy Research, Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
- **Florian Beissner,
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13
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Pielmus AG, Mühlstef J, Bresch E, Glos M, Jungen C, Mieke S, Orglmeister R, Schulze A, Stender B, Voigt V, Zaunseder S. Surrogate based continuous noninvasive blood pressure measurement. ACTA ACUST UNITED AC 2021; 66:231-245. [PMID: 33565285 DOI: 10.1515/bmt-2020-0209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/28/2020] [Indexed: 11/15/2022]
Abstract
Arterial blood pressure is one of the most often measured vital parameters in clinical practice. State-of-the-art noninvasive ABP measurement technologies have noticeable limitations and are mainly based on uncomfortable techniques of complete or partial arterial occlusion by cuffs. Most commonplace devices provide only intermittent measurements, and continuous systems are bulky and difficult to apply correctly for nonprofessionals. Continuous cuffless ABP measurements are still an unmet clinical need and a topic of ongoing research, with only few commercially available devices. This paper discusses surrogate-based noninvasive blood pressure measurement techniques. It covers measurement methods of continuously and noninvasively inferring BP from surrogate signals without applying external pressures, except for reference or initialization purposes. The BP is estimated by processing signal features, so called surrogates, which are modulated by variations of BP. Discussed techniques include well-known approaches such as pulse transit time and pulse arrival time techniques, pulse wave analysis or combinations thereof. Despite a long research history, these methods have not found widespread use in clinical and ambulatory practice, in part due to technical limitations and the lack of a standardized regulatory framework. This work summarizes findings from an invited workshop of experts in the fields covering clinical expertise, engineering aspects, commercialization and standardization issues. The goal is to provide an application driven outlook, starting with clinical needs, and extending to technical actuality. It provides an outline of recommended research directions and includes a detailed overview of clinical use case scenarios for these technologies, opportunities, and limitations.
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Affiliation(s)
| | - Jens Mühlstef
- Research Group 'Patient Care Solutions', Philips Research Europe, Eindhoven, The Netherlands
| | - Erik Bresch
- Research Group 'Patient Care Solutions', Philips Research Europe, Eindhoven, The Netherlands
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christiane Jungen
- Klinik und Poliklinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg, Hamburg, Germany
| | - Stefan Mieke
- Physikalisch-Technische Bundesanstalt, Berlin, Germany
| | - Reinhold Orglmeister
- Electronics and Medical Signal Processing, Technical University of Berlin, Berlin, Germany
| | - Andreas Schulze
- Research Group 'Patient Care Solutions', Philips Research Europe, Eindhoven, The Netherlands
| | | | - Verena Voigt
- Klinik für Anästhesiologie, Sektion Medizintechnik, Uniklinik RWTH Aachen, Aachen, Germany
| | - Sebastian Zaunseder
- Technical University of Dresden, Dresden, Germany.,Fachhochschule Dortmund, Dortmund, Germany
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14
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Quan X, Liu J, Roxlo T, Siddharth S, Leong W, Muir A, Cheong SM, Rao A. Advances in Non-Invasive Blood Pressure Monitoring. SENSORS (BASEL, SWITZERLAND) 2021; 21:s21134273. [PMID: 34206457 PMCID: PMC8271585 DOI: 10.3390/s21134273] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 01/30/2023]
Abstract
This paper reviews recent advances in non-invasive blood pressure monitoring and highlights the added value of a novel algorithm-based blood pressure sensor which uses machine-learning techniques to extract blood pressure values from the shape of the pulse waveform. We report results from preliminary studies on a range of patient populations and discuss the accuracy and limitations of this capacitive-based technology and its potential application in hospitals and communities.
