Small intra-individual variability of the preejection period justifies the use of pulse transit time as approximation of the vascular transit

Background Vascular transit time (VTT) is the propagation time of a pulse wave through an artery; it is a measure for arterial stiffness. Because reliable non-invasive VTT measurements are difficult, as an alternative we measure pulse transit time (PTT). PTT is defined as the time between the R-wave on electrocardiogram and arrival of the resulting pulse wave in a distal location measured with photoplethysmography (PPG). The time between electrical activation of the ventricles and the resulting pulse wave after opening of the aortic valve is called the pre-ejection period (PEP), a component of PTT. The aim of this study was to estimate the variability of PEP at rest, to establish how accurate PTT is as approximation of VTT. Methods PTT was measured and PEP was assessed with echocardiography (gold standard) in three groups of 20 volunteers: 1) a control group without cardiovascular disease aged 50 years, and 3) a group with cardiovascular risk factors, defined as arterial hypertension, dyslipidemia, kidney failure and diabetes mellitus. Results Per group, the mean PEP was: 1) 58.5 ± 13.0 ms, 2) 52.4 ± 11.9 ms, and 3) 57.6 ± 11.6 ms. However, per individual the standard deviation was much smaller, i.e. 1) 2.0-5.9 ms, 2) 2.8-5.1 ms, and 3) 1.6-12.0 ms, respectively. There was no significant difference in the mean PEP of the 3 groups (p = 0.236). Conclusion In conclusion, the intra-individual variability of PEP is small. A change in PT

The Speed of Waves : Measuring the velocity of pressure pulse waves traveling through peripheral blood vessels

Worldwide, cardiovascular diseases (CVDs) are the number one cause of death. Therefore, there is a strong and urgent need for an easy and quick prognostic indicator of this disease to support early diagnosis. The gold standard for determining arterial stiffness is measuring the pulse wave velocity (PWV), which is the speed of the pressure pulse traveling through the moving blood. The goal of this Ph.D. study was to develop and validate a non-invasive, photoplethysmography (PPG)-based device for peripheral measurement of the PWV on the finger. To this aim a novel sensor, called “Multi Photodiode Array” (‘MPA’), was designed for peripheral, non-invasive PWV measurements. Next, the MPA was shown to deliver reliable and accurate PWV measurements with a deviation below 3% within clinically relevant ranges. During the course of the research it was observed that the MPA positioning on the finger could strongly affect the quality of the PWV measurements. Therefore, an explorative study was conducted to find the optimal use condition of the MPA. The final clinical study showed that the MPA could be placed easily, rapidly, and consistently, irrespective of the volunteer whose PWV was measured, and delivered reliable and repeatable results. Overall, the results in this thesis suggest that the novel PPG-based MPA allows accurate and reliable PWV measurements within clinically relevant ranges. In the future, the MPA may substantially simplify PWV measurements and enable long-term monitoring of vascular health, which will contribute to improving prevention, diagnosis and treatment of CVD

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