Innovative Multi-Site Photoplethysmography Analysis for Quantifying Pulse Amplitude and Timing Variability Characteristics in Peripheral Arterial Disease

Photoplethysmography (PPG) is a simple-to-perform vascular optics measurement technique that can detect blood volume changes in the microvascular bed of tissue. Beat-to-beat analysis of the PPG waveform enables the study of the variability of pulse features, such as the amplitude and the pulse arrival time (PAT), and when quantified in the time and frequency domains, has considerable potential to shed light on perfusion changes associated with peripheral arterial disease (PAD). In this pilot study, innovative multi-site bilateral finger and toe PPG recordings from 43 healthy control subjects and 31 PAD subjects were compared (recordings each at least five minutes, collected in a warm temperature-controlled room). Beat-to-beat normalized amplitude variability and PAT variability were then quantified in the time-domain using two simple statistical measures and in the frequency-domain bilaterally using magnitude squared coherence (MSC). Significantly reduced normalized amplitude variability (healthy control 0.0384 (interquartile range 0.0217–0.0744) vs. PAD 0.0160 (0.0080–0.0338) (p < 0.0001)) and significantly increased PAT variability (healthy control 0.0063 (0.0052–0.0086) vs. PAD 0.0093 (0.0078–0.0144) (p < 0.0001)) was demonstrated for the toe site in PAD using the time-domain analysis. Frequency-domain analysis demonstrated significantly lower MSC values across a range of frequency bands for PAD patients. These changes suggest a loss of right-to-left body side coherence and cardiovascular control in PAD. This study has also demonstrated the feasibility of using these measurement and analysis methods in studies investigating multi-site PPG variability for a wide range of cardiac and vascular patient groups.

[1]  Mikko Peltokangas,et al.  Parameters Extracted From Arterial Pulse Waves as Markers of Atherosclerotic Changes: Performance and Repeatability , 2018, IEEE Journal of Biomedical and Health Informatics.

[2]  S. Gough,et al.  Management of peripheral arterial disease in primary care , 2003, BMJ : British Medical Journal.

[3]  C. Heneghan,et al.  Continuous Blood Pressure Monitoring using ECG and Finger Photoplethysmogram , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[4]  Gerard Stansby,et al.  Peripheral arterial disease: diagnostic challenges and how photoplethysmography may help. , 2015, The British journal of general practice : the journal of the Royal College of General Practitioners.

[5]  Kirk H. Shelley,et al.  The relationship between the photoplethysmographic waveform and systemic vascular resistance , 2007, Journal of Clinical Monitoring and Computing.

[6]  Ying-Ying Zheng,et al.  Radial pulse transit time is an index of arterial stiffness , 2011, Hypertension Research.

[7]  Thomas Penzel,et al.  An Algorithm for Real-Time Pulse Waveform Segmentation and Artifact Detection in Photoplethysmograms , 2017, IEEE Journal of Biomedical and Health Informatics.

[8]  Stephen E Greenwald,et al.  Validation of a device to measure arterial pulse wave velocity by a photoplethysmographic method. , 2002, Physiological measurement.

[9]  L. Norgren,et al.  Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). , 2007, Journal of vascular surgery.

[10]  A. Buchs,et al.  Right-left correlation of the sympathetically induced fluctuations of photoplethysmographic signal in diabetic and non-diabetic subjects , 2006, Medical and Biological Engineering and Computing.

[11]  Alan Murray,et al.  Variability of photoplethysmography peripheral pulse measurements at the ears, thumbs and toes , 2000 .

[12]  M. Nitzan,et al.  Influence of thoracic sympathectomy on cardiac induced oscillations in tissue blood volume , 2001, Medical and Biological Engineering and Computing.

[13]  Emma Pickwell-MacPherson,et al.  Noninvasive cardiac output estimation using a novel photoplethysmogram index , 2009, 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[14]  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.

[15]  Mikko Peltokangas,et al.  Areas under peripheral pulse waves: a potential marker of atherosclerotic changes , 2018, Physiological measurement.

[16]  N. Kayalvizhi,et al.  Measurement of Pulse Transit Time (PTT) Using Photoplethysmography , 2017 .