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Affiliation(s)
- Xina Quan
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
- Correspondence: ; Tel.: +1-408-216-0099
| | - Junjun Liu
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - Thomas Roxlo
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - Siddharth Siddharth
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - Weyland Leong
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - Arthur Muir
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - So-Min Cheong
- Department of Geography & Atmospheric Science, University of Kansas, Lawrence, KS 66045, USA;
| | - Anoop Rao
- Department of Pediatrics, Neonatology, Stanford University, Palo Alto, CA 94304, USA;
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15
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Zhang Z, Peng B, Luo CH, Tai CC. ANFIS-GA system for three-dimensional pulse image of normal and string-like pulse in Chinese medicine using an improved contour analysis method. Eur J Integr Med 2021. [DOI: 10.1016/j.eujim.2021.101301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Abstract
Hypertension is a highly common condition with well-established adverse consequences. Ambulatory blood pressure monitoring has repeatedly been shown to better predict cardiovascular outcomes and mortality, compared to single office visit blood pressure. Non-dipping of sleep-time blood pressure is an independent marker for increased cardiovascular risk. We review blood pressure variability and the challenges of blood pressure monitoring during sleep. Although pathological sleep such as obstructive sleep apnea has been associated with non-dipping of sleep-time blood pressure, blood pressure is not routinely measured during sleep due to lack of unobtrusive blood pressure monitoring technology. Second, we review existing noninvasive continuous blood pressure monitoring technologies. Lastly, we propose including sleep-time blood pressure monitoring during sleep studies and including sleep studies in patients undergoing ambulatory blood pressure monitoring.
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17
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Fleischhauer V, Ruprecht N, Sorelli M, Bocchi L, Zaunseder S. Pulse decomposition analysis in photoplethysmography imaging. Physiol Meas 2020; 41:095009. [PMID: 33021236 DOI: 10.1088/1361-6579/abb005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Photoplethysmography imaging (PPGI) has gained immense attention over the last few years but only a few works have addressed morphological analysis so far. Pulse wave decomposition (PWD), i.e. the decomposition of a pulse wave by a varying number of kernels, allows for such analyses. This work investigates the applicability of PWD algorithms in the context of PPGI. APPROACH We used simulated and experimental data to compare various PWD algorithms from the literature regarding their robustness against noise and motion artifacts while preserving morphological information as well as regarding their ability to reveal physiological changes by PPGI. MAIN RESULTS Our experiments prove that algorithms that combine Gamma and Gaussian distributions outperform other choices. Further, algorithms with two kernels exhibit the highest robustness against noise and motion artifacts (improvement in [Formula: see text] of 14.09 %) while preserving the morphology similarly to algorithms using more kernels. Lastly, we showed that PWD can reveal physiological changes upon distal stimuli by PPGI. SIGNIFICANCE This work proves the feasibility of pulse decomposition analysis in PPGI, particularly for algorithms with a low number of kernels, and opens up novel applications for PPGI. Not only for PPGI but for future research on PWD in general, our findings have importance as they elucidate differences between PWD algorithms and emphasize the importance of using initial values. To support such future research, we have released the algorithms and simulated data to the public.
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18
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Sturchio A, Dwivedi AK, Marsili L, Hadley A, Sobrero G, Heldman D, Maule S, Lopiano L, Comi C, Versino M, Espay AJ, Merola A. Kinematic but not clinical measures predict falls in Parkinson-related orthostatic hypotension. J Neurol 2020; 268:1006-1015. [PMID: 32979099 DOI: 10.1007/s00415-020-10240-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We sought to test the hypothesis that technology could predict the risk of falls in Parkinson's disease (PD) patients with orthostatic hypotension (OH) with greater accuracy than in-clinic assessment. METHODS Twenty-six consecutive PD patients with OH underwent clinical (including home-like assessments of activities of daily living) and kinematic evaluations of balance and gait as well as beat-to-beat blood pressure (BP) monitoring to estimate their association with the risk of falls. Fall frequency was captured by a diary collected prospectively over 6 months. When applicable, the sensitivity, specificity, and diagnostic accuracy were measured using the area under the receiver operating characteristics curve (AUC). Additional in-clinic assessments included the OH Symptom Assessment (OHSA), the OH Daily Activity Score (OHDAS), and the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS The prevalence of falls was 53.8% over six months. There was no association between the risk of falls and test of gait and postural stability (p ≥ 0.22) or home-like activities of daily living (p > 0.08). Conversely, kinematic data (waist sway during time-up-and-go, jerkiness, and centroidal frequency during postural sway with eyes-opened) predicted the risk of falls with high sensitivity and specificity (> 80%; AUC ≥ 0.81). There was a trend for higher risk of falls in patients with orthostatic mean arterial pressure ≤ 75 mmHg. CONCLUSIONS Kinematic but not clinical measures predicted falls in PD patients with OH. Orthostatic mean arterial pressure ≤ 75 mmHg may represent a hemodynamic threshold below which falls become more prevalent, supporting the aggressive deployment of corrective measures.
