Blood Pressure Morphology Assessment from Photoplethysmogram and Demographic Information Using Deep Learning with Attention Mechanism

Arterial blood pressure (ABP) is an important vital sign from which it can be extracted valuable information about the subject’s health. After studying its morphology it is possible to diagnose cardiovascular diseases such as hypertension, so ABP routine control is recommended. The most common method of controlling ABP is the cuff-based method, from which it is obtained only the systolic and diastolic blood pressure (SBP and DBP, respectively). This paper proposes a cuff-free method to estimate the morphology of the average ABP pulse (ABPM¯) through a deep learning model based on a seq2seq architecture with attention mechanism. It only needs raw photoplethysmogram signals (PPG) from the finger and includes the capacity to integrate both categorical and continuous demographic information (DI). The experiments were performed on more than 1100 subjects from the MIMIC database for which their corresponding age and gender were consulted. Without allowing the use of data from the same subjects to train and test, the mean absolute errors (MAE) were 6.57 ± 0.20 and 14.39 ± 0.42 mmHg for DBP and SBP, respectively. For ABPM¯, R correlation coefficient and the MAE were 0.98 ± 0.001 and 8.89 ± 0.10 mmHg. In summary, this methodology is capable of transforming PPG into an ABP pulse, which obtains better results when DI of the subjects is used, potentially useful in times when wireless devices are becoming more popular.

[1]  Mohamed Elgendi,et al.  Optimal Signal Quality Index for Photoplethysmogram Signals , 2016, Bioengineering.

[2]  Jeffrey M. Hausdorff,et al.  Physionet: Components of a New Research Resource for Complex Physiologic Signals". Circu-lation Vol , 2000 .

[3]  Alice Stanton,et al.  Differential Impact of Blood Pressure–Lowering Drugs on Central Aortic Pressure and Clinical Outcomes: Principal Results of the Conduit Artery Function Evaluation (CAFE) Study , 2006, Circulation.

[4]  Yoshua Bengio,et al.  Learning Phrase Representations using RNN Encoder–Decoder for Statistical Machine Translation , 2014, EMNLP.

[5]  Jimmy Ba,et al.  Adam: A Method for Stochastic Optimization , 2014, ICLR.

[6]  Nigel H. Lovell,et al.  The use of photoplethysmography for assessing hypertension , 2019, npj Digital Medicine.

[7]  M. Elgendi,et al.  Photoplethysmography and Deep Learning: Enhancing Hypertension Risk Stratification , 2018, Biosensors.

[8]  Mang I Vai,et al.  On an automatic delineator for arterial blood pressure waveforms , 2010, Biomed. Signal Process. Control..

[9]  Cheolsoo Park,et al.  End-To-End Deep Learning Architecture for Continuous Blood Pressure Estimation Using Attention Mechanism , 2020, Sensors.

[10]  F. Yasuma,et al.  Aortic Pressure Augmentation as a Marker of Cardiovascular Risk in Obstructive Sleep Apnea Syndrome , 2008, Hypertension Research.

[11]  Panayiotis A. Kyriacou,et al.  A review of machine learning techniques in photoplethysmography for the non-invasive cuff-less measurement of blood pressure , 2020, Biomed. Signal Process. Control..

[12]  Y. T. Zhang,et al.  Noninvasive and cuffless measurements of blood pressure for telemedicine , 2001, 2001 Conference Proceedings of the 23rd Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[13]  Sepp Hochreiter,et al.  Fast and Accurate Deep Network Learning by Exponential Linear Units (ELUs) , 2015, ICLR.

[14]  E. O’Brien,et al.  The British Hypertension Society protocol for the evaluation of automated and semi-automated blood pressure measuring devices with special reference to ambulatory systems. , 1990, Journal of hypertension.

[15]  Dingchang Zheng,et al.  Cuffless Single-Site Photoplethysmography for Blood Pressure Monitoring , 2020, Journal of clinical medicine.

[16]  Enric Monte-Moreno,et al.  Non-invasive estimate of blood glucose and blood pressure from a photoplethysmograph by means of machine learning techniques , 2011, Artif. Intell. Medicine.

[17]  A. Tajik,et al.  Noninvasive measurement of central vascular pressures with arterial tonometry: clinical revival of the pulse pressure waveform? , 2010, Mayo Clinic proceedings.

[18]  A. Savitzky,et al.  Smoothing and Differentiation of Data by Simplified Least Squares Procedures. , 1964 .

