The relationship between the photoplethysmographic waveform and systemic vascular resistance

Awad, Aymen A.; Haddadin, Ala S.; Tantawy, Hossam; Badr, Tarek; Stout, Robert G.; Silverman, David G.; Shelley, Kirk H.

doi:10.1007/s10877-007-9097-5

Cited by 119 publications

(84 citation statements)

References 9 publications

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“…With increased vascular resistance, it has been reported that the reflected wave arrives earlier, appearing during systole in cases of high systemic vascular resistance (SVR) so that it becomes difficult to distinguish between the forward travelling and reflected waves [8]. According to Awad et al A p value of \0.05 was considered statistically significant [16] the increase in PW half reflects increases in SVR, while other studies have shown that increases in RI reflect increased resistance [35]. These results suggest that changing the position of the hand temporarily alters the effective vascular flow resistance.…”

Section: Discussionmentioning

confidence: 99%

“…Pulse Width at Half Height (PW half ) This is the width of the pulse at the half height of the systolic peak amplitude. Awad et al [16] suggested that this correlates with systemic vascular resistance better than the systolic amplitude. To reduce the effect of inter-subject variability, this variable was normalised to the PPG width (PW).…”

Section: Data Analysis and Statisticsmentioning

confidence: 99%

“…Other common features that have been extracted from the PPG waveform include crest time, pulse width/height ratios and area under the pulse [15,16]. These various analysis techniques have been applied to assess cardiovascular aging and systemic vascular resistance [9,15], endothelial function and the response to vasoactive drugs [17,18], in attempts to assess arterial blood pressure noninvasively [19], and even to assess systemic conditions such as chronic fatigue syndrome [20].…”

Section: Introductionmentioning

confidence: 99%

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Investigation of peripheral photoplethysmographic morphology changes induced during a hand-elevation study

Hickey

Phillips

Kyriacou

2015

J Clin Monit Comput

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Abstract A hand-elevation study was carried out in the laboratory in order to alter peripheral blood flow with the aim of increasing understanding of factors affecting the morphology of peripheral photoplethysmographic signals. Photoplethysmographic (PPG) signals were recorded from twenty healthy volunteer subjects during a hand-elevation study in which the right hand was raised and lowered relative to heart level, while the left hand remained static. Red and infrared (IR) PPG signals were obtained from the right and left index fingers using a custom-made PPG processing system. PPG features were identified using a feature-detection algorithm based on the first derivative of the PPG signal. The systolic PPG amplitude, the reflection index, crest time, pulse width at half height, and delta T were calculated from 20 s IR PPG signals from three positions of the right hand with respect to heart level (-50, 0, ?50 cm) in 19 volunteers. PPG features were found to change with hand elevation. On lowering the hand to 50 cm below heart level, ac systolic PPG amplitudes from the finger decreased by 68.32 %, while raising the arm increased the systolic amplitude by 69.99 %. These changes in amplitude were attributed to changes in hydrostatic pressure and the venoarterial reflex. Other morphological variables, such as crest time, were found to be statistically significantly different across hand positions, indicating increased vascular resistance on arm elevation than on dependency. It was hypothesized that these morphological PPG changes were influenced by changes in downstream venous resistance, rather than arterial, or arteriolar, resistance. Changes in hand position relative to heart level can significantly affect the morphology of the peripheral ac PPG waveform. These alterations are due to a combination of physical effects and physiological responses to changes in hand position, which alter vascular resistance. Care should be taken when interpreting morphological data derived from PPG signals and methods should be standardized to take these effects into account. Permanent repository link

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Section: Discussionmentioning

confidence: 99%

Section: Data Analysis and Statisticsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Investigation of peripheral photoplethysmographic morphology changes induced during a hand-elevation study

Hickey

Phillips

Kyriacou

2015

J Clin Monit Comput

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“…[14][15][16] Then, in 2007, Shelley's group attempted to use the PPG waveform to develop a quantitative estimate of SVR. 19 Specifically, this group proposed that pulse width was correlated with SVR (Pearson correlation r = 0.56) as measured in patients undergoing cardiac surgery. By combining pulse amplitude and width as well as integrating oximeters from multiple sites (e.g., ear, finger), the correlation was marginally improved.…”