[17]  A Stefanovska,et al.  Spectral analysis of the laser Doppler perfusion signal in human skin before and after exercise. , 1998, Microvascular research.

[18]  Conor Heneghan,et al.  Towards Using Photo-Plethysmogram Amplitude to Measure Blood Pressure During Sleep , 2010, Annals of Biomedical Engineering.

[19]  Y. Slovik,et al.  Sympathetically induced spontaneous fluctuations of the photoplethysmographic signal , 2006, Medical and Biological Engineering and Computing.

[20]  Aneta Stefanovska,et al.  Physics of the human cardiovascular system , 1999 .

[21]  John Allen Photoplethysmography and its application in clinical physiological measurement , 2007, Physiological measurement.

[22]  M. Nitzan,et al.  The variability of the photoplethysmographic signal - a potential method for the evaluation of the autonomic nervous system , 1998, Physiological measurement.

[23]  S. Homer-Vanniasinkam,et al.  Peripheral arterial disease: a literature review. , 2012, British medical bulletin.

[24]  Christopher M Kramer,et al.  Multimodality Imaging of Lower Extremity Peripheral Arterial Disease: Current Role and Future Directions , 2012, Circulation. Cardiovascular imaging.

[25]  昭 榊原,et al.  変調周波数追随反応の検出におけるmagnitude-squared coherence法の応用 , 1994 .

[26]  Dong Yeon Lee,et al.  Photoplethysmography and Continuous-Wave Doppler Ultrasound as a Complementary Test to Ankle–Brachial Index in Detection of Stenotic Peripheral Arterial Disease , 2013, Angiology.

[27]  Mikko Peltokangas,et al.  Combining finger and toe photoplethysmograms for the detection of atherosclerosis. , 2017, Physiological measurement.

[28]  S. Johansson,et al.  Time trends in peripheral artery disease incidence, prevalence and secondary preventive therapy: a cohort study in The Health Improvement Network in the UK , 2018, BMJ Open.

[29]  Gregory T. A. Kovacs,et al.  Noninvasive pulse transit time measurement for arterial stiffness monitoring in microgravity , 2015, 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[30]  G. Schuler,et al.  Automated photoplethysmography-based determination of ankle-brachial index: a validation study against Doppler sonography , 2012, Clinical Research in Cardiology.

[31]  R. Fried Diagnosis and treatment of peripheral arterial disease. , 2002, JAMA.

[32]  A. Murray,et al.  Age-related changes in the characteristics of the photoplethysmographic pulse shape at various body sites , 2003, Physiological measurement.

[33]  Alan Murray,et al.  A prospective comparison of bilateral photoplethysmography versus the ankle-brachial pressure index for detecting and quantifying lower limb peripheral arterial disease. , 2008, Journal of vascular surgery.

[34]  R. Edelman,et al.  Evaluation of Peripheral Arterial Disease with Nonenhanced Quiescent-Interval Single-Shot MR Angiography. , 2017, Radiology.

[35]  A. Stefanovska,et al.  Low-frequency oscillations of the laser Doppler perfusion signal in human skin. , 2006, Microvascular research.

[36]  A Murray,et al.  Similarity in bilateral photoplethysmographic peripheral pulse wave characteristics at the ears, thumbs and toes , 2000, Physiological measurement.

[37]  A. Stefanovska,et al.  Low-frequency blood flow oscillations in congestive heart failure and after β1-blockade treatment , 2008, Microvascular research.

[38]  D. Mukherjee,et al.  Peripheral arterial disease: Epidemiology, natural history, diagnosis and treatment , 2007, The International journal of angiology : official publication of the International College of Angiology, Inc.

[39]  Alan Murray,et al.  Photoplethysmography detection of lower limb peripheral arterial occlusive disease: a comparison of pulse timing, amplitude and shape characteristics , 2005, Physiological measurement.

[40]  C. Roe,et al.  Photoplethysmography: a simplified method for the office measurement of ankle brachial index in individuals with diabetes. , 2013, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[41]  R. Edelman,et al.  Evaluation of peripheral arterial disease with nonenhanced quiescent-interval single-shot MR angiography. , 2011, Radiology.