Non-Contact Heart Rate Estimation via Adaptive RGB/NIR Signal Fusion

We propose a non-contact heart rate (HR) estimation method that is robust to various situations, such as bright, low-light, and varying illumination scenes. We utilize a camera that records red, green, and blue (RGB) and near-infrared (NIR) information to capture the subtle skin color changes induced by the cardiac pulse of a person. The key novelty of our method is the adaptive fusion of RGB and NIR signals for HR estimation based on the analysis of background illumination variations. RGB signals are suitable indicators for HR estimation in bright scenes. Conversely, NIR signals are more reliable than RGB signals in scenes with more complex illumination, as they can be captured independently of the changes in background illumination. By measuring the correlations between the lights reflected from the background and facial regions, we adaptively utilize RGB and NIR observations for HR estimation. The experiments demonstrate the effectiveness of the proposed method.

Flexible Piezoresistive Sensors with Wide-Range Pressure Measurements Based on a Graded Nest-like Architecture

Flexible pressure sensors present great potential in the application of human health monitoring, tactile function of prosthesis, and electronic skin for robotics. These applications require different trade-off between the sensitivity and sensing range, therefore, it is imperative to develop range-specific sensitivities in a single sensor. In this paper, a bioinspired strategy for a resistive pressure sensor using a graded porous material is proposed to measure pressures from several pascals to megapascals. Its fabrication is based on an easily accessible template method. The nest-architecture-based wide-range pressure sensor exhibits adequate sensitivity under an extensive pressure regime (20 Pa to 1.2 MPa). In addition, with rational structural design and subtle engineering of the material properties, the sensor achieves remarkable mechanical stability. To prove the concept, sensors were attached on a bicycle wheel to monitor the tire-pavement pressure and on human skin to detect biosignals such as venous and arterial blood pressure pulses.

Blind Source Separation on Non-Contact Heartbeat Detection by Non-Negative Matrix Factorization Algorithms

In non-contact heart rate (HR) monitoring via Doppler radar, the disturbance from respiration and/or body motion is treated as a key problem on the estimation of HR. This paper proposes a blind source separation (BSS) approach to mitigate the noise effect in the received radar signal, and incorporates the sparse spectrum reconstruction to achieve a high-resolution of heartbeat spectrum. The proposed BSS decomposes the spectrogram of mixture signal into original sources, including heartbeat, using non-negative matrix factorization (NMF) algorithms, through learning the complete basis spectra (BS) by a hierarchical clustering. In particular, to exploit the temporal sparsity of heartbeat component, two variants of NMF algorithms with sparseness constraints are applied as well, namely sparse NMF and weighted sparse NMF. Compared with usual BSS, our proposed BSS has three advantages: 1) clustering-induced unsupervised manner; 2) compact demixing architecture; and 3) merely requiring single-channel input data. In addition, the HR estimation method using our proposal delivers more satisfactory precision and robustness over other existing methods, which is demonstrated through the measurements of distinguishing people's activities, gaining both smallest absolute errors of HR estimation for sitting still and typewriting.

Pulse Arrival Time and Pulse Interval as Accurate Markers to Detect Mechanical Alternans

Mechanical alternans (MA) is a powerful predictor of adverse prognosis in patients with heart failure and cardiomyopathy, but its use remains limited due to the need of invasive continuous arterial pressure recordings. This study aims to assess novel cardiovascular correlates of MA in the intact human heart to facilitate affordable and non-invasive detection of MA and advance our understanding of the underlying pathophysiology. Arterial pressure, respiration, and ECG were recorded in 12 subjects with healthy ventricles during voluntarily controlled breathing at different respiratory rate, before and after administration of beta-blockers. MA was induced by ventricular pacing. A total of 67 recordings lasting approximately 90 s each were analyzed. Mechanical alternans (MA) was measured in the systolic blood pressure. We studied cardiovascular correlates of MA, including maximum pressure rise during systole (dPdtmax), pulse arrival time (PAT), pulse wave interval (PI), RR interval (RRI), ECG QRS complexes and T-waves. MA was detected in 30% of the analyzed recordings. Beta-blockade significantly reduced MA prevalence (from 50 to 11%, p < 0.05). Binary classification showed that MA was detected by alternans in dPdtmax (100% sens, 96% spec), PAT (100% sens, 81% spec) and PI (80% sens, 81% spec). Alternans in PAT and in PI also showed high degree of temporal synchronization with MA (80 ± 33 and 73 ± 40%, respectively). These data suggest that cardiac contractility is a primary factor in the establishment of MA. Our findings show that MA was highly correlated with invasive measurements of PAT and PI. Since PAT and PI can be estimated using non-invasive technologies, these markers could potentially enable affordable MA detection for risk-prediction.

Can pulse check by the photoplethysmography sensor on a smart watch replace carotid artery palpation during cardiopulmonary resuscitation in cardiac arrest patients? a prospective observational diagnostic accuracy study

OBJECTIVE

The purpose of this study was to assess whether a photoplethysmography (PPG) sensor in a smart watch can accurately recognise the return of spontaneous circulation (ROSC) in cardiac arrest patients compared with carotid artery palpation.

METHODS

This prospective observational study was conducted on 50 out-of-hospital cardiac arrest patients who visited the emergency department (ED) of one tertiary hospital. As soon as the patient arrived at the ED, advanced cardiac life support was carried out immediately. At this time, three smart watches were attached to the carotid artery, forehead and wrist and were checked for pulse measurements every 2 min. In the case of ROSC, blood pressure, heart rate and heart rate regularity were confirmed, and pulse was simultaneously measured at three sites with smart watches. In the case of no ROSC, only the pulse was measured at three sites with the smart watches.

RESULTS

There were 33 males (66%) and the mean age was 68±11.57 years. In 14 patients (28%), spontaneous circulation was recovered through cardiopulmonary resuscitation, and all survived. The sensitivity and specificity of manual palpation were 78.6% and 90.4%, respectively. False-positive and false-negative rates were 9.6% and 21.4%, respectively. Smart watches at all three sites had the same or higher sensitivity than manual palpation. The sensitivity of the smart watch was the highest, at 100%, in the carotid region and the lowest, at 78.6%, in the wrist region. The specificity of the smart watch was the highest, at 100%, in the wrist region and the lowest, at 78.7%, in the carotid region.

CONCLUSION

Compared with manual pulse check, the PPG sensor embedded in the smart watch showed the same sensitivity and a higher specificity for recognising ROSC when measured at the wrist.