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Affiliation(s)
- Andrea Sturchio
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
- University of Pavia, Pavia, Italy
- Neurology Unit, Varese ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Luca Marsili
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Aaron Hadley
- Great Lakes NeuroTechnologies, Cleveland, OH, USA
| | - Gabriele Sobrero
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
- Ambulatorio per le Disautonomie e l'Ipotensione Ortostatica, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Simona Maule
- Ambulatorio per le Disautonomie e l'Ipotensione Ortostatica, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy
| | - Cristoforo Comi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Maurizio Versino
- Neurology Unit, Varese ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
- DMC, University of Insubria, Varese, Italy
| | - Alberto J Espay
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Aristide Merola
- Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
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19
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Whittaker JR, Driver ID, Venzi M, Bright MG, Murphy K. Corrigendum: Cerebral Autoregulation Evidenced by Synchronized Low Frequency Oscillations in Blood Pressure and Resting-State fMRI. Front Neurosci 2020; 14:544. [PMID: 32670004 PMCID: PMC7327440 DOI: 10.3389/fnins.2020.00544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/04/2020] [Indexed: 12/05/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fnins.2019.00433.].
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Affiliation(s)
- Joseph R. Whittaker
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom
| | - Ian D. Driver
- CUBRIC, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Marcello Venzi
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom
| | - Molly G. Bright
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kevin Murphy
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom
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20
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Evaluating the Performance of Cardiac Pulse Duplicators Through the Concept of Fidelity. Cardiovasc Eng Technol 2019; 10:423-436. [PMID: 31041729 DOI: 10.1007/s13239-019-00416-3] [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] [Received: 06/26/2018] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The advanced design techniques used in modern prosthetic heart valve (PHV) development require accurate replication of the entire cardiac cycle. While cardiac pulse duplicator (CPD) design has a direct impact on the PHV test data generated, no clear guidelines exist to evaluate the CPD's performance. In response to this, we present a method to quantitatively assess CPD performance. MATERIALS AND METHODS A method to establish the fidelity of CPDs was formulated based on the pressure/time relationship and the error related to this relationship's target. This method was applied to assess the performance of a custom-made CPD. The performance evaluation included the assessment of the motion control system and overall repeatability of pressure measurements using a St Jude Epic 21 mm aortic valve. RESULTS The CPD's motion control system had an average root mean square error (RMSE) beat-to-beat tracking accuracy of 0.046 ± 0.008 mm. Assessment of the pressure measurements yielded a repeatability of < 2.4 ± 0.9 mmHg RMSE beat-to-beat differential pressure. The combination of pressure and its location within a heartbeat (fidelity) was within 5.0% of the individual targets for at least 95% of heartbeats. CONCLUSION Fidelity can be used to objectively quantify the performance of various aspects of CPDs and to identify the cause of unexpected PHV or CPD behaviour. It also enables comparisons to be made among various CPDs in terms of overall performance. This approach may enable standardization of the assessment of CPD performance in the future.
