Non-invasive vascular assessment using photoplethysmography

Photoplethysmography (PPG) has become widely accepted as a valuable clinical tool for performing non-invasive biomedical monitoring. The dominant clinical application of PPG has been pulse oximetry, which uses spectral analysis of the peripheral blood supply to establish haemoglobin saturation. PPG has also found success in screening for venous dysfunction, though to a limited degree. Arterial Disease (AD) is a condition where blood flow in the arteries of the body is reduced,a condition known as ischaernia. Ischaernia can result in pain in the affected areas, such as chest pain for an ischearnic heart, but does not always produce symptoms. The most common form of AD is arteriosclerosis, which affects around 5% of the population over 50 years old. Arteriosclerosis, more commonly known as 'hardening of the arteries' is a condition that results in a gradual thickening, hardening and loss of elasticity in the walls of the arteries, reducing overall blood flow. This thesis investigates the possibility of employing PPG to perform vascular assessment, specifically arterial assessment, in two ways. PPG based perfusion monitoring may allow identification of ischaernia in the periphery. To further investigate this premise, prospective experimental trials are performed, firstly to assess the viability of PPG based perfusion monitoring and culminating in the development of a more objective method for determining ABPI using PPG based vascular assessment. A complex interaction between the heart and the connective vasculature, detected at the measuring site, generates the PPG signal. The haemodynamic properties of the vasculature will affect the shape of the PPG waveform, characterising the PPG signal with the properties of the intermediary vasculature. This thesis investigates the feasibility of deriving quantitative vascular parameters from the PPG signal. A quantitative approach allows direct identification of pathology, simplifying vascular assessment. Both forward and inverse models are developed in order to investigate this topic. Application of the models in prospective experimental trials with both normal subjects and subjects suffering PVD have shown encouraging results. It is concluded that the PPG signal contains information on the connective vasculature of the subject. PPG may be used to perform vascular assessment using either perfusion based techniques, where the magnitude of the PPG signal is of interest, or by directly assessing the connective vasculature using PPG, where the shape of the PPG signal is of interest. it is argued that PPG perfusion based techniques for performing the ABPI diagnosis protocol can offer greater sensitivity to the onset of PAD, compared to more conventional methods. It is speculated that the PPG based ABPI diagnosis protocol could provide enhanced PAD diagnosis, detecting the onset of the disease and allowing a treatmenpt lan to be formed soonert han was possible previously. The determination of quantitative vascular parameters using PPG shape could allow direct vascular diagnosis, reducing subjectivity due to interpretation. The prospective trials investigating PPG shape analysis concentrated on PVD diagnosis, but it is speculated that quantitative PPG shaped based vascular assessment could be a powerful tool in the diagnosis of many vascular based pathological conditions

Effect of postural changes on lower limb blood volume, detected with non-invasive photoplethysmography

This paper describes the effect of passive leg raising on blood volume change in the lower limb, using a dual probe photoplethysmography (PPG) system employing a tissue optics model. The normalized AC/DC ratio and DC value are introduced from the model to evaluate the dynamic pulsation and total blood volume changes due to postural effects. The AC and DC components of PPG signals were collected from a passive leg raising protocol. With the leg raised, the normalized AC/DC ratio significantly decreased when supine, while the normalized DC value increased significantly in both supine and reclining positions. The parameters from the stationary leg showed similar but smaller responses. These results demonstrate a local and systemic physiological phenomenon in the lower limb blood volume change caused by postural changes. The normalized AC/DC ratio and DC value derived from the tissue optics model could be applied to assess the blood volume change

Study on blood pulse photoplethysmography signal on toe under different body posture and lower limb height

Under two body-postures (supine and 45° reclining) the blood pulse signal on toe was detected via non-invasive photoplethysmography technique while the lower limb was passively raised in different height. The regulations of blood pulse volume and lower limb height were found and their relation was described through curves in figures

Non-invasive measurement of peripheral venous oxygen saturation using a new venous oximetry method: evaluation during bypass in heart surgery

Monitoring of mixed venous oxygen saturation (SvO2) is currently performed using invasive fibre-optic catheters. This procedure is not without risk as complications may arise from catheterization. This paper describes an alternative, non-invasive method of monitoring peripheral venous oxygen saturation (SxvO2) which, although it cannot replace pulmonary artery catheters, can serve as an adjunct/early warning indicator of when there is an imbalance in oxygen supply and demand. The technique requires the generation of an artificial venous pulse at the finger, thereby causing modulation of the venous blood volume within the digit. The blood volume changes aremonitored using an optical sensor. Just as pulse oximetry utilizes the natural arterial pulse to perform a spectrophotometric analysis of the peripheral blood in order to estimate the arterial blood oxygen saturation, the proposed venous oximetry technique uses the artificially generated venous pulse to estimate SxvO2. A prototype device was tested in a pilot study with patients undergoing heart surgery. Data from this study support the notion that the method is capable of tracking haemodynamic changes and suggests the technique is worthy of further development and evaluation

Poincare plot analysis for pulse interval extracted from non-contact photoplethysmography

An analysis of pulse-to-pulse interval (PPI) derived from non-contact photoplethysmography (PPG) is performed using the Poincare plot technique. Eleven healthy volunteers participated in a protocol utilising both spontaneous and paced breathing methodologies with a customised non-contact PPG system to obtain adequate quality signals for a distance of 80 mm between source and detector. An adaptive trough-searching algorithm (ATSA) is developed to extract the PPI which is effective in the presence of artefact during non-contact PPG measurement. A Poincare plot for each 5 minute period of the protocol shows significant pattern differences between spontaneous and paced breathing measurements. Geometric parameters extracted from the Poincare plot are shown to be sensitive to breathing interval changes and are a useful indicator for the variation of pulse rate variability measured using non-contact PP

Investigation of blood pulse PPG signal regulation on toe effect of body posture and lower limb height

Objective. To study the regulation of blood pulse volume via photoplethysmography (PPG) signal detected from toe, while the lower limb is passively raised in different height positions. Methods. Use a modified non-invasive PPG technique to detect the blood pulse signal on toe with infrared (IR) photo sensor. A protocol consisting of two postures, i.e., supine and 45° reclining, was designed to conduct laboratory trial in this study. During the period of performing the protocol of these postures, the lower limb was passively raised from the heights of 10 cm to 60 cm randomly and individually with sponge blocks underneath the foot. Results. In the supine posture, the higher the foot was passively raised, the more the blood PPG signal decreased. In the 45° reclining posture, the blood PPG signal increased at the beginning and then decreased in the foot height position from 10 cm to 60 cm. In both postures the normalized AC signal changes significantly while the normalized DC signal changes little. Conclusion. The toe PPG signals can obviously indicate the regulated blood volume change with the designated postural procedures due to the heart level position

Complex character analysis of heart rate variability following brain asphyxia

In the present study Renyi entropy and L–Z complexity were used to characterize heart rate variability (HRV) of rats that were suffered from brain asphyxia and ischemia. Two groups of rats were studied: (a) rats (n = 5) injected with NAALADase inhibitor, 2-PMPA, which has been proven neuroprotective in asphyxia injury and (b) control subjects (n = 5) without medication. Renyi entropy and L–Z complexity of the R–R intervals (RRI) at different experiment stages were investigated in the two groups. The results show that both measures indicate less injury and better recovery in the drug injection group. The dynamic change of 90 min RRI signal after the asphyxia was investigated. The sudden reduction of the two parameters shows their sensitivity to the asphyxia insult