A Stochastic Gradient Approach for Robust Heartbeat Detection With Doppler Radar Using Time-Window-Variation Technique

Heart rate (HR) variability indicates health condition and mental stress. The development of non-contact HR monitoring techniques with Doppler radar is attracting great attention. However, the performance of heartbeat detection via radar signals easily degrades due to respiration and body motion. In this paper, first, a stochastic gradient approach is applied to reconstruct the high-resolution spectrum of heartbeat by proposing the zero-attracting sign least-mean-square (ZA-SLMS) algorithm. To correct the quantized gradient of cost function and penalize the sparse constraint on updating the spectrum, a more accurate heartbeat spectrum is reconstructed. Then, to better adapt to the noises of different strengths caused by subjects' movements, an adaptive regularization parameter is introduced in the ZA-SLMS algorithm as an improved variant, which can adaptively regulate the proportion between gradient correction and sparse penalty. Moreover, in view of the stability of the location of the spectral peak associated with the HR when the size of time window slightly changes, a time-window-variation (TWV) technique is further incorporated in the improved ZA-SLMS (IZA-SLMS) algorithm for more stable HR estimation. Through the experiments on five subjects, our proposal is demonstrated to bring a significant improvement in accuracy compared with existing detection methods. Specifically, the IZA-SLMS algorithm with TWV achieves the smallest average error of 3.79 beats per minute when subjects type on a laptop.

Using the Pulse Contour Method to Measure the Changes in Stroke Volume during a Passive Leg Raising Test

The pulse contour method is often used with the Windkessel model to measure stroke volume. We used a digital pressure and flow sensors to detect the parameters of the Windkessel model from the pulse waveform. The objective of this study was to assess the stability and accuracy of this method by making use of the passive leg raising test. We studied 24 healthy subjects (40 ± 9.3 years), and used the Medis^® CS 1000, an impedance cardiography, as the comparing reference. The pulse contour method measured the waveform of the brachial artery by using a cuff. The compliance and resistance of the peripheral artery was detected from the cuff characteristics and the blood pressure waveform. Then, according to the method proposed by Romano et al., the stroke volume could be measured. This method was implemented in our designed blood pressure monitor. A passive leg raising test, which could immediately change the preloading of the heart, was done to certify the performance of our method. The pulse contour method and impedance cardiography simultaneously measured the stroke volume. The measurement of the changes in stroke volume using the pulse contour method had a very high correlation with the Medis^® CS 1000 measurement, the correlation coefficient of the changed ratio and changed differences in stroke volume were r² = 0.712 and r² = 0.709, respectively. It was shown that the stroke volume measured by using the pulse contour method was not accurate enough. But, the changes in the stroke volume could be accurately measured with this pulse contour method. Changes in stroke volume are often used to understand the conditions of cardiac preloading in the clinical field. Moreover, the operation of the pulse contour method is easier than using impedance cardiography and echocardiography. Thus, this method is suitable to use in different healthcare fields.

Pressure Pulse Distortion by Needle and Fiber-Optic Hydrophones due to Nonuniform Sensitivity

Needle and fiber-optic hydrophones have frequency-dependent sensitivity, which can result in substantial distortion of nonlinear or broadband pressure pulses. A rigid cylinder model for needle and fiber-optic hydrophones was used to predict this distortion. The model was compared with measurements of complex sensitivity for a fiber-optic hydrophone and three needle hydrophones with sensitive element sizes ( ) of 100, 200, 400, and . Theoretical and experimental sensitivities agreed to within 12 ± 3% [root-mean-square (RMS) normalized magnitude ratio] and 8° ± 3° (RMS phase difference) for the four hydrophones over the range from 1 to 10 MHz. The model predicts that distortions in peak positive pressure can exceed 20% when and spectral index (SI) >7% and can exceed 40% when and SI >14%, where is the wavelength of the fundamental component and SI is the fraction of power spectral density contained in harmonics. The model predicts that distortions in peak negative pressure can exceed 15% when . Measurements of pulse distortion using a 2.25 MHz source and needle hydrophones with , 400, and agreed with the model to within a few percent on the average for SI values up to 14%. This paper 1) identifies conditions for which needle and fiber-optic hydrophones produce substantial distortions in acoustic pressure pulse measurements and 2) offers a practical deconvolution method to suppress these distortions.

The impact of Fruit-Vegetable Diet on High Signal Resolution Pulse Wave (HSR-PW) Parameters

OBJECTIVES

The diet and lifestyle affect our life. Inadequate nutrition can cause various diseases including cardiovascular diseases. The aim of this study was to show the correlations between the fruit and vegetable diet and high signal resolution pulse wave parameters.

DESIGN

This was an observational study.

SETTINGS

The study was done during two-weeks rehabilitation treatment.

PARTICIPANTS

In this study 154 people using the fruit and vegetable diet have been examined.

MEASUREMENTS

The participants were monitored using a new diagnostic method high signal resolution pulseoximetry (HSR-PW). They were examined two times: before starting the diet and after two weeks of using it. The high signal resolution pulse wave and its characteristic parameters have been compared.

RESULTS

Analyzing the research results at the beginning and after two weeks of using this diet, the improvement of selected parameters has been noticed. With the improvement in the pulse wave was observed weight loss, improved blood counts (e.g. cholesterol, triglycerides) as well as decreased blood pressure particularly in people with treated hypertension.

CONCLUSIONS

The study shows that applied fruit and vegetable diet influenced favorably the people using it and contributed to the improvement of the HSR-PW parameters which are the source of information about the state of the cardiovascular system.

Fusing Partial Camera Signals for Noncontact Pulse Rate Variability Measurement

Remote camera-based measurement of physiology has great potential for healthcare and affective computing. Recent advances in computer vision and signal processing have enabled photoplethysmography (PPG) measurement using commercially available cameras. However, there remain challenges in recovering accurate noncontact PPG measurements in the presence of rigid head motion. When a subject is moving, their face may be turned away from one camera, be obscured by an object, or move out of the frame resulting in missing observations. As the calculation of pulse rate variability (PRV) requires analysis over a time window of several minutes, the effect of missing observations on such features is deleterious. We present an approach for fusing partial color-channel signals from an array of cameras that enable physiology measurements to be made from moving subjects, even if they leave the frame of one or more cameras, which would not otherwise be possible with only a single camera. We systematically test our method on subjects ( N=25) using a set of six, 5-min tasks (each repeated twice) involving different levels of head motion. This results in validation across 25 h of measurement. We evaluate pulse rate and PRV parameter estimation including statistical, geometric, and frequency-based measures. The median absolute error in pulse rate measurements was 0.57 beats-per-minute (BPM). In all but two tasks with the greatest motion, the median error was within 0.4 BPM of that from a contact PPG device. PRV estimates were significantly improved using our proposed approach compared to an alternative not designed to handle missing values and multiple camera signals; the error was reduced by over 50%. Without our proposed method, errors in pulse rate would be very high, and estimation of PRV parameters would not be feasible due to significant data loss.

