Hsien-Tsai Wu

Arterial Stiffness Using Radial Arterial Waveforms Measured at the Wrist as an Indicator of Diabetic Control in the Elderly

Although current technique of photoplethysmography (PPG) is a popular noninvasive method of waveform contour analysis in assessing arterial stiffness, data obtained are frequently affected by various environmental and physiological factors. We proposed an easily operable air pressure sensing system (APSS) for radial arterial signal capturing. Totally, 108 subjects (young, the aged with or without diabetes) were recruited from July 2009 to May 2010. Arterial waveform signals from the wrist were obtained and analyzed using Hilbert-Huang transformation (HHT). Through ensemble empirical mode decomposition (EEMD), the signals were decomposed into eight intrinsic mode functions (IMF1-8) of which IMF5 was found to be the desired signal with a discernible diastolic peak. The results showed significant differences in reflection index (RI) and stiffness index (SI) from the young subjects and those from the aged participants with or without diabetes. Significant differences in RI and SI were also noted between subjects with well-controlled diabetes and those without. Good reproducibility and correlation were demonstrated. In conclusion, the present study proposed the application of radial arterial signal capturing subsystem and HHT in acquiring more reliable data on RI and SI compared with the conventional PPG method.

Multiscale Entropy Analysis of Pulse Wave Velocity for Assessing Atherosclerosis in the Aged and Diabetic

This study proposed a dynamic pulse wave velocity (PWV)-based biomedical parameter in assessing the degree of atherosclerosis for the aged and diabetic populations. Totally, 91 subjects were recruited from a single medical institution between July 2009 and October 2010. The subjects were divided into four groups: young healthy adults (Group 1, n = 22), healthy upper middle-aged adults (Group 2, n = 28), type 2 diabetics with satisfactory blood sugar control (Group 3, n = 21), and unsatisfactory blood sugar control (Group 4, n = 20). A self-developed six-channel electrocardiography (ECG)-PWV-based equipment was used to acquire 1000 successive recordings of PWVfoot values within 30 min. The data, thus, obtained were analyzed with multiscale entropy (MSE). Large-scale MSE index (MEILS) was chosen as the assessment parameter. Not only did MEILS successfully differentiate between subjects in Groups 1 and 2, but it also showed a significant difference between Groups 3 and 4. Compared with the conventional parameter of PWVfoot and MEI on R-R interval [i.e., MEI (RRI)] in evaluating the degree of atherosclerotic change, the dynamic parameter, MEILS (PWV), could better reflect the impact of age and blood sugar control on the progression of atherosclerosis.

Assessment of Endothelial Function Using Arterial Pressure Signals

Peripheral arterial tonometry (PAT) is a useful method to assess endothelial function. Analysis of pulse wave amplitude with PAT during reactive hyperemia can be used to study peripheral vascular endothelial function very well. We had injected a specific nitric oxide (NO) synthesize inhibitor intra-arterially into five adult male rats to verify the validation of our proposed photoplethysmograpy (PPG) system for endothelial function assessment. However, the reproducibility was not good for the system applied for measuring fingertip peripheral arteries. Therefore, an air-pressure sensing system with the high reproducibility was developed for peripheral vascular endothelial function assessment. This study showed that the vasodilatation index measured with air-pressure sensing system correlated very well with that measured using peripheral arterial tonometry. In addition, only few minutes are needed for conducting a self endothelial function assessment at home. And, early self-monitoring of cardiovascular dysfunction and arterial stiffness can be easily and effectively achieved.

Multiscale cross-approximate entropy analysis as a measure of complexity among the aged and diabetic.

Complex fluctuations within physiological signals can be used to evaluate the health of the human body. This study recruited four groups of subjects: young healthy subjects (Group 1, n = 32), healthy upper middle-aged subjects (Group 2, n = 36), subjects with well-controlled type 2 diabetes (Group 3, n = 31), and subjects with poorly controlled type 2 diabetes (Group 4, n = 24). Data acquisition for each participant lasted 30 minutes. We obtained data related to consecutive time series with R-R interval (RRI) and pulse transit time (PTT). Using multiscale cross-approximate entropy (MCE), we quantified the complexity between the two series and thereby differentiated the influence of age and diabetes on the complexity of physiological signals. This study used MCE in the quantification of complexity between RRI and PTT time series. We observed changes in the influences of age and disease on the coupling effects between the heart and blood vessels in the cardiovascular system, which reduced the complexity between RRI and PTT series.