Section: Physiology Of the Ppgmentioning

confidence: 99%

Advances in photoplethysmography: beyond arterial oxygen saturation

Bartels

Thiele

2015

Can J Anesth/J Can Anesth

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Purpose Photoplethysmography permits continuous measurement of heart rate and peripheral oxygen saturation and has been widely used to inform clinical decisions. Recently, a myriad of noninvasive hemodynamic monitoring devices using this same technology have been increasingly available. This narrative review aims to summarize the principles that form the basis for the function of these devices as well as to comment on trials evaluating their accuracy and clinical application. Principal findings Advanced monitoring devices extend photoplethysmography technology beyond measuring oxygen concentration and heart rate. Quantification of respiratory variation of the photoplethysmographic waveform reflects respiratory variation of the arterial pressure waveform and can be used to gauge volume responsiveness. Both the volume-clamp and physiocal techniques are extensions of conventional photoplethysmography and permit continuous measurement of finger arterial blood pressure. Finger arterial pressure waveforms can subsequently inform estimations of cardiac output. Conclusions Although respiratory variations of the plethysmographic waveform correlate only modestly with the arterial blood pressure waveform, fluid responsiveness can be relatively consistently assessed using both approaches. Continuous blood pressure measurements obtained using the volume-clamp technique may be as accurate as conventional brachial noninvasive blood pressure measurements. Most importantly, clinical comparative effectiveness studies are still needed in order to determine if these technologies can be translated into improvement of relevant patient outcomes. RésuméObjectif La photopléthysmographie permet la mesure continue de la fréquence cardiaque et de la saturation en oxygène périphérique, et elle est largement utilisée pour les prises de décisions cliniques. Depuis peu, un très grand nombre de dispositifs non invasifs de surveillance hémodynamique utilisant la même technologie envahit le marché. Cette synthèse narrative vise à résumer les principes à la base du fonctionnement de ces dispositifs et à commenter les essais évaluant leur exactitude ainsi que leurs applications cliniques. Constatations principales Les dispositifs de surveillance avancée étendent la technologie de photopléthysmographie au-delà de la mesure de la concentration en oxygène et de la fréquence cardiaque. La quantification de la variation respiratoire du tracé photopléthysmographique reflète la variation respiratoire du tracé de pression artérielle et peut servir à jauger la réactivité au volume. Les deux techniques de compression volumique (volume-clamp) au doigt et la technique physiocal sont des prolongements de Author contributions Karsten Bartels wrote approximately 50% of the manuscript and critically edited the remainder. Robert H. Thiele wrote approximately 50% of the manuscript and critically edited the remainder.

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“…For instance, the study [2] describes a method to determine the attenuation of the signal energy through the region of the body in the heart area using Gaussian pulses whose pulse width varies from 1 to 10 GHz. In the photoplethysmography, a correlation of changes in the pulse width of the measured photoplethysmographic signal with changes in peripheral vascular resistance was found in [3]. The paper [4] provides an overview of methods dealing with energy concentration in the time-frequency domain.…”

Section: Introductionmentioning

confidence: 99%

Requirements on Needed Frequency Bandwidth Depending on Pulse Waveforms and Their Allowed Distortion

Sigmund

Brančík

2016

Journal of Electrical Engineering

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The relationship between the photoplethysmographic waveform and systemic vascular resistance

Abstract: The data indicate that pulse width of finger and ear plethysmographic tracing are more sensitive to changes in SVR than the other indices. An appreciation of changes in pulse width may provide valuable evidence with respect to changes in peripheral vascular tone.

Cited by 119 publications

References 9 publications

Investigation of peripheral photoplethysmographic morphology changes induced during a hand-elevation study

Investigation of peripheral photoplethysmographic morphology changes induced during a hand-elevation study

Advances in photoplethysmography: beyond arterial oxygen saturation

Requirements on Needed Frequency Bandwidth Depending on Pulse Waveforms and Their Allowed Distortion

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