Evaluation of the health status of six volunteers from the Mars 500 project using pulse analysis

OBJECTIVE

To comprehensively evaluate the health status of 6 volunteers from the Mars 500 Project through analyzing their pulse graphs and determining the changes in cardiovascular function, degree of fatigue and autonomic nervous function.

METHODS

Six volunteers were recruited; all were male aged 26-38 years (average 31.83±4.96 years). Characteristic parameters reflflecting the status of cardiovascular functions were extracted, which included left ventricular contraction, vascular elasticity and peripheral resistance. The degree of fatigue was determined depending on the difference between the calendar age and biological age, which was calculated through the analysis of blood pressure value and characteristic parameters. Based on the values of pulse height variation and pulse time variation on a 30-s pulse graph, autonomic nervous function was evaluated. All parameters examined were marked on an equilateral polygon to form an irregular polygon of the actual fifigure, then health status was evaluated based on the coverage area of the actual fifigure.

RESULTS

The results demonstrated: (1) volunteers developed weakened pulse power, increased vascular tension and peripheral resistance, and slight decreased ventricular systolic function; (2) the degree of fatigue was basically mild or moderate; and (3) autonomic nervous function was excited but generally balanced.

CONCLUSIONS

These volunteers were in the state of sub-health. According to Chinese medicine theories, such symptoms are mainly caused by the weakening of healthy qi, Gan (Liver) failing in free coursing, and disharmony between Gan and Wei (Stomach), which manifests as a weak and string-like pulse.

[Reduction of intraocular pressure and ocular pulse amplitude during general anesthesia]

AIM

Measurement of the intraocular pressure (IOP) is an important tool for glaucoma diagnostics in children or patients with impaired cooperation. General anesthesia (GA) may significantly influence the IOP. This study aimed to evaluate the reduction of IOP during GA.

PATIENTS AND METHODS

The IOP was measured in 229 patients in a recumbent position in the non-operated eye prior to and 5 min after the beginning of GA with a dynamic contour tonometer (DCT).

RESULTS

The average IOP decreased from 19.9 ± 3.7 mmHg prior to GA to 14.1 ± 3.5 mmHg 5 min after beginning GA (p < 0.0001, IOP decrease 30 %). The GA caused a decrease of up to 2 mmHg in 6.1 %, 2-4 mmHg in 18.8 %, 4-6 mmHg in 21.0 %, 6-8 mmHg in 36.6 %, 8-10 mmHg in 13.6 %, 10-12 mmHg in 2.2 % and more than 12 mmHg in 1.7 % of the eyes. The ocular pulse amplitude (OPA) decreased from a mean of 3.4 ± 1.5 mmHg to 1.9 ± 1.0 mmHg (p < 0.0001, OPA decrease 41 %) under GA.

CONCLUSION

A significant decrease of IOP (mean 6 mmHg) occurs during GA and under extreme conditions up to 13.8 mmHg. A decrease of OPA of 1.5 mmHg should be taken into consideration for patients under general anesthesia and under extreme conditions up to 7 mmHg.

Systematic screening for the detection of atrial fibrillation

BACKGROUND

Atrial fibrillation (AF), the most common arrhythmia in clinical practice, is a leading cause of morbidity and mortality. Screening for AF in asymptomatic patients has been proposed as a way of reducing the burden of the disease by detecting people who would benefit from prophylactic anticoagulation therapy before the onset of symptoms. However, for screening to be an effective intervention, it must improve the detection of AF and provide benefit for those detected earlier as a result of screening.

OBJECTIVES

This review aims to answer the following questions.Does systematic screening increase the detection of AF compared with routine practice? Which combination of screening population, strategy and test is most effective for detecting AF compared with routine practice? What safety issues and adverse events may be associated with individual screening programmes? How acceptable is the intervention to the target population? What costs are associated with systematic screening for AF?

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and EMBASE (Ovid) up to 11 November 2015. We searched other relevant research databases, trials registries and websites up to December 2015. We also searched reference lists of identified studies for potentially relevant studies, and we contacted corresponding authors for information about additional published or unpublished studies that may be relevant. We applied no language restrictions.

SELECTION CRITERIA

Randomised controlled trials comparing screening for AF with routine practice in people 40 years of age and older were eligible. Two review authors (PM and CT) independently selected trials for inclusion.

DATA COLLECTION AND ANALYSIS

Two review authors (PM and CT) independently assessed risk of bias and extracted data. We used odds ratios (ORs) and 95% confidence intervals (CIs) to present results for the primary outcome, which is a dichotomous variable. As we identified only one study for inclusion, we performed no meta-analysis. We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) method to assess the quality of the evidence and GRADEPro to create a 'Summary of findings' table.

MAIN RESULTS

One cluster-randomised controlled trial met the inclusion criteria for this review. This study compared systematic screening (by invitation to have an electrocardiogram (ECG)) and opportunistic screening (pulse palpation during a general practitioner (GP) consultation for any reason, followed by an ECG if pulse was irregular) versus routine practice (normal case finding on the basis of clinical presentation) in people 65 years of age or older.Results show that both systematic screening and opportunistic screening of people over 65 years of age are more effective than routine practice (OR 1.57, 95% CI 1.08 to 2.26; and OR 1.58, 95% CI 1.10 to 2.29, respectively; both moderate-quality evidence). We found no difference in the effectiveness of systematic screening and opportunistic screening (OR 0.99, 95% CI 0.72 to 1.37; low-quality evidence). A subgroup analysis found that systematic screening and opportunistic screening were more effective in men (OR 2.68, 95% CI 1.51 to 4.76; and OR 2.33, 95% CI 1.29 to 4.19, respectively) than in women (OR 0.98, 95% CI 0.59 to 1.62; and OR 1.2, 95% CI 0.74 to 1.93, respectively). No adverse events associated with screening were reported.The incremental cost per additional case detected by opportunistic screening was GBP 337, compared with GBP 1514 for systematic screening. All cost estimates were based on data from the single included trial, which was conducted in the UK between 2001 and 2003.

AUTHORS' CONCLUSIONS

Evidence suggests that systematic screening and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice. Although these approaches have comparable effects on the overall AF diagnosis rate, the cost of systematic screening is significantly greater than the cost of opportunistic screening from the perspective of the health service provider. Few studies have investigated effects of screening in other health systems and in younger age groups; therefore, caution needs to be exercised in relation to transferability of these results beyond the setting and population in which the included study was conducted.Additional research is needed to examine the effectiveness of alternative screening strategies and to investigate the effects of the intervention on risk of stroke for screened versus non-screened populations.

