Utility of Second Derivative of the Finger Photoplethysmogram for the Estimation of the Risk of Coronary Heart Disease in the General Population

Abstract

oronary heart disease (CHD) is still one of the major causes of deaths in Japan. 1 Moreover, CHD mortality is expected to increase in the near future because the lifestyles of the Japanese, such as their dietary habits, have become westernized. 2 Indeed, it has been reported that young Japanese patients with CHD who have multiple coronary risk factors, including hypertension, hyperlipidemia, and obesity, all of which might be associated with their lifestyles, have been increasing. 3 Therefore, it is important in the field of cardiovascular preventive medicine to identify those at risk of CHD in general populations.Increased arterial stiffness has been shown to be associated not only with several coronary risk factors, 4-11 but also with the future development of CHD. [12][13][14][15][16][17][18] Recently, the second derivative of the finger photoplethysmogram (SDPTG) has been developed as one of the non-invasive and convenient methods for pulse-wave analysis. [19][20][21] The SDPTG is obtained from double differentiation of the finger photoplethysmogram (PTG) and is thought to provide structural and functional properties of both central and peripheral arteries. 19 Indeed, an index calculated from the SDPTG showed a significant association with age, 19,20,[22][23][24] carotid arterial distensibility, 25 and the aortic augmentation index (AIx). 19,21 In addition, the SDPTG indices were independently influenced by several risk factors for atherosclerosis in patients with hypertension 23 and in the general population. 24 However, it is still unclear as to whether the SDPTG indices are related to the coronary risk factors, or moreover, the risk for the future development of CHD in apparently healthy individuals.Thus, we conducted a cross-sectional study in a Japanese community to assess the relationship between the SDPTG indices and coronary risk factors in subjects with no apparent atherosclerotic disorders. Furthermore, we calculated the Framingham risk score, 26 which has been used to estimate an individual's risk of CHD, and determined the optimal cut-off points of the SDPTG indices to discriminate individuals at risk of CHD. Methods Study PopulationIn the present study, 211 subjects (age: 63±15 years, range: 21-91 years, 93 males) who underwent both SDPTG recording and blood sampling after an overnight fast were recruited from the annual health examination in a community, Yamanashi, Japan, in 2004 and. Subjects with a history or presence of atherosclerotic disorders, such as CHD, stroke, and peripheral obstructive arterial disease, were excluded from the study. We also excluded subjects with renal dysfunction (serum creatinine ≥1.3 mg/dl) or patients who had taken medications for hypertension, hyperlipidemia, or diabetes mellitus. Subjects with abnormal Q-waves on the 12-lead electrocardiogram at rest were also excluded. This study protocol was approved by the

Responses of the second derivative of the finger photoplethysmogram indices and hemodynamic parameters to anesthesia induction

“…Among these variables, age is an important factor affecting aortic stiffness; SBP is influenced by the stiffness of large arteries, 27 and SBP continues to rise until the eighth or ninth decade. 28 Our findings suggested that vascular aging-like mechanisms, which include increased arterial stiffness and increased peripheral vascular resistance, 6 occurred during induction of sevoflurane anesthesia. This finding is considered to be mainly due to increased cardiac sympathetic nerve activity.…”

“…The d/a represents a reflection wave from the periphery and is used as an index of peripheral vascular resistance or left ventricular after-load. 6 The AGI, which is defined as the equation of (b-c-d-e)/a, is associated with atherosclerotic alterations, which are based on the history of coronary heart disease, peripheral vascular disease, stroke or abdominal aortic aneurysm, and therefore, it is used as an index of vascular aging. 1 However, the clinical significance of c/a is not well understood.…”

“…The SDPTG is considered to provide structural and functional properties of both large and peripheral arteries. 6 The SDPTG is effective for screening of atherosclerotic disease, such as hypertension, diabetes mellitus or coronary heart disease, 7 and enables evaluation of cardiovascular aging in hypertensive patients 8 by means of categorized wave patterns. 9 It has also been suggested that the SDPTG is useful for estimating the risk of coronary heart disease.…”

“…9 It has also been suggested that the SDPTG is useful for estimating the risk of coronary heart disease. 6 In the anesthesiology field, it is considered that the stress of laryngoscopy and tracheal intubation, which stimulate cardiac sympathetic activity and intrinsic catecholamine secretion and lead to acute hypertension and tachycardia, may be harmful to patients with cardiovascular or cerebrovascular disease, exposing them to risks of morbidity and mortality. 10 For example, the incidence of myocardial ischemia is highest at the time of intubation during non-cardiac surgery in coronary artery disease patients, 11 and similarly, coronary hypoperfusion has been observed at the immediate postintubation period in coronary artery disease patients.…”

Associations between the Autonomic Nervous System and the Second Derivative of the Finger Photoplethysmogram Indices

“…The power spectrum of the HRV was divided into very-low-frequency (VLF; 0.003-0.04 Hz), low-frequency (LF; 0.04-0.15 Hz) and high-frequency (HF; 0.15-0.40 Hz) bands. These parameters tional properties of large and peripheral arteries 2) . The a-wave (initial positive wave) and b-wave (initial negative wave) correspond to the early systolic component of the PTG, while the c-wave (re-increasing wave) and d-wave (late re-decreasing wave) correspond to the late systolic component 3) .…”