Blood pressure pulse wave velocity (PWV) is a parameter which is related to arterial distensibility. Its direct assessment, by measuring the appearance time of a pressure pulse in two sites along an artery and the distance between the two sites, is complicated and inaccurate. In the current study, pulse transit time (PTT) to the toes and fingers of 44 normotensive male subjects was measured by photoplethysmography (PPG) and ECG. The arrival time of the pulses at the toe and finger was determined from the foot of the systolic rise of the PPG signal, i.e. at end-diastolic time. Two parameters, which are related to PWV, were tested: the time delay between the ECG R-wave and the arrival time of the pulses at the toe (E-T PTT), and the difference in the transit time of the blood pressure pulses between the toe and finger (T-F PTTD). E-T PTT and T-F PTTD decreased as functions of the subject's age and systolic blood pressure (SBP), but their dependence on the diastolic blood pressure (DBP) was not statistically significant. The decrease of the PTT parameters with age is attributed to the direct structural decrease of the arterial compliance with age and not to functional effects associated with the increase of the blood pressure with age, since the PTT parameters did not depend on DBP though the measurements were performed at end-diastole.

Photoplethysmography (PPG) records the cardiac-induced changes in tissue blood volume by light-transmission measurements. The baseline and amplitude of the PPG signal show very low-frequency (VLF) spontaneous fluctuations, which are mediated by the sympathetic nervous system, and high correlation between right and left extremities of healthy subjects. As sympathetic neuropathy is one of the diabetic complications, the right-left correlation of the PPG fluctuations was examined in diabetic patients. The PPG signal was simultaneously measured in the two index fingers and the two second toes of 35 diabetic patients and 33 non-diabetic subjects. For each PPG pulse, the baseline and amplitude were determined, and the right-left correlation coefficients of the VLF fluctuations in the baseline and amplitude were derived. The VLF fluctuations in the baseline showed high right-left correlation, both for fingers (0.93 +/- 0.05) and toes (0.93 +/- 0.06), for the non-diabetic subjects, and significantly lower correlation (0.78 +/- 0.22 and 0.84 +/- 0.17, respectively) for the diabetic patients. Similar results were obtained for the amplitude VLF fluctuations. The right-left correlation coefficients for diabetic patients decreased with the disease duration for the toe baseline and toe amplitude fluctuations and correlated with heart rate response to deep breathing for the finger baseline and toe amplitude fluctuations. The right-left correlation coefficients of the PPG fluctuations provide a simple and convenient means for assessing the adequacy of the sympathetic nervous system function.

The photoplethysmographic signal shows very low-frequency (VLF) spontaneous fluctuations that have been shown to be mediated by the sympathetic nervous system. In the current study, the photoplethysmographic signal was simultaneously measured in the two index fingers and the two second toes of 54 healthy male subjects. For each photoplethysmographic pulse, two parameters were derived: the pulse amplitude and its baseline, which are related to the arterial wall compliance and to the arterial blood volume, respectively. The baseline and the amplitude VLF fluctuations showed high right-left correlation both for hands (mean +/- SD 0.94 +/- 0.05 and 0.92 +/- 0.07, respectively) and for feet (0.90 +/- 0.08 and 0.89 +/- 0.07, respectively) that only slightly depended on the subject's age. Lower correlation was found between the hand and the foot (0.73 +/- 0.12 and 0.72 +/- 0.12 for the baseline and the amplitude, respectively). For each hand and foot the baseline and the amplitude VLF fluctuations were also correlated, with the baseline fluctuations lagging the amplitude fluctuations by 3-20 pulses. The amplitude-baseline correlation and the standard deviation of the amplitude or the baseline divided by its mean significantly decreased with age. The VLF fluctuations of the photoplethysmographic parameters and the correlation coefficients between them provide better understanding of the autonomic nervous regulation of the blood circulation.

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