Lower Limb Pulse Rise Time as a Marker of Peripheral Arterial Disease.

OBJECTIVE: The aim of the study was to show if pulse rise times (PRTs) extracted from photoplethysmographic (PPG) pulse waves (PWs) have an association with peripheral arterial disease (PAD) or its endovascular treatment, percutanoeus transluminal angioplasty (PTA) of the superficial femoral artery. METHODS: Lower and upper limb PPG PWs were recorded and analyzed from 24 patients who suffered from PAD. The measurements were conducted before and after the treatment, and one month later by using transmission-mode PPG-probes placed in the index finger and second toe. Ankle-to-brachial pressure index and toe pressures were used as references in clinical patient measurements. PRTs, i.e., the time from the foot point to the peak point of the PW, were extracted from the PWs and compared bilaterally. The results from the PAD patients were also compared with 31 same-aged and 34 younger control subjects. RESULTS: Statistically significant differences were found between the pretreatment PRTs of the treated limb of the PAD patients and the same-aged control subjects ( , Mann-Whitney U-test). The changes in the PRT of the treated lower limb were observed immediately after the PTA ( , Student's t-test), and after one month ( ), whereas the PRTs of the non-treated lower limb and upper limb did not indicate changes between different examinations. CONCLUSION: Results show that a PRT greater than 240 ms indicates PAD-lesions in the lower limb. SIGNIFICANCE: This proof-of-concept study suggests that the PRT could be an effective and easy-to-use indicator for PAD and monitoring the effectiveness of its treatment.

Photoplethysmography signal analysis to assess obesity, age group and hypertension.

Photoplethysmography (PPG) provides a simple, convenient and noninvasive method to assess pulse oximetry. Several attempts have been made to use PPG also to estimate blood pressure and arterial stiffness. This paper attempts to assess obesity classes, age group, and hypertension classes using PPG measured from the finger. One set of features was derived from the normalized pulse width of PPG and the other from original PPG. The features were calculated based on the pulse decomposition analysis using five lognormal functions and the up-slope of the PPG pulse. Using kNN and SVM as classifiers, the results were validated using leave-one-out validation. Performances of both features sets have no significant difference, and the kNN outperformed the SVM. The best accuracies are 93%, 88%, and 92% for obesity (5 classes), age group (7 classes), and hypertension (4 classes) respectively. These three assessment targets have a strong relationship with arterial stiffness, therefore it also leads to a study about arterial stiffness using PPG. Width normalization to 1 second might affect some features points based on pulse decomposition analysis. This study also found that the up-slope analysis might give good indices when width normalization was employed. However, these findings still require more experiments to gain conclusions that are more comprehensive.

Combining finger and toe photoplethysmograms for the detection of atherosclerosis.

In this study, we propose and analyze a noninvasive method for detecting the atherosclerotic changes of vasculature based on the analysis of photoplethysmographic (PPG) signals. METHODS: the proposed method is called finger-toe (FT)-plot analysis that utilizes both finger and toe PPG signals. For the features extracted from the FT-plots, we implemented different linear discriminant analysis based classifiers and analyzed seven promising ones in detail. We used the signals recorded from altogether 75 test subjects (categorized as 27 atherosclerotic patients and 48 control subjects based on ankle brachial pressure index, symptoms and disease history) in the training, and testing of the method. Besides leave one out cross validation, we tested the method by using training data independent signals recorded with two different PPG devices. The performance of the FT-plot is compared with other indicators related to the risk of cardiovascular diseases. RESULTS: we found an average area under ROC (receiver operating characteristic) curve of [Formula: see text] (mean ± standard deviation based on different datasets), sensitivity of [Formula: see text], specificity of [Formula: see text], accuracy of [Formula: see text], performance of [Formula: see text] and positive and negative predictive values of [Formula: see text] and [Formula: see text], respectively, for the different tested classifiers. CONCLUSIONS: the study shows that the FT-plot analysis could be a useful additional tool for detecting atherosclerotic changes. Our findings provide evidence for the utility of multi-channel pulse wave measurements and analysis for the detection of atherosclerosis. This may facilitate development of novel early diagnostic approaches and preventive strategies.

Monitoring arterial pulse waves with synchronous body sensor network.

A wireless body sensor network for arterial pulse wave (PW) measurements is presented and tested with ten subjects. The system is capable of recording both mechanical PW contours with sensors made of a low-cost polypropylene-based material called electromechanical film (EMFi) and volume pulse signal with photoplethysmographic transducers. By using both types of sensors, the PW contours can be recorded from various locations. The system combined with automatic analysis methods enables to easily analyze the PW contours in order to obtain a more comprehensive view on the vascular health. To demonstrate this, two parameters used in literature, reflection index and radial augmentation index were calculated for the test subjects as a function of time. The results show that these parameter values may vary more than 20% in a period of 100 s, which suggests that a large number of PWs should be analyzed before making conclusions based on the calculated indices. In addition, the effects of the static bias force to the mechanical PW signal recorded with the EMFi sensors were studied. The PW signal with the maximum amplitude is obtained when the pressure caused by the static bias force corresponds to the contact pressure between typical systolic and diastolic blood pressures. The EMFi sensors used in the proposed system are a potential low-cost alternative for tonometric sensors in collecting data in the PW analysis for arterial screening.