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Whittaker JR, Driver ID, Venzi M, Bright MG, Murphy K. Cerebral Autoregulation Evidenced by Synchronized Low Frequency Oscillations in Blood Pressure and Resting-State fMRI. Front Neurosci 2019; 13:433. [PMID: 31133780 PMCID: PMC6514145 DOI: 10.3389/fnins.2019.00433] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/15/2019] [Indexed: 01/23/2023] Open
Abstract
Resting-state functional magnetic resonance imaging (rs-fMRI) is a widely used technique for mapping the brain’s functional architecture, so delineating the main sources of variance comprising the signal is crucial. Low frequency oscillations (LFO) that are not of neural origin, but which are driven by mechanisms related to cerebral autoregulation (CA), are present in the blood-oxygenation-level-dependent (BOLD) signal within the rs-fMRI frequency band. In this study we use a MR compatible device (Caretaker, Biopac) to obtain a non-invasive estimate of beat-to-beat mean arterial pressure (MAP) fluctuations concurrently with rs-fMRI at 3T. Healthy adult subjects (n = 9; 5 male) completed two 20-min rs-fMRI scans. MAP fluctuations were decomposed into different frequency scales using a discrete wavelet transform, and oscillations at approximately 0.1 Hz show a high degree of spatially structured correlations with matched frequency fMRI fluctuations. On average across subjects, MAP fluctuations at this scale of the wavelet decomposition explain ∼2.2% of matched frequency fMRI signal variance. Additionally, a simultaneous multi-slice multi-echo acquisition was used to collect 10-min rs-fMRI at three echo times at 7T in a separate group of healthy adults (n = 5; 5 male). Multiple echo times were used to estimate the R2∗ decay at every time point, and MAP was shown to strongly correlate with this signal, which suggests a purely BOLD (i.e., blood flow related) origin. This study demonstrates that there is a significant component of the BOLD signal that has a systemic physiological origin, and highlights the fact that not all localized BOLD signal changes necessarily reflect blood flow supporting local neural activity. Instead, these data show that a proportion of BOLD signal fluctuations in rs-fMRI are due to localized control of blood flow that is independent of local neural activity, most likely reflecting more general systemic autoregulatory processes. Thus, fMRI is a promising tool for studying flow changes associated with cerebral autoregulation with high spatial resolution.
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Affiliation(s)
- Joseph R Whittaker
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom
| | - Ian D Driver
- CUBRIC, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Marcello Venzi
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom
| | - Molly G Bright
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kevin Murphy
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom
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Peltokangas M, Telembeci AA, Verho J, Mattila VM, Romsi P, Vehkaoja A, Lekkala J, Oksala N. Parameters Extracted From Arterial Pulse Waves as Markers of Atherosclerotic Changes: Performance and Repeatability. IEEE J Biomed Health Inform 2018; 22:750-757. [DOI: 10.1109/jbhi.2017.2679904] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gratz I, Deal E, Spitz F, Baruch M, Allen IE, Seaman JE, Pukenas E, Jean S. Continuous Non-invasive finger cuff CareTaker® comparable to invasive intra-arterial pressure in patients undergoing major intra-abdominal surgery. BMC Anesthesiol 2017; 17:48. [PMID: 28327093 PMCID: PMC5361833 DOI: 10.1186/s12871-017-0337-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/01/2017] [Indexed: 11/17/2022] Open
Abstract
Background Despite increased interest in non-invasive arterial pressure monitoring, the majority of commercially available technologies have failed to satisfy the limits established for the validation of automatic arterial pressure monitoring by the Association for the Advancement of Medical Instrumentation (AAMI). According to the ANSI/AAMI/ISO 81060–2:2013 standards, the group-average accuracy and precision are defined as acceptable if bias is not greater than 5 mmHg and standard deviation is not greater than 8 mmHg. In this study, these standards are used to evaluate the CareTaker® (CT) device, a device measuring continuous non-invasive blood pressure via a pulse contour algorithm called Pulse Decomposition Analysis. Methods A convenience sample of 24 patients scheduled for major abdominal surgery were consented to participate in this IRB approved pilot study. Each patient was monitored with a radial arterial catheter and CT using a finger cuff applied to the contralateral thumb. Hemodynamic variables were measured and analyzed from both devices for the first thirty minutes of the surgical procedure including the induction of anesthesia. The mean arterial pressure (MAP), systolic and diastolic blood pressures continuously collected from the arterial catheter and CT were compared. Pearson correlation coefficients were calculated between arterial catheter and CT blood pressure measurements, a Bland-Altman analysis, and polar and 4Q plots were created. Results The correlation of systolic, diastolic, and mean arterial pressures were 0.92, 0.86, 0.91, respectively (p < 0.0001 for all the comparisons). The Bland-Altman comparison yielded a bias (as measured by overall mean difference) of −0.57, −2.52, 1.01 mmHg for systolic, diastolic, and mean arterial pressures, respectively with a standard deviation of 7.34, 6.47, 5.33 mmHg for systolic, diastolic, and mean arterial pressures, respectively (p < 0.001 for all comparisons). The polar plot indicates little bias between the two methods (90%/95% CI at 31.5°/52°, respectively, overall bias = 1.5°) with only a small percentage of points outside these lines. The 4Q plot indicates good concordance and no bias between the methods. Conclusions In this study, blood pressure measured using the non-invasive CT device was shown to correlate well with the arterial catheter measurements. Larger studies are needed to confirm these results in more varied settings. Most patients exhibited very good agreement between methods. Results were well within the limits established for the validation of automatic arterial pressure monitoring by the AAMI.