Arterial Waveforms Measured at the Wrist as Indicators of Diabetic Endothelial Dysfunction in the Elderly

Although air pressure sensing system (APSS) is a reliable means of assessing vascular endothelial function with high reproducibility, it cannot distinguish between the effects of age and diabetes. This paper aimed at investigating the potential benefit of utilizing signal-processing technique in improving the clinical validity of APSS. Arterial waveforms acquired from the left wrist before and after induction of reactive hyperemia over the left arm were recorded using APSS. Values of dilatation index (DI) were calculated and compared before (DIORIGINAL) and after (DIEEMD) ensemble empirical mode decomposition (EEMD). Compared with DIORIGINAL, DIEEMD showed better negative correlations with anthropometric, hemodynamic, and biochemical parameters (all P <; 0.05). Instead of DIORIGINAL, DIEEMD significantly distinguished between the two groups of testing subjects (P = 0.008). EEMD further refined the validity of DI obtained through APSS, which is a simple self-operable system in evaluating endothelial function for the general public. It may also serve as an assessment tool for clinicians to implement timely therapeutic measures for diabetic patients.

Novel application of parameters in waveform contour analysis for assessing arterial stiffness in aged and atherosclerotic subjects

OBJECTIVE Although contour analysis of pulse waves has been proposed as a non-invasive means in assessing arterial stiffness in atherosclerosis, accurate determination of the conventional parameters is usually precluded by distorted waveforms in the aged and atherosclerotic objects. We aimed at testing reliable indices in these patient populations. METHODS Digital volume pulse (DVP) curve was obtained from 428 subjects recruited from a health screening program at a single medical center from January 2007 to July 2008. Demographic data, blood pressure, and conventional parameters for contour analysis including pulse wave velocity (PWV), crest time (CT), stiffness index (SI), and reflection index (RI) were recorded. Two indices including normalized crest time (NCT) and crest time ratio (CTR) were also analysed and compared with the known parameters. RESULTS Though ambiguity of dicrotic notch precluded an accurate determination of the two key conventional parameters for assessing arterial stiffness (i.e. SI and RI), NCT and CTR were unaffected because the sum of CT and T(DVP) (i.e. the duration between the systolic and diastolic peak) tended to remain constant. NCT and CTR also correlated significantly with age, systolic and diastolic blood pressure, PWV, SI and RI (all P<0.01). CONCLUSION NCT and CTR not only showed significant positive correlations with the conventional parameters for assessment of atherosclerosis (i.e. SI, RI, and PWV), but they also are of particular value in assessing degree of arterial stiffness in subjects with indiscernible peak of diastolic wave that precludes the use of conventional parameters in waveform contour analysis.

Application of a Modified Entropy Computational Method in Assessing the Complexity of Pulse Wave Velocity Signals in Healthy and Diabetic Subjects

Using 1000 successive points of a pulse wave velocity (PWV) series, we previously distinguished healthy from diabetic subjects with multi-scale entropy (MSE) using a scale factor of 10. One major limitation is the long time for data acquisition (i.e., 20 min). This study aimed at validating the sensitivity of a novel method, short time MSE (sMSE) that utilized a substantially smaller sample size (i.e., 600 consecutive points), in differentiating the complexity of PWV signals both in simulation and in human subjects that were divided into four groups: healthy young (Group 1; n = 24) and middle-aged (Group 2; n = 30) subjects without known cardiovascular disease and middle-aged individuals with well-controlled (Group 3; n = 18) and poorly-controlled (Group 4; n = 22) diabetes mellitus type 2. The results demonstrated that although conventional MSE could differentiate the subjects using 1000 consecutive PWV series points, sensitivity was lost using only 600 points. Simulation study revealed consistent results. By contrast, the novel sMSE method produced significant differences in entropy in both simulation and testing subjects. In conclusion, this study demonstrated that using a novel sMSE approach for PWV analysis, the time for data acquisition can be substantially reduced to that required for 600 cardiac cycles (~10 min) with remarkable preservation of sensitivity in differentiating among healthy, aged, and diabetic populations.