Photoplethysmography-Based Heart Rate Monitoring in Physical Activities via Joint Sparse Spectrum Reconstruction

GOAL

A new method for heart rate monitoring using photoplethysmography (PPG) during physical activities is proposed.

METHODS

It jointly estimates the spectra of PPG signals and simultaneous acceleration signals, utilizing the multiple measurement vector model in sparse signal recovery. Due to a common sparsity constraint on spectral coefficients, the method can easily identify and remove the spectral peaks of motion artifact (MA) in the PPG spectra. Thus, it does not need any extra signal processing modular to remove MA as in some other algorithms. Furthermore, seeking spectral peaks associated with heart rate is simplified.

RESULTS

Experimental results on 12 PPG datasets sampled at 25 Hz and recorded during subjects' fast running showed that it had high performance. The average absolute estimation error was 1.28 beat/min and the standard deviation was 2.61 beat/min.

CONCLUSION AND SIGNIFICANCE

These results show that the method has great potential to be used for PPG-based heart rate monitoring in wearable devices for fitness tracking and health monitoring.

Blood pressure and pulse interval coupling: A copula approach

In this paper a copula approach is applied as a tool for assessing the measure of statistical dependence of parallel cardiovascular time series. Families of Archimedean copulas (Clayton, Frank and Gumbel) are applied to pulse interval, systolic and diastolic blood pressure recorded from male Wistar rats at baseline conditions, and to their isodistributional surrogates with the same marginal, but randomized joint distribution functions. The influence of time offset of the parallel time series is explored. The amount of data required for a stable working point is discussed.

Digital Photoplethysmography for Assessment of Arterial Stiffness: Repeatability and Comparison with Applanation Tonometry

Introduction

Arterial stiffness is an independent risk factor for cardiovascular morbidity and can be assessed by applanation tonometry by measuring pulse wave velocity (PWV) and augmentation index (AIX) by pressure pulse wave analysis (PWA). As an inexpensive and operator independent alternative, photoelectric plethysmography (PPG) has been introduced with analysis of the digital volume pulse wave (DPA) and its second derivatives of wave reflections.

Objective

The objective was to investigate the repeatability of arterial stiffness parameters measured by digital pulse wave analysis (DPA) and the associations to applanation tonometry parameters.

Methods and Results

112 pregnant and non-pregnant individuals of different ages and genders were examined with SphygmoCor arterial wall tonometry and Meridian DPA finger photoplethysmography. Coefficients of repeatability, Bland-Altman plots, intraclass correlation coefficients and correlations to heart rate (HR) and body height were calculated for DPA variables, and the DPA variables were compared to tonometry variables left ventricular ejection time (LVET), PWV and AIX. No DPA variable showed any systematic measurement error or excellent repeatability, but dicrotic index (DI), dicrotic dilatation index (DDI), cardiac ejection elasticity index (EEI), aging index (AI) and second derivatives of the crude pulse wave curve, b/a and e/a, showed good repeatability. Overall, the correlations to AIX were better than to PWV, with correlations coefficients >0.70 for EEI, AI and b/a. Considering the level of repeatability and the correlations to tonometry, the overall best DPA parameters were EEI, AI and b/a. The two pansystolic time parameters, ejection time compensated (ETc) by DPA and LVET by tonometry, showed a significant but weak correlation.

Conclusion

For estimation of the LV function, ETc, EEI and b/a are suitable, for large artery stiffness EEI, and for small arteries DI and DDI. The only global parameter, AI, showed a high repeatability and the overall best correlations with AIX and PWV.

Stress-induced inhibition of LH pulses in female rats: role of GABA in arcuate nucleus

Stress exerts profound inhibitory effects on reproductive function by suppression of the pulsatile release of GnRH and therefore LH. Besides the corticotrophin-releasing factor (CRF), this effect also might be mediated via GABAergic signaling within the arcuate nucleus (ARC) since its inhibitory effects on LH pulses and increased activity during stress. In the present study, we investigated the role of endogenous GABAergic signaling within the ARC in stress-induced suppression of LH pulses. Ovariectomised oestradiol-replaced rats were implanted with bilateral and unilateral cannulae targeting toward the ARC and lateral cerebral ventricle respectively. Blood samples (25 μl) were taken via chronically implanted cardiac catheters every 5 min for 6 h for measurement of LH pulses. Intra-ARC infusion of GABAA receptor antagonist, bicuculline (0.2 pmol in 200 nl artificial cerebrospinal fluid (aCSF) each side, three times at 20-min intervals) markedly attenuated the inhibitory effect of lipopolysaccharide (LPS; 25 μg/kg i.v.) but not restraint (1 h) stress on pulsatile LH secretion. In contrast, restraint but not LPS stress-induced suppression of LH pulse frequency was reversed by intra-ARC administration of GABABR antagonist, CGP-35348 (1.5 nmol in 200 nl aCSF each side, three times at 20-min intervals). Moreover, intra-ARC application of either bicuculline or CGP-35348 attenuated the inhibitory effect of CRF (1 nmol in 4 μl aCSF, i.c.v.) on the LH pulses. These data indicate a pivotal and differential role of endogenous GABAA and GABAB signaling mechanisms in the ARC with respect to mediating immunological and psychological stress-induced suppression of the GnRH pulse generator respectively.

Quantitative assessment of the impact of blood pulsation on images of the pupil in infrared light

Pulsation in the blood vessels of the eye has a big impact on the dynamics of the entire eyeball and its individual elements. Blood pulsation in the retina can be recorded by the pupil, whose size is also subject to dynamic changes. The study involved synchronous measurements of pupil size using a high-speed camera, and blood pulsation using a pulse oximeter placed on the ear lobe. In addition, there were no metrologically significant differences in the phase shift between the average brightness of the individual pupil quadrants. Blood pulsation in other ocular tissues can affect the dynamics of the optical properties of the eye. As demonstrated in this paper, it affects the pupil behavior and its parameters to a considerable extent.

Holographic laser Doppler imaging of pulsatile blood flow

We report on wide-field imaging of pulsatile motion induced by blood flow using heterodyne holographic interferometry on the thumb of a healthy volunteer, in real time. Optical Doppler images were measured with green laser light by a frequency-shifted Mach-Zehnder interferometer in off-axis configuration. The recorded optical signal was linked to local instantaneous out-of-plane motion of the skin at velocities of a few hundreds of microns per second and compared to blood pulse monitored by plethysmoraphy during an occlusion-reperfusion experiment.

