Noninvasive Acquisition of the Aortic Blood Pressure Waveform

Blood pressure reflects the status of our cardiovascular system. For the measurement of blood pressure, we typically use brachial devices on the upper arm, and much less often, the radial devices with pressure sensors on the wrist. Medical doctors know that this is an unfortunate case. The brachial pressure and even more, the radial pressure, both are poor replacements for the central aortic pressure (CAP). Moreover, the devices on the market cannot provide continuous measurements 24 h. In addition, most of the ambulatory and wearable monitors do not enable acquisition of the blood pressure curves in time. These circumstances limit the accuracy of diagnosing. The aim of this chapter is to introduce our experiments, experiences and results in developing the wearable monitor for central aortic blood pressure curve by using electrical bioimpedance sensing and measurement. First, electronic circuitry with embedded data acquisition and signal processing approaches is given. Second, finding appropriate materials, configurations and placements of electrodes is of interest. Third, the results of modelling and simulations are discussed for obtaining the best sensitivity and stability of the measurement procedures. Finally, the discussion on the provided provisional experiments evaluates the obtained results. The conclusions are drawn together with the need for further development

Bioimpedance as a predictor of survival in renal failure and associated comorbidities.

Background: Renal failure requiring dialysis is associated with a high mortality. One of the contributing causes is overhydration. Overhydration can be assessed by bioimpedance analysis (BIA)– the non-invasive electrical measure of small current through the tissues that estimates the proportion of fluid that is intracellular water (ICW, typically muscle which is healthy) and extracellular (ECW, which in excess causes tissue oedema and is potentially dangerous). Several studies indicate that a extracellular water to total body water (TBW) ratio is associated with increased risk of death in dialysis patients but it is not clear if this is independent of other risk factors for death, namely comorbidity. Aims and objectives: To establish the prognostic value of BIA in the prediction of survival on dialysis in the context of other known predictors of survival or hospitalisation. With further analysis of the applicability of the same scenario to heart failure patients. Methodology: To conduct a systematic review using a standardised approach including a prespecified research question, search terms and criteria for study inclusion. With independent selection for inclusion in the study and quality appraisal by multiple authors with different backgrounds and experience. Results: 2701 studies identified by literature search, plus an additional 4 through reference checking. 38 papers included in final analysis, 4 of which were regarding heart failure cohorts. Analysis of the research shows that BIA is an independent predictor of mortality. Conclusion: BIA shown to be an independent predictor of mortality in dialysis patients, further research needed to extrapolate to heart failure (HF) populations

Energy-Efficient PRBS Impedance Spectroscopy on a Digital Versatile Platform

partially_open6siThis research has been partially funded by the Italian Ministry of University and Research (MUR) through the program “Dipartimenti di Eccellenza” (2018-2022). The research has also received partial support from the Italian Ministry of University and Research (MUR) and the Eranet FLAG ERA initiative within CONVERGENCE project (CUP B84I16000030005) through the IUNET Consortium.This paper presents the digital design of a versatile and low-power broadband impedance spectroscopy (IS) system based on pseudo-random binary sequence (PRBS) excitation. The PRBS technique allows fast, and low-power estimation of the impedance spectrum over a wide bandwidth with adequate accuracy, proving to be a good candidate for portable medical devices, especially. This paper covers the low-power design of the firmware algorithms and implements them on a versatile and reconfigurable digital platform that can be easily adjusted to the specific application. It will analyze the digital platform with the aim of reducing power consumption while maintaining adequate accuracy of the estimated spectrum. The paper studies two main algorithms (time-domain and frequency-domain) used for PRBS-based IS and implements both of them on the ultra-low-power GAP-8 digital platform. They are compared in terms of accuracy, measurement time, and power budget, while general design trade-offs are drawn out. The time-domain algorithm demonstrated the best accuracy while the frequency-domain one contributes more to save power and energy. However, analysis of the energy-per-error FOM revealed that the time-domain algorithm outperforms the frequency-domain algorithm offering better accuracy for the same energy consumption. Numerical methods and microprocessor resources are exploited to optimize the implementation of both algorithms achieving 27 ms in processing time, power consumption as low as 1.4 mW and a minimum energy consumption per measurement of 0.5 mJ, for a dense impedance spectrum estimation of 214 points.embargoed_20210525Luciani G.; Crescentini M.; Romani A.; Chiani M.; Benini L.; Tartagni M.Luciani G.; Crescentini M.; Romani A.; Chiani M.; Benini L.; Tartagni M