[19]  Peter Szolovits,et al.  MIMIC-III, a freely accessible critical care database , 2016, Scientific Data.

[20]  Yoshua Bengio,et al.  Neural Machine Translation by Jointly Learning to Align and Translate , 2014, ICLR.

[21]  Mark Butlin,et al.  Arterial blood pressure measurement and pulse wave analysis—their role in enhancing cardiovascular assessment , 2010, Physiological measurement.

[22]  Mahdi Shabany,et al.  Cuffless Blood Pressure Estimation Algorithms for Continuous Health-Care Monitoring , 2017, IEEE Transactions on Biomedical Engineering.

[23]  M. O'Rourke,et al.  Prospective Evaluation of a Method for Estimating Ascending Aortic Pressure From the Radial Artery Pressure Waveform , 2001, Hypertension.

[24]  L A Geddes,et al.  Pulse transit time as an indicator of arterial blood pressure. , 1981, Psychophysiology.

[25]  Survi Kyal,et al.  Toward Ubiquitous Blood Pressure Monitoring via Pulse Transit Time: Theory and Practice , 2015, IEEE Transactions on Biomedical Engineering.

[26]  Mitja Lustrek,et al.  Blood Pressure Estimation from Photoplethysmogram Using a Spectro-Temporal Deep Neural Network , 2019, Sensors.

[27]  Kilian Q. Weinberger,et al.  Densely Connected Convolutional Networks , 2016, 2017 IEEE Conference on Computer Vision and Pattern Recognition (CVPR).

[28]  L. Geddes,et al.  Measurements of Young's Modulus of Elasticity of the Canine Aorta with Ultrasound , 1979 .

[29]  Domenico Grimaldi,et al.  A Neural Network-based method for continuous blood pressure estimation from a PPG signal , 2013, 2013 IEEE International Instrumentation and Measurement Technology Conference (I2MTC).

[30]  Alun D. Hughes,et al.  Differential Impact of Blood Pressure–Lowering Drugs on Central Aortic Pressure and Clinical Outcomes: Principal Results of the Conduit Artery Function Evaluation (CAFE) Study , 2006 .

[31]  Surya Ganguli,et al.  Exact solutions to the nonlinear dynamics of learning in deep linear neural networks , 2013, ICLR.

[32]  Y. Imai,et al.  Indices of pulse wave analysis are better predictors of left ventricular mass reduction than cuff pressure. , 2007, American journal of hypertension.

[33]  Francesca N. Delling,et al.  Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association , 2020, Circulation.

[34]  Rabab Ward,et al.  An optimal filter for short photoplethysmogram signals , 2018, Scientific Data.

[35]  J. Ruiz-Rodríguez,et al.  Innovative continuous non-invasive cuffless blood pressure monitoring based on photoplethysmography technology , 2013, Intensive Care Medicine.

[36]  Mohammad Monir Uddin,et al.  Estimating Blood Pressure from the Photoplethysmogram Signal and Demographic Features Using Machine Learning Techniques , 2020, Sensors.

[37]  M. Elgendi,et al.  Can Photoplethysmography Replace Arterial Blood Pressure in the Assessment of Blood Pressure? , 2018, Journal of clinical medicine.

[38]  R. Payne,et al.  Pulse transit time measured from the ECG: an unreliable marker of beat-to-beat blood pressure. , 2006, Journal of applied physiology.

[39]  Jiann-Shing Shieh,et al.  Genetic Deep Convolutional Autoencoder Applied for Generative Continuous Arterial Blood Pressure via Photoplethysmography , 2020, Sensors.

[40]  Guigang Zhang,et al.  Deep Learning , 2016, Int. J. Semantic Comput..

[41]  Christopher D. Manning,et al.  Effective Approaches to Attention-based Neural Machine Translation , 2015, EMNLP.

[42]  Majid Sarrafzadeh,et al.  Building Continuous Arterial Blood Pressure Prediction Models Using Recurrent Networks , 2016, 2016 IEEE International Conference on Smart Computing (SMARTCOMP).

[43]  J. Staessen,et al.  Clinical applications of arterial stiffness; definitions and reference values. , 2002, American journal of hypertension.

[44]  Paolo Salvi,et al.  Pulse Waves: How Vascular Hemodynamics Affects Blood Pressure , 2012 .

[45]  J. Auer,et al.  Prolonged mechanical systole and increased arterial wave reflections in diastolic dysfunction , 2006, Heart.