An ultrasonographic technique to assess the jugular venous pulse: a proof of concept

The purpose of the work described here was to investigate the feasibility of assessing the jugular venous pulse (JVP) using ultrasound (US) equipment. Three young healthy subjects underwent a B-mode US scan of the internal jugular vein (IJV) to acquire a sonogram sequence in the transverse plane. On each acquired sonogram, the IJV contour was manually traced, and both the cross-sectional area (CSA) and the perimeter were measured. The CSA data set represents the US jugular diagram (USJD). The arterial distension waveform of the subjects was compared with its USJD. The correlation between the CSA and the perimeter was assessed during the cardiac cycle to verify IJV distension. For each subject, a short sonogram sequence of a few seconds was recorded, and the USJD obtained exhibited periodic behavior. Furthermore, for all subjects, the CSA was found to be correlated with the perimeter (Pearson coefficient, R > 0.9), indicating that the IJV in supine position is distended. We compared 390 manually traced contours of the IJV cross-sectional area with corresponding values semi-automatically calculated by an algorithm developed in-house. For all subjects, the sensitivity, specificity and accuracy were around 95%, 85% and 90% respectively. We found that a diagram reflecting the JVP can be obtained by analyzing a B-mode sonogram sequence of the IJV; such a diagram can result in a new methodology to assess the IJV functionality.

Comparison of Three Different Types of Wrist Pulse Signals by Their Physical Meanings and Diagnosis Performance

Increasing interest has been focused on computational pulse diagnosis where sensors are developed to acquire pulse signals, and machine learning techniques are exploited to analyze health conditions based on the acquired pulse signals. By far, a number of sensors have been employed for pulse signal acquisition, which can be grouped into three major categories, i.e., pressure, photoelectric, and ultrasonic sensors. To guide the sensor selection for computational pulse diagnosis, in this paper, we analyze the physical meanings and sensitivities of signals acquired by these three types of sensors. The dependence and complementarity of the different sensors are discussed from both the perspective of cardiovascular fluid dynamics and comparative experiments by evaluating disease classification performance. Experimental results indicate that each sensor is more appropriate for the diagnosis of some specific disease that the changes of physiological factors can be effectively reflected by the sensor, e.g., ultrasonic sensor for diabetes and pressure sensor for arteriosclerosis, and improved diagnosis performance can be obtained by combining three types of signals.

A robust method for pulse peak determination in a digital volume pulse waveform with a wandering baseline

This paper presents a robust method for pulse peak determination in a digital volume pulse (DVP) waveform with a wandering baseline. A proposed new method uses a modified morphological filter (MMF) to eliminate a wandering baseline signal of the DVP signal with minimum distortion and a slope sum function (SSF) with an adaptive thresholding scheme to detect pulse peaks from the baseline-removed DVP signal. Further in order to cope with over-detected and missed pulse peaks, knowledge based rules are applied as a postprocessor. The algorithm automatically adjusts detection parameters periodically to adapt to varying beat morphologies and fluctuations. Compared with conventional methods (highpass filtering, linear interpolation, cubic spline interpolation, and wavelet adaptive filtering), our method performs better in terms of the signal-to-error ratio, the computational burden (0.125 seconds for one minute of DVP signal analysis with the Intel Core 2 Quad processor @ 2.40 GHz PC), the true detection rate (97.32% with an acceptance level of 4 ms ) as well as the normalized error rate (0.18%). In addition, the proposed method can detect true positions of pulse peaks more accurately and becomes very useful for pulse transit time (PTT) and pulse rate variability (PRV) analyses.

Visualization of the ocular pulse in the anterior chamber of the mouse eye in vivo using phase-sensitive optical coherence tomography

We report on a phase-based method for accurately measuring the ocular pulse in the anterior chamber in vivo. Using phase-sensitive optical coherence tomography with optimized scanning protocols and equations for compensating bulk motion and environmental vibrations, a high sensitivity of 0.9 μm/s minimal velocity is demonstrated at a wide detection band of 0 to 380 Hz. The pulsatile relative motion between cornea and crystalline lens in rodents is visualized and quantified. The relative motion is most likely caused by respiration (1.6 Hz) and heartbeat (6.6 Hz). The velocity amplitude of the relative motion is 10.3 ± 2.4 μm/s. The displacement amplitudes at the respiratory and cardiac frequencies are 202.5 ± 64.9 and 179.9 ± 49.4 nm, respectively. The potential applications the measurement technique can be found in the evaluation of intraocular pressure and the measurement of biomechanical properties of the ocular tissue, which are important in several ocular diseases.

Glaucomatous and age-related changes in corneal pulsation shape. The ocular dicrotism

PURPOSE

To ascertain whether the incidence of ocular dicrotic pulse (ODP) increases with age, it is more pronounced in glaucomatous than in normal eyes and whether it is related to cardiovascular activity.

METHODS

261 subjects aged 47 to 78 years were included in the study and classified into four groups: primary open angle glaucoma (POAG), primary angle-closure glaucoma (PACG), glaucoma suspects with glaucomatous optic disc appearance (GODA) and the controls (CG). Additionally, in each group, subjects with ODP were divided into two age subgroups around the median age. A non-contact ultrasonic method was used to measure corneal indentation pulse (CIP) synchronically with the acquisition of electrocardiography (ECG) and blood pulse signals. ODP was assessed from the acquired signals that were numerically processed in a custom written program.

RESULTS

ODP incidence was about 78%, 66%, 66% and 84% for CG, GODA, POAG, and PACG group, respectively. With advancing age, the ODP incidence increased for all subjects (Δ = 12%), the highest being for the PACG and POAG groups (Δ = 30%). GODA group did not show an age-related increase in the incidence of ODP.

CONCLUSIONS

The ocular dicrotism, measured with non-contact ultrasonic method, was found to be a common phenomenon in elderly subjects. The increased ODP incidence in PACG and POAG group may correspond to either higher stiffness of glaucoma eyes, biochemical abnormalities in eye tissues, changes in ocular hemodynamics, may reflect the effect of medications or be a combination of all those factors. The results of GODA group suggest different mechanisms governing their ocular pulse that makes them less susceptible to generating ODP and having decreased predisposition to glaucoma.

The MAIN Shirt: a textile-integrated magnetic induction sensor array

A system is presented for long-term monitoring of respiration and pulse. It comprises four non-contact sensors based on magnetic eddy current induction that are textile-integrated into a shirt. The sensors are technically characterized by laboratory experiments that investigate the sensitivity and measuring depth, as well as the mutual interaction between adjacent pairs of sensors. The ability of the device to monitor respiration and pulse is demonstrated by measurements in healthy volunteers. The proposed system (called the MAIN (magnetic induction) Shirt) does not need electrodes or any other skin contact. It is wearable, unobtrusive and can easily be integrated into an individual's daily routine. Therefore, the system appears to be a suitable option for long-term monitoring in a domestic environment or any other unsupervised telemonitoring scenario.

