Sergey Podtaev

Assessment of endothelial dysfunction in patients with impaired glucose tolerance during a cold pressor test

The objective of this study is to explore changes in microvascular tone during a contralateral cold pressor test and to compare the results obtained in healthy subjects and in patients with impaired glucose tolerance (IGT) and type 2 diabetes. Low-amplitude fluctuations of skin temperature in the appropriate frequency ranges were used as a characteristic for the mechanism for vascular tone regulation. In total, 13 adults with type 2 diabetes aged 40–67 years and 18 adults with IGT aged 31–60 years participated in this pilot study. The control group included 12 healthy men and women aged 39–60 years. The response to the cold pressor test in patients with type 2 diabetes and with IGT differs essentially from that of healthy subjects in the endothelial frequency range. Endothelial dysfunction occurs in the preclinical stage of diabetes and manifests, in particular, as a disturbance of the endothelial part of vascular tone regulation.

Wavelet-analysis of skin temperature oscillations during local heating for revealing endothelial dysfunction

Skin microvessels have proven to be a model to investigate the mechanisms of vascular disease; in particular, endothelial dysfunction. To analyze skin blood flow, high-resolution thermometry can be used because low-amplitude skin temperature oscillations are caused by changes in the tone of skin vessels. The aim of our study was to test the possibilities of wavelet analysis of skin temperature (WAST) for the diagnosis of impaired regulation of microvascular tone in patients with type 2 diabetes. A local heating functional test was used for the assessment of microvascular tone regulation. A control group consisted of healthy male and female volunteers (n=5 each), aged 39.1±5.3years. A group of patients with type 2 diabetes comprised thirteen people, seven men and six women, aged 36 to 51years old (43.2±3.4years). The diagnosis of diabetes was made according to the criteria of the World Health Organization (WHO). The mean disease duration was 7.36±0.88years. Skin temperature oscillations, reflecting intrinsic myogenic activity (0.05-0.14Hz), neurogenic factors (0.02-0.05Hz) and endothelial activity (0.0095-0.02Hz) increase greatly during local heating for healthy subjects. In the group of patients with type 2 diabetes, no statistically significant differences in the amplitudes in the endothelial range were observed. Relative changes in the oscillation amplitudes in patients with type 2 diabetes were markedly lower compared to the control group. The latter indicates that the WAST method enables assessment of the state of vascular tone and the effects of mechanisms responsible for regulation of blood flow in the microvasculature.

Skin blood flow and temperature oscillations during cold pressor test

We study the relationship between the blood flow and skin temperature variations under a cold pressor test (CPT). The simultaneous laser Doppler flowmetry (LDF) and skin temperature (ST) measurements were carried out for 8 healthy subjects on the skin surface of the distal phalanx of the second (LDF) and third (ST) fingers. The skin blood perfusion decreases stepwise about twice during contralateral CPT for all 8 subjects. The temperature of the finger pad decays monotonically during the test and dropped about 1°C in mean. The power spectral densities of LDF flow and ST variations are also affected by the CPT, but subjects under study demonstrate two different types of reaction. LDF pulsations at the frequency about 0.1 Hz, which corresponds to the myogenic mechanism of vascular tone regulation, decreases in 5 subjects and increases in other 3 subjects. However in all subjects the ST pulsations behave contradictory, namely, the changes in amplitude of blood perfusion and ST pulsations due to cold pressor test are strongly anticorrelated. We discuss possible mechanisms of vascular reaction that can cause the behavior observed.

Quantifying the correlation between photoplethysmography and laser Doppler flowmetry microvascular low-frequency oscillations

Abstract. Photoplethysmography (PPG) and laser Doppler flowmetry (LDF) are two recognized optical techniques that can track low-frequency perfusion changes in microcirculation. The aim of this study was to determine, in healthy subjects, the correlation between the techniques for specific low-frequency bands previously defined for microcirculation. Twelve healthy male subjects (age range 18 to 50 years) were studied, with PPG and LDF signals recorded for 20 min from their right and left index (PPG) and middle (LDF) fingers. Wavelet analysis comprised dividing the low-frequency integral wavelet spectrum (IWS) into five established physiological bands relating to cardiac, respiratory, myogenic, neurogenic, and endothelial activities. The correlation between PPG and LDF was quantified using wavelet correlation analysis and Spearman correlation analysis of the median IWS amplitude. The median wavelet correlation between signals (right-left side average) was 0.45 (cardiac), 0.49 (respiratory), 0.86 (myogenic), 0.91 (neurogenic), and 0.91 (endothelial). The correlation of IWS amplitude values (right-left side average) was statistically significant for the cardiac (ρ=0.64, p<0.05) and endothelial (ρ=0.62, p<0.05) bands. This pilot study has shown good correlation between PPG and LDF for specific physiological frequency bands. In particular, the results suggest that PPG has the potential to be a low-cost replacement for LDF for endothelial activity assessments.

Relationship of oscillating and average components of laser Doppler flowmetry signal

Abstract. Signals from laser Doppler flowmeters widely used in intravital studies of skin blood flow include, along with a slowly varying average component, an oscillating part. However, in most clinical studies, pulsations are usually smoothed by data preprocessing and only the mean blood flow is analyzed. To reveal the relationship between average and oscillating perfusion components measured by a laser Doppler flowmeter, we examined the microvascular response to the contralateral cold pressor test recorded at two different sites of the hand: dorsal part of the arm and finger pad. Such a protocol makes it possible to provide a wide range of perfusion. The average perfusion always decreases during cooling, while the oscillating component demonstrates a differently directed response. The wavelet analysis of laser Doppler flowmetry (LDF) signals shows that the pulsatile component is nonlinearly related to the average perfusion. Under low perfusion, the amplitude of pulsations is proportional to its mean value, but, as perfusion increases, the amplitude of pulsations becomes lower. The type of response is defined by the basal perfusion and the degree of vasoconstriction caused by cooling. Interpretation of the results is complicated by the nonlinear transfer function of the LDF device, the contribution of which is studied using artificial examples.