REDUCTION OF SKIN STRETCH INDUCED MOTION ARTIFACTS IN ELECTROCARDIOGRAM MONITORING USING ADAPTIVE FILTERING

Cardiovascular disease (CVD) is the leading cause of death in many regions worldwide, accounting for nearly one third of global deaths in 2001. Wearable electrocardiographic cardiovascular monitoring devices have contributed to reduce CVD mortality and cost by enabling the diagnosis of conditions with infrequent symptoms, the timely detection of critical signs that can be precursor to sudden cardiac death, and the long-term assessment/monitoring of symptoms, risk factors, and the effects of therapy. However, the effectiveness of ambulatory electrocardiography to improve the treatment of CVD can be significantly impaired by motion artifacts which can cause misdiagnoses, inappropriate treatment decisions, and trigger false alarms. Skin stretch associated with patient motion is a main source of motion artifact in current ECG monitors. A promising approach to reduce motion artifact is the use of adaptive filtering that utilizes a measured reference input correlated with the motion artifact to extract noise from the ECG signal. Previous attempts to apply adaptive filtering to electrocardiography have employed either electrode deformation or acceleration, body acceleration, or skin/electrode impedance as a reference input, and were not successful at reducing motion artifacts in a consistent and reproducible manner. This has been essentially attributed to the lack of correlation between the reference input selected and the induced noise. In this study, motion artifacts are adaptively filtered by using skin strain as the reference signal. Skin strain is measured non-invasively using a light emitting diode (LED) and an optical sensor incorporated in an ECG electrode. The optical strain sensor is calibrated on animal skin samples and finally in-vivo, in terms of sensitivity and measurement range. Skin stretch induced artifacts are extracted in-vivo using adaptive filters. The system and method are tested for different individuals and under various types of ambulatory conditions with the noise reduction performance quantified

Enabling Wearable Hemodynamic Monitoring Using Multimodal Cardiomechanical Sensing Systems

Hemodynamic parameters such as blood pressure and stroke volume are instrumental to understanding the pathogenesis of cardiovascular disease. Unfortunately, the monitoring of these hemodynamic parameters is still limited to in-clinic measurements and cumbersome hardware precludes convenient, ubiquitous use. To address this burden, in this work, we explore seismocardiogram-based wearable multimodal sensing techniques to estimate blood pressure and stroke volume. First, the performance of a multimodal, wrist-worn device capable of obtaining noninvasive pulse transit time measurements is used to estimate blood pressure in an unsupervised, at-home setting. Second, the feasibility of this wrist-worn device is comprehensively evaluated in a diverse and medically underserved population over the course of several perturbations used to modulate blood pressure through different pathways. Finally, the ability of wearable signals—acquired from a custom chest-worn biosensor—to noninvasively quantify stroke volume in patients with congenital heart disease is examined in a hospital setting. Collectively, this work demonstrates the advancements necessary towards enabling noninvasive, longitudinal, and accurate measurements of these hemodynamic parameters in remote settings, which offers to improve health equity and disease monitoring in low-resource settings.Ph.D

Advanced sensors technology survey

This project assesses the state-of-the-art in advanced or 'smart' sensors technology for NASA Life Sciences research applications with an emphasis on those sensors with potential applications on the space station freedom (SSF). The objectives are: (1) to conduct literature reviews on relevant advanced sensor technology; (2) to interview various scientists and engineers in industry, academia, and government who are knowledgeable on this topic; (3) to provide viewpoints and opinions regarding the potential applications of this technology on the SSF; and (4) to provide summary charts of relevant technologies and centers where these technologies are being developed

Presentation of acute heart failure and its consequences

Background: Acute heart failure (AHF) is a heterogeneous in aetiology, pathophysiology and presentation and very difficult to classify. Despite this diversity, clinical trials in AHF deal with this syndrome as a single entity, which may be one reason for repeated failures. It is generally believed that patients with AHF present with severe breathlessness at rest but epidemiological data suggest otherwise.Methods: Different data sets were used to assess the presentation of AHF and its consequences. I conducted a detailed case note review to determine what proportions of patients were Short Of Breath At Rest (SOBAR) and Comfortable At Rest but Breathless On Slight Exertion (CARBOSE). Euro Heart Failure Survey 1 (EHFS1) screened consecutive deaths and discharges during 2000-2001 in 24 countries, to ascertain patients with known or suspected Heart Failure (HF). Information on presenting symptoms and signs were gathered. Mortality was assessed during hospital admission and then 3 months after discharge.Results: Of 697 patients, those with SOBAR (45%) had higher median heart rate blood pressure and respiratory rate and these changed quickly in first 24 hours after presentation as compare to CARBOSE (55%) but had better long term prognosis. Of all 10,701 patients admitted with suspected HF in EHFS1, Heart failure was considered to be the primary reason for admission in 4,234 (40%), secondary reason for admission if complicated or prolonged stay in further 1,772 (17%), and in 4,695 (43%) it was uncertain that HF is actively contributing in index admission. Mortality was highest in the secondary heart failure group and lowest in the uncertain group. Heart failure with cardiac arrest/ventricle arrhythmia had worst mortality followed by HF with ACS but considerable number of patients died in uncertain group.Conclusion: AHF is complex, with diverse presentations that are associated with very different subsequent prognosis. Attempts to investigate the effect of agents in all patients with a diagnosis of AHF may be futile. A more coherent approach of focused and tighter patient selection for drug therapy targeted by clinical presentation is more likely to succeed

Combinational photoplethysmography based model for blood pressure measurement

Blood pressure (BP) is an important and commonly used vital sign to monitor a patient’s health. Current methods for monitor blood pressure are unsuitable for continuous, uninterrupted measurement of blood pressure outside of a hospital setting as such methods are invasive and could pose risks if complications occur. This research has investigated the possibility of using two photoplethysmography (PPG) sensors to monitor a patient’s pulse at two sites; the ear and the finger. Through the use of these two simultaneous and continuous measurements the ultimate aim is develop a method of continous non-invasive blood pressure (CNIBP) monitoring