Effectiveness of systematic screening for the detection of atrial fibrillation

BACKGROUND

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is a leading cause of morbidity and mortality. Screening for AF in asymptomatic patients has been proposed as a way of reducing the burden of the disease by detecting people who would benefit from prophylactic anticoagulation therapy prior to the onset of symptoms. However, for screening to be an effective intervention it must improve the detection of AF and provide benefit for those who are detected earlier as a result of screening.

OBJECTIVES

The primary objective of this review was to examine whether screening programmes increase the detection of new cases of AF compared to routine practice. The secondary objectives were to identify which combination of screening strategy and patient population is most effective, as well as assessing any safety issues associated with screening, its acceptability within the target population and the costs involved.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE (Ovid) and EMBASE (Ovid) up to March 2012. Other relevant research databases, trials registries and websites were searched up to June 2012. Reference lists of identified studies were also searched for potentially relevant studies and we contacted corresponding authors for information about additional published or unpublished studies that may be relevant. No language restrictions were applied.

SELECTION CRITERIA

Randomised controlled trials, controlled before and after studies and interrupted time series studies comparing screening for AF with routine practice in people aged 40 years and over were eligible. Two authors (PM, CT or MF) independently selected the trials for inclusion.

DATA COLLECTION AND ANALYSIS

Assessment of risk of bias and data extraction were performed independently by two authors (PM, CT). Odds ratios (OR) and 95% confidence intervals (CI) were used to present the results for the primary outcome, which is a dichotomous variable. Since only one included study was identified, no meta-analysis was performed.

MAIN RESULTS

One cluster randomised controlled trial met the inclusion criteria for this review. This study compared systematic screening (by invitation to have an electrocardiogram (ECG)) and opportunistic screening (pulse palpation during a general practitioner (GP) consultation for any reason followed by an ECG if pulse was irregular) to routine practice (normal case finding on the basis of clinical presentation) in people aged 65 years or older. The risk of bias in the included study was judged to be low.Both systematic and opportunistic screening of people over the age of 65 years are more effective than routine practice (OR 1.57, 95% CI 1.08 to 2.26 and OR 1.58, 95% CI 1.10 to 2.29, respectively). The number needed to screen in order to detect one additional case compared to routine practice was 172 (95% CI 94 to 927) for systematic screening and 167 (95% CI 92 to 806) for opportunistic screening. Both systematic and opportunistic screening were more effective in men (OR 2.68, 95% CI 1.51 to 4.76 and OR 2.33, 95% CI 1.29 to 4.19, respectively) than in women (OR 0.98, 95% CI 0.59 to 1.62 and OR 1.2, 95% CI 0.74 to 1.93, respectively). No data on the effectiveness of screening in different ethnic or socioeconomic groups were available. There were insufficient data to compare the effectiveness of screening programmes in different healthcare settings.Systematic screening was associated with a better overall uptake rate than opportunistic screening (53% versus 46%) except in the ≥ 75 years age group where uptake rates were similar (43% versus 42%). In both screening programmes men were more likely to participate than women (57% versus 50% in systematic screening, 49% versus 41% in opportunistic screening) and younger people (65 to 74 years) were more likely to participate than people aged 75 years and over (61% versus 43% systematic, 49% versus 42% opportunistic). No adverse events associated with screening were reported.The incremental cost per additional case detected by opportunistic screening was GBP 337, compared to GBP 1514 for systematic screening. All cost estimates were based on data from the single included trial, which was conducted in the UK between 2001 and 2003.

AUTHORS' CONCLUSIONS

Systematic and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice. While both approaches have a comparable effect on the overall AF diagnosis rate, the cost of systematic screening is significantly more than that of opportunistic screening from the perspective of the health service provider. The lack of studies investigating the effect of screening in other health systems and younger age groups means that caution needs to be exercised in relation to the transferability of these results beyond the setting and population in which the included study was conducted.Additional research is needed to examine the effectiveness of alternative screening strategies and to investigate the effect of the intervention on the risk of stroke for screened versus non-screened populations.

Pulse waveform analysis as a bridge between pulse examination in Chinese medicine and cardiology

Pulse examination was probably the earliest attempt to distinguish between health and illnesses. Starting at the pre-Hippocratic era, Chinese medicine practitioners developed techniques for pulse examination and defined pulse images based on their perceptions of pulse waveforms at the radial artery. Pulse images were described using basic variables (frequency, rhythm, wideness, length, deepness, and qualities) developed under philosophical trends such as Taoism and Confucianism. Recent advances in biomedical instrumentation applied to cardiology opened possibilities to research on pulse examination based on ancient Chinese medical theories: the pulse wave analysis. Although strongly influenced by philosophy, some characteristics used to describe a pulse image are interpretable as parameters obtained by pulse waveform analysis such as pulse wave velocity and augmentation index. Those clinical parameters reflect concepts unique to Chinese medicine - such as yinyang - while are based on wave reflection and resonance theories of fluids mechanics. Major limitations for integration of Chinese and Western pulse examination are related to quantitative description of pulse images and pattern differentiation based on pulse examination. Recent evidence suggests that wave reflection and resonance phenomena may bridge Chinese medicine and cardiology to provide a more evidence-based medical practice.

Echocardiography and pulse contour analysis to assess cardiac output in trauma patients

BACKGROUND

Echocardiography is a valuable technique to assess cardiac output (CO) in trauma patients, but it does not allow a continuous bedside monitoring. Beat-to-beat CO assessment can be obtained by other techniques, including the pulse contour method MostCare. The aim of our study was to compare CO obtained with MostCare (MC-CO) with CO estimated by transthoracic echocardiography (TTE-CO) in trauma patients.

METHODS

Forty-nine patients with blunt trauma admitted to an intensive care unit and requiring hemodynamic optimization within 24 hours from admission were studied. TTE-CO and MC-CO were estimated simultaneously at baseline, after a fluid challenge and after the start of vasoactive drug therapy.