Multiscale Cross-Approximate Entropy Analysis as a Measurement of Complexity between ECG R-R Interval and PPG Pulse Amplitude Series among the Normal and Diabetic Subjects

Physiological signals often show complex fluctuation (CF) under the dual influence of temporal and spatial scales, and CF can be used to assess the health of physiologic systems in the human body. This study applied multiscale cross-approximate entropy (MC-ApEn) to quantify the complex fluctuation between R-R intervals series and photoplethysmography amplitude series. All subjects were then divided into the following two groups: healthy upper middle-aged subjects (Group 1, age range: 41–80 years, n = 27) and upper middle-aged subjects with type 2 diabetes (Group 2, age range: 41–80 years, n = 24). There are significant differences of heart rate variability, LHR, between Groups 1 and 2 (1.94 ± 1.21 versus 1.32 ± 1.00, P = 0.031). Results demonstrated differences in sum of large scale MC-ApEn (MC-ApEnLS) (5.32 ± 0.50 versus 4.74 ± 0.78, P = 0.003). This parameter has a good agreement with pulse-pulse interval and pulse amplitude ratio (PAR), a simplified assessment for baroreflex activity. In conclusion, this study employed the MC-ApEn method, integrating multiple temporal and spatial scales, to quantify the complex interaction between the two physical signals. The MC-ApEnLS parameter could accurately reflect disease process in diabetics and might be another way for assessing the autonomic nerve function.

Multiscale Entropy Analysis of Heart Rate Variability for Assessing the Severity of Sleep Disordered Breathing

Obstructive sleep apnea (OSA) is an independent cardiovascular risk factor to which autonomic nervous dysfunction has been reported to be an important contributor. Ninety subjects recruited from the sleep center of a single medical center were divided into four groups: normal snoring subjects without OSA (apnea hypopnea index, AHI < 5, n = 11), mild OSA (5 ≤ AHI < 15, n = 10), moderate OSA (15 ≤ AHI < 30, n = 24), and severe OSA (AHI ≥ 30, n = 45). Demographic (i.e., age, gender), anthropometric (i.e., body mass index, neck circumference), and polysomnographic (PSG) data were recorded and compared among the different groups. For each subject, R-R intervals (RRI) from 10 segments of 10-minute electrocardiogram recordings during non-rapid eye movement sleep at stage N2 were acquired and analyzed for heart rate variability (HRV) and sample entropy using multiscale entropy index (MEI) that was divided into small scale (MEISS, scale 1–5) and large scale (MEILS, scale 6–10). Our results not only demonstrated that MEISS could successfully distinguish normal snoring subjects and those with mild OSA from those with moderate and severe disease, but also revealed good correlation between MEISS and AHI with Spearman correlation analysis (r = −0.684, p < 0.001). Therefore, using the two parameters of EEG and ECG, MEISS may serve as a simple preliminary screening tool for assessing the severity of OSA before proceeding to PSG analysis.

Six-channel ECG-based pulse wave velocity for assessing whole-body arterial stiffness

Abstract Background. Despite the proposal of different means of non-invasive arterial stiffness assessment, none offers simultaneous information on whole-body peripheral arterial condition. We investigated the validity of applying a six-channel electrocardiogram-based pulse wave velocity (ECG-PWV) measurement system for this purpose. Methods. The study consisted of two parts. Part One enrolled hypertensive (Group 1, n = 32) and normal (Group 2, n = 32) subjects, whereas Part Two recruited diabetic (Group 3, n = 50) and normal (Group 4, n = 50) subjects. To validate the application of ECG-PWV in assessing peripheral arterial stiffness in different parts of body, ECG-PWV data were compared with three other parameters including the cardio-ankle vascular index (CAVI), pulse wave velocity–digital volume pulse (PWV-DVP) and intima-media thickness (IMT). Results. ECG-PWV in healthy subjects in Part One correlated significantly with CAVI and PWV-DVP (p < 0.05), whereas ECG-PWV and CAVI were significantly different between the hypertensive and normal subjects. Moreover, comparison of IMT and ECG-PWV from different sites showed significant correlation only between IMT and ECG-PWV from earlobe (r = 0.495, p = 0.004). No significant association, however, was noted between IMT and CAVI. For Part Two, significant differences existed between diabetic and normal subjects in body weight, waist circumference, level of HbA1c, fasting blood sugar, serum creatinine and ECG-PWV from the foot. However, no significant difference was noted in PWV-DVP between two groups. Conclusions. Six-channel ECG-PWV measurement system showed remarkable correlation with IMT in hypertensive subjects and with key anthropometric and biochemical parameters in diabetic patients, suggesting its validity in assessing whole-body arterial stiffness in subjects with peripheral arterial diseases within 10 min.