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Affiliation(s)
- Irwin Gratz
- Department of Anesthesiology, Cooper Medical School at Rowan University Cooper University Hospital, Camden, New Jersey, USA
| | - Edward Deal
- Department of Anesthesiology, Cooper Medical School at Rowan University Cooper University Hospital, Camden, New Jersey, USA
| | - Francis Spitz
- Department of Anesthesiology, Cooper Medical School at Rowan University Cooper University Hospital, Camden, New Jersey, USA
| | - Martin Baruch
- Empirical Technologies Corporation, Charlottesville, Virginia, USA
| | - I Elaine Allen
- Department of Biostatistics and Epidemiology, University of California, San Francisco, CA, USA
| | - Julia E Seaman
- Department of Pharmaceutical Chemistry, University of California, San Francisco, California, USA
| | - Erin Pukenas
- Department of Anesthesiology, Cooper Medical School at Rowan University Cooper University Hospital, Camden, New Jersey, USA
| | - Smith Jean
- Department of Anesthesiology, Cooper Medical School at Rowan University Cooper University Hospital, Camden, New Jersey, USA.
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Sirevaag EJ, Casaccia S, Richter EA, O'Sullivan JA, Scalise L, Rohrbaugh JW. Cardiorespiratory interactions: Noncontact assessment using laser Doppler vibrometry. Psychophysiology 2016; 53:847-67. [PMID: 26970208 DOI: 10.1111/psyp.12638] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/17/2016] [Indexed: 01/02/2023]
Abstract
The application of a noncontact physiological recording technique, based on the method of laser Doppler vibrometry (LDV), is described. The effectiveness of the LDV method as a physiological recording modality lies in the ability to detect very small movements of the skin, associated with internal mechanophysiological activities. The method is validated for a range of cardiovascular variables, extracted from the contour of the carotid pulse waveform as a function of phase of the respiration cycle. Data were obtained from 32 young healthy participants, while resting and breathing spontaneously. Individual beats were assigned to four segments, corresponding with inspiration and expiration peaks and transitional periods. Measures relating to cardiac and vascular dynamics are shown to agree with the pattern of effects seen in the substantial body of literature based on human and animal experiments, and with selected signals recorded simultaneously with conventional sensors. These effects include changes in heart rate, systolic time intervals, and stroke volume. There was also some evidence for vascular adjustments over the respiration cycle. The effectiveness of custom algorithmic approaches for extracting the key signal features was confirmed. The advantages of the LDV method are discussed in terms of the metrological properties and utility in psychophysiological research. Although used here within a suite of conventional sensors and electrodes, the LDV method can be used on a stand-alone, noncontact basis, with no requirement for skin preparation, and can be used in harsh environments including the MR scanner.