RESULTS

One hundred sixteen paired CO values were obtained. TTE-CO values ranged from 2.9 to 7.6 L·min(-1), and MC-CO ranged from 2.8 to 8.2 L·min(-1). The correlation between the two methods was 0.94 (95% confidence interval [CI]=0.89 to 0.97; P<0.001). The mean bias was -0.06 L·min(-1) with limits of agreements (LoA) of -0.94 to 0.82 L·min(-1) (lower 95% CI, -1.16 to -0.72; upper 95% CI, 0.60 to 1.04) and a percentage error of 18%. Changes in CO showed a correlation of 0.91 (95% CI=0.87 to 0.95; P<0.001), a mean bias of -0.01 L·min(-1) with LoA of -0.67 to 0.65 L·min(-1) (lower 95% CI, -0.83 to -0.51; upper 95% CI, 0.48 to 0.81).

CONCLUSION

CO measured by MostCare showed good agreement with CO obtained by transthoracic echocardiography. Pulse contour analysis can complement echocardiography in evaluating hemodynamics in trauma patients.

Use of PC mouse components for continuous measuring of human heartbeat

A new technology for remote measuring of vibration sources was recently developed for industrial, medical, and security-related applications [Int. Appl. Patent No: PCT/IL2008/001008]. It requires relatively expensive equipment, such as high-speed complementary metal oxide semiconductor (CMOS) sensors and customized optics. In this paper, we demonstrate how the usage of a simple personal computer (PC) mouse as an optical system composed of a low-power laser and a CMOS circuitry on the same integrated circuit package, can be used to monitor heartbeat from the wrist. The method is based on modifying the mouse optical system in such a way that it will recognize temporal change in skin's vibration profile, generated due to the heart pulses, as mouse movement. The tests that were carried out show a very good correlation between the heartbeat rate measured from human skin and the reference values taken manually.

Use of ambient light in remote photoplethysmographic systems: comparison between a high-performance camera and a low-cost webcam

Imaging photoplethysmography (PPG) is able to capture useful physiological data remotely from a wide range of anatomical locations. Recent imaging PPG studies have concentrated on two broad research directions involving either high-performance cameras and or webcam-based systems. However, little has been reported about the difference between these two techniques, particularly in terms of their performance under illumination with ambient light. We explore these two imaging PPG approaches through the simultaneous measurement of the cardiac pulse acquired from the face of 10 male subjects and the spectral characteristics of ambient light. Measurements are made before and after a period of cycling exercise. The physiological pulse waves extracted from both imaging PPG systems using the smoothed pseudo-Wigner-Ville distribution yield functional characteristics comparable to those acquired using gold standard contact PPG sensors. The influence of ambient light intensity on the physiological information is considered, where results reveal an independent relationship between the ambient light intensity and the normalized plethysmographic signals. This provides further support for imaging PPG as a means for practical noncontact physiological assessment with clear applications in several domains, including telemedicine and homecare.

[The pulse wave velocity and fatal events rate in hypertensive patients have gone through acute coronary syndrome]

There are several stratification scales of major cardiovascular events rate for patients have gone through acute coronary syndrome (ACS). None of them is perfect one. Arterial hypertension is included into some scales for post ACS patients but the features of it and its impact on coronary artery disease after ACS have never studied before. We studied the reasonability of Pulse Wave Velocity (PWV) measurement for fatal events rate in hypertensive patients have gone through ACS. 326 patients were examined. They were enrolled into the study in stable condition on 10th day after ACS has occurred. As a result of two years observation the increase PWV on carotid-femoral segment associated with the most negative (fatal) events in hypertensive patients have gone through ACS.

Association between silent brain infarct and arterial stiffness indicated by brachial-ankle pulse wave velocity

OBJECTIVE

The aim of this hospital-based cohort study was to clarify the independent association between silent brain infarct (SBI) and arterial stiffness indicated by brachial-ankle pulse wave velocity (baPWV) including the cutoff value for SBI.

METHODS

We studied 240 consecutive patients (mean age 69 years) with no history of stroke. We assessed the presence of SBI, white matter hyperintensities (WMHs), and risk factors. Arterial stiffness was evaluated using baPWV. We measured the intima-media thickness of the common carotid artery (CCAIMT) using carotid ultrasonography. We divided patients into two groups according to the presence or absence of SBI, and compared clinical characteristics between the two groups.

RESULTS

In multivariable analysis, increased baPWV [by 1 m/s; odds ratio (OR) 1.13, 95% confidence interval (CI) 1.02-1.25] was independently associated with SBI. The baPWV cutoff value for SBI was 17.49 m/s. Patients with baPWV≥17.49 m/s had a higher possibility of the presence of SBI (OR 2.30, 95% CI 1.02-5.34) compared with patients with baPWV <17.49 m/s. Furthermore, the adjusted OR for the presence of SBI of the combination of baPWV≥17.49 m/s and CCAIMT≥1.1 mm (OR 2.73, 95% CI 1.24-6.11) was higher compared with that of baPWV≥17.49 m/s (OR 2.47, 95% CI 1.11-5.65).

CONCLUSION

Arterial stiffness is independently associated with SBI. Measurement of baPWV can indicate the presence of SBI, especially in patients with baPWV≥17.49 m/s.

[24-Hour arterial pressure variability and 24-hour variability of pulse carries unidirectional character and is not associated with left ventricular hypertrophy (results of population study)]

Alternative prognostic interpretation of variability of arterial pressure (AP) and pulse seems contradictory if one considers classical conceptions of close physiological connection between AP and pulse. It is logical to expect that elevated variability of AP should be associated with elevated variability of pulse and vice versa. Within framework of the project EPOCH we examined a populational sample of inhabitants of Novosibirsk (129 men and 170 women) formed according to the family principle. Ambulatory 24-hour registration of AP and pulse was carried out with 15-30 minutes interval. Variability of AP turned out to be unidirectionally interconnected with variability of pulse and was not an independent marker of hypertrophy of the left ventricle but was associated with it at the account of concealed dependence on mean 24-hour AP. Cornell voltage index in persons with normal AP, "white coat" arterial hypertension (AH), "masked" AH was comparable and significantly lower than in subjects with sustained AH.

Non-contact, automated cardiac pulse measurements using video imaging and blind source separation

Remote measurements of the cardiac pulse can provide comfortable physiological assessment without electrodes. However, attempts so far are non-automated, susceptible to motion artifacts and typically expensive. In this paper, we introduce a new methodology that overcomes these problems. This novel approach can be applied to color video recordings of the human face and is based on automatic face tracking along with blind source separation of the color channels into independent components. Using Bland-Altman and correlation analysis, we compared the cardiac pulse rate extracted from videos recorded by a basic webcam to an FDA-approved finger blood volume pulse (BVP) sensor and achieved high accuracy and correlation even in the presence of movement artifacts. Furthermore, we applied this technique to perform heart rate measurements from three participants simultaneously. This is the first demonstration of a low-cost accurate video-based method for contact-free heart rate measurements that is automated, motion-tolerant and capable of performing concomitant measurements on more than one person at a time.