Local Heating Test for Detection of Microcirculation Abnormalities in Patients with Diabetes-Related Foot Complications.

OBJECTIVE: In this study, authors used a wavelet analysis of skin temperature (WAST) to assess the mechanisms of microvascular tone regulation during the local heating test in patients with diabetic foot syndrome (DFS). PARTICIPANTS: The participants included control subjects and 36 hospitalized patients with DFS between 52 and 79 years old (68 ± 8 years old). They were distributed among 5 groups: 15 control subjects, 8 patients with DFS who did not develop ulcerative or necrotic disorders, 10 patients who developed the neuroischemic form of DFS complicated by foot ulceration, 12 patients with DFS complicated by toe necrosis, and 6 patients with DFS and foot gangrene. OUTCOME MEASURES: A comparison among the groups was made using a nonparametric Mann-Whitney U test. Spearman correlation coefficients were used to assess the relationship between WAST results, aortoarteriography, and ultrasonic dopplerography data. MAIN RESULTS: In control subjects, a local increase in temperature (up to 42° C) causes a more than 3-fold increase in the amplitude of foot skin temperature oscillations. In patients with DFS, the response to the local heating test was much weaker. High correlations of WAST results to arterial patency of the lower extremities and the state of the vascular walls were established. CONCLUSIONS: The WAST technique may have considerable value in evaluating the progression of DFS and the effectiveness of therapeutic interventions. The low cost of an individual test makes the WAST technique suitable for routine use in most healthcare facilities.

Detection of Endothelial Dysfunction Using Skin Temperature Oscillations Analysis During Local Heating in Patients With Peripheral Arterial Disease

The purpose of this study was to examine correlations between laboratory markers of ED and the degree of endothelium‐dependent vasodilation using WAST during a local heating test in patients with PAD.

Relationship between skin blood flow regulation mechanisms and vascular endothelial growth factor in patients with metabolic syndrome

The focus of this paper is the determination of endothelial dysfunction in patients with metabolic syndrome (MetS) and the establishment of a relationship between the traditional biomarkers of endothelial dysfunction and the vascular tone regulation indices obtained from indirect cold tests in MetS patients. Our investigation was conducted on 30 patients aged 45.5±9 years. The control group comprised 14 healthy subjects aged 48.2±2.4 years. The mechanism of vascular tone regulation was investigated using the wavelet analysis of skin temperature oscillations (WAST). The degrees of microvascular vasoconstriction and vasodilatation were determined during contralateral cold tests in the endothelial (0.02-0.0095 Hz), neurogenic (0.05-0.02 Hz) and myogenic (0.05-0.14 Hz) frequency ranges. In MetS patients, vasoconstriction indices were higher and vasodilatation indices were lower than in the subjects of the control group, which is indicative of disorders in the mechanisms of microvascular tone regulation. These indices correlate with the metabolic parameters and VEGF (vascular endothelial growth factor) levels. The correlation of vasoconstriction and vasodilatation indices with the main factors of the metabolic syndrome testifies that the biological and functional aspects of the endothelial dysfunction are closely related.

Assessment of cardiac time intervals by wavelet transform of the impedance cardiogram

BACKGROUND Impedance cardiography (ICG) is an inexpensive, noninvasive technique for estimating hemodynamic parameters. ICG can be used to obtain the ejection fraction of the left atrium and to monitor systolic time intervals. Traditional ICG technique does not enable unambiguous detection of the left ventricle ejection time (LVET) and the time relationships between specific marker points. OBJECTIVE This work aims to approbate a new approach for ICG signal processing using wavelet transform (WT) and to investigate the possibilities of this approach for determination of the parameters which are related to the stroke volume (SV), in particular LVET. METHODS Thoracic tetrapolar polyrheocardiography method for simultaneous registration of ECG, ICG and phonocardiograms has been used. A control group consisted of eight healthy men aged 20-25 years. In addition, four patients with essential hypertension participated in the study. Wavelet representation of the ICG data produced local maxima in a two dimensional distribution of the wavelet coefficient. Each extremum point was characterized by the amplitude, scale and time, which determine SV. RESULTS LVET was defined as the scale corresponding to the E-wave maximum related to the systolic phase of the cardiac cycle. Also, we defined the initial systolic time interval (ISTI) as the time interval between R peak in the ECG and E-wave maximum on the wavelet plane. During functional test LVET and ISTI values defined by WT demonstrated a proper hemodynamic response to loading for the control group and patients with essential hypertension. CONCLUSION The proposed approach demonstrates the ability of ICG-WT technique for adequate assessment of SV parameters, including cardiac time intervals.

Wavelet Analysis in Impedance Rheocardiography

Impedance cardiography is an inexpensive, noninvasive technique for estimating hemodynamic parameters. Impedance cardiography can be used to obtain the ejection fraction of the left atrium and to monitor systolic time intervals. The wavelet spectrogram provides an illustrative representation of the rheocardiographic measurements. Time-frequency localization of the systolic cardiac wave allows us to define the parameters related to the stroke volume and to control beat-to-beat variations of cardiac parameters in the systolic and diastolic phases of the cardiac cycle. The advantage of the wavelet-based approach is demonstrated by an example of determining the stroke volume variation during the respiratory cycle. Wavelet-based processing of impedance cardiography signals reduces the influence of artifacts and the interference of breathing modulation and displays the morphological features of cardiac cycles. In particular, the advantages of the method are considered by the isometric test of patients with hypertension.