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Affiliation(s)
- Erik J Sirevaag
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sara Casaccia
- Preston M. Green Department of Electrical and Systems Engineering, School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Industrial Engineering and Mathematical Science, Università Politecnica delle Marche, Ancona, Italy
| | - Edward A Richter
- Preston M. Green Department of Electrical and Systems Engineering, School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joseph A O'Sullivan
- Preston M. Green Department of Electrical and Systems Engineering, School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Lorenzo Scalise
- Department of Industrial Engineering and Mathematical Science, Università Politecnica delle Marche, Ancona, Italy
| | - John W Rohrbaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Peltokangas M, Vehkaoja A, Verho J, Mattila VM, Romsi P, Lekkala J, Oksala N. Age Dependence of Arterial Pulse Wave Parameters Extracted From Dynamic Blood Pressure and Blood Volume Pulse Waves. IEEE J Biomed Health Inform 2015; 21:142-149. [PMID: 26625436 DOI: 10.1109/jbhi.2015.2503889] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Atherosclerosis is a significant cause of mortality in the aged population, and it affects arterial wall properties causing differences in measured arterial pulse wave (PW). In this study, both dynamic arterial blood pressure PWs and blood volume PWs are analyzed. The PWs are recorded noninvasively from multiple measurement points from the upper and lower limbs from 52 healthy (22-90-year-old) volunteers without known cardiovascular diseases. For each signal, various parameters earlier proposed in the literature are computed, and 25 different novel parameters are formed by combining these parameters. The results are evaluated in terms of age and heart rate (HR) dependence of the parameters. In general, the results show that 14 out of 25 tested combined parameters have stronger age dependence than any of the individual parameters. The highest obtained linear correlation coefficients between the age and combined parameter and individual parameter equal to 0.85 ( ) and 0.79 ( ), respectively. Most of the combined parameters have also improved discrimination capability when classifying the test subjects into different age groups. This is a promising result for further studies, but indicate that the age dependence of the parameters must be taken into account in further studies with atherosclerotic patients.
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Affiliation(s)
- Mikko Peltokangas
- Department of Automation Science and Engineering, Tampere University of Technology, BioMediTech, Tampere, Finland
| | - Antti Vehkaoja
- Department of Automation Science and Engineering, Tampere University of Technology, BioMediTech, Tampere, Finland
| | - Jarmo Verho
- Department of Automation Science and Engineering, Tampere University of Technology, BioMediTech, Tampere, Finland
| | | | | | - Jukka Lekkala
- Department of Automation Science and Engineering, Tampere University of Technology, BioMediTech, Tampere, Finland
| | - Niku Oksala
- Tampere University Hospital, Tampere, Finland
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Epstein S, Willemet M, Chowienczyk PJ, Alastruey J. Reducing the number of parameters in 1D arterial blood flow modeling: less is more for patient-specific simulations. Am J Physiol Heart Circ Physiol 2015; 309:H222-34. [PMID: 25888513 PMCID: PMC4491523 DOI: 10.1152/ajpheart.00857.2014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/11/2015] [Indexed: 01/09/2023]
Abstract
Patient-specific one-dimensional (1D) blood flow modeling requires estimating model parameters from available clinical data, ideally acquired noninvasively. The larger the number of arterial segments in a distributed 1D model, the greater the number of input parameters that need to be estimated. We investigated the effect of a reduction in the number of arterial segments in a given distributed 1D model on the shape of the simulated pressure and flow waveforms. This is achieved by systematically lumping peripheral 1D model branches into windkessel models that preserve the net resistance and total compliance of the original model. We applied our methodology to a model of the 55 larger systemic arteries in the human and to an extended 67-artery model that contains the digital arteries that perfuse the fingers. Results show good agreement in the shape of the aortic and digital waveforms between the original 55-artery (67-artery) and reduced 21-artery (37-artery) models. Reducing the number of segments also enables us to investigate the effect of arterial network topology (and hence reflection sites) on the shape of waveforms. Results show that wave reflections in the thoracic aorta and renal arteries play an important role in shaping the aortic pressure and flow waves and in generating the second peak of the digital pressure and flow waves. Our novel methodology is important to simplify the computational domain while maintaining the precision of the numerical predictions and to assess the effect of wave reflections.
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Affiliation(s)
- Sally Epstein
- Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom; and
| | - Marie Willemet
- Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom; and
| | - Phil J Chowienczyk
- Department of Clinical Pharmacology, St. Thomas' Hospital, King's College London, London, United Kingdom
| | - Jordi Alastruey
- Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom; and
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