Is pulse transit time a good indicator of blood pressure changes during short physical exercise in a young population?

The Pulse Transit Time (PTT) is generally assumed to be a good surrogate measure to comfortably track blood pressure (BP) and blood pressure changes. This paper investigates PTT variations for healthy young subjects during a sequence of short-term physical exercises. PTT was measured by two different methodologies having different measurement accuracies as well as underlying assumptions: the total PTT from heart to fingertip and the difference of fingertip and earlobe PTTs. Small non consistent changes and very low correlation of both PTTs with systolic blood pressure (SBP) have been observed for the study population (-0.19 ± 0.45 and 0.22 ± 0.46). In conclusion, there might be a need for an improved measurement accuracy of the sensors and data processing techniques in use. The applicability of the Moens-Korteweg equation is also questionable for young people having flexible arteries. In this case, significant radius changes do occur in the large arteries during exercise, which might counteract a PTT decrease with the BP elevation. These radius effects are excluded from the Moens-Korteweg model.

[Prospects for the assessment of cardiac rhythm variability in patients with rheumatoid arthritis and systemic lupus erythematosus]

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are chronic autoimmune diseases associated with confirmed high risk of cardiovascular pathology. Most low-risk patients develop cardiovascular complications (CVC) with the involvement of traditional factors of limited diagnostic value which requires introduction of new efficacious methods for CVC prognostication. Reduced cardiac rhythm variability (CRV) along with increased levels of inflammation markers is an independent predictor of unfavourable outcome in patients with coronary heart disease, chronic cardiac insufficiency, diabetes mellitus, arterial hypertension, and metabolic syndrome; it may be a consequence of joint contribution of sympatic activation and inflammation to the development of atherothrombotic complications. This review is focused on the methods of CRV evaluation, possible mechanisms of mutual potentiation of autonomous nervous system disturbances and inflammatory process, factors responsible for cardiac autonomous dysfunction in RA and SLE. Much attention is given to the possibilities of correction of vegetative dysregulation of cardiac activity in patients with autoimmune diseases.

Plasma levels of MMP-2, MMP-9 and TIMP-1 are not associated with arterial stiffness in subjects with type 2 diabetes mellitus

OBJECTIVE

Increased arterial stiffness is a marker of atherosclerosis and is recognised early in the course of type 2 diabetes mellitus (T2DM). Matrix metalloproteinases (MMP) and their tissue inhibitors (TIMP) are a family of proteolytic enzymes which are essential for the structure and function of large arteries. In this study, we examined for relationships between MMP and TIMP-1 and indices of arterial stiffness in subjects with T2DM.

RESEARCH DESIGN AND METHODS

A total of 60 subjects with T2DM and 60 nondiabetic subjects were recruited. Aortic distensibility (AD) was assessed noninvasively by ultrasonography and augmentation index by pulse wave analysis.

RESULTS

The values of AD were lower in subjects with T2DM than in controls (P<.001), while those of augmentation index were not significantly different between the two groups. Plasma concentrations of MMP-2 and MMP-9 were not different between diabetic and nondiabetic participants, while those of TIMP-1 were lower in the diabetic patients (P=.005). In the diabetes group, no significant associations were found between either AD or augmentation index and MMPs as well as TIMP-1, while duration of diabetes emerged as the strongest predictor of AD (P<.001). In the nondiabetic group, nonsignificant associations were also found between AD or augmentation index and MMPs as well as TIMP-1.

CONCLUSION

In patients with T2DM, plasma levels of MMP and TIMP-1 are not associated with arterial stiffness assessed by either AD or augmentation index.

Aortic Pulse Wave Analysis is not a surrogate for central arterial Pulse Wave Velocity

Arterial Stiffness (AS) is a primary cardiovascular risk factor. AS increases myocardial oxygen demand and LV work and decreases coronary perfusion. Pulse Wave Velocity (PWV) is considered the gold standard for assessing AS. However, PWV testing is time consuming and impractical in the clinical setting. The purpose of this study was to determine if Pulse Wave Analysis (PWA) parameters obtained with applanation tonometry can be used to predict PWV. Radial artery PWA testing and aortic PWV measurements were performed on 77 apparently healthy subjects. A correlation matrix between all the studied variables and a stepwise multiple regression were performed. The best regression equation was obtained with central PWV as the dependent variable and Age, Height, Weight, Brachial Systolic and Diastolic Blood pressures, normalized and non-normalized Augmentation Index, Cardiac Cycle time, Ejection Duration, reflected wave round trip travel time, and time to peak pressure as independent variables. Finally, a Bland-Altman test was performed to determine the agreement between measured and predicted PWV. No significant correlations between PWV and PWA parameters were found. The resulting stepwise regression equation was PWV = 1.76 + 0.044*Age + 0.023*SBP (R = 0.544, Adj-R(2) = 0.28, P < 0.001). No agreement between measured and predicted PWV was observed using the Bland-Altman test. Although the regression equation is significant, the adjusted coefficient of determination shows that the model could explain just 28% of PWV variability. These findings suggest that PWA should not be used as a surrogate measure for assessing aortic PWV and stiffness.

Radial Pulse Character Relationships to Systolic Blood Pressure andTrauma Outcomes

BACKGROUND

Patient measurements that do not require monitoring equipment may be the only way to evaluate casualties in austere conditions to determine treatment and transport priority. Objective. To test the hypothesis that palpable pulse characteristics in the radial artery would estimate systolic blood pressure (SBP) and predict outcome in trauma patients.

METHODS

Data were analyzed from the medical records of 342 trauma patients ranging from 18 to 50 years of age. Prehospital data were collected by helicopter emergency medical personnel at the scene of the injury. Based on radial pulse character, patients were divided into normal (n = 313) and weak (n = 29) groups. Those whose medical records did not describe pulse characters were not considered. Differences in SBP, mortality, and medical interventions between the radial-pulse-character groups were evaluated.

RESULTS

The SBP taken at the scene was a mean of 26 mm Hg lower in those patients with weak radial pulse characters (102 mm Hg versus 128 mm Hg). Similarly, the lowest mean SBPs recorded in the field between the normal- and weak-pulse-character groups were 112 mm Hg and 99 mm Hg, respectively. Patient mortality increased with weak pulse character such that the mortality rats were 3% for the normal-pulse-character group and 29% for the weak-pulse-character-group (odds ratio = 15.2).

CONCLUSIONS

These preliminary data suggest that a weak radial pulse may be an acceptable method for initial rapid evaluation of trauma patients. This simple and rapid method of pulse evaluation should be considered for the triage of trauma patients in field conditions with limited instrumentation.