Pulse Arrival Time Segmentation Into Cardiac and Vascular Intervals - Implications for Pulse Wave Velocity and Blood Pressure Estimation

• Published in: IEEE transactions on biomedical engineering Vol. 68; no. 9; pp. 2810 - 2820
• Main Authors: Beutel, Fabian, Van Hoof, Chris, Rottenberg, Xavier, Reesink, Koen, Hermeling, Evelien
• Format: Journal Article
• Language: English
• Published: United States IEEE 01.09.2021; The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
• Subjects: Algorithms; biomarkers; Biomedical measurement; biomedical signal processing; biomedical transducers; Blood pressure; Cardiovascular diseases; Contraction; Distension; EKG; Electrocardiography; Estimation; Health risks; Heart; Hypertension; Intervals; Matlab; patient monitoring; Risk assessment; Segmentation; sensor fusion; Stiffness; Transit time; Ultrasonic imaging; ultrasonography; Velocity; Wave velocity; Waveforms
• ISSN: 0018-9294; 1558-2531; 1558-2531
• DOI: 10.1109/TBME.2021.3055154

Objective: This study demonstrates a novel method for pulse arrival time (PAT) segmentation into cardiac isovolumic contraction (IVC) and vascular pulse transit time to approximate central pulse wave velocity (PWV). Methods: 10 subjects (38 ± 10 years, 121 ± 12 mmHg SBP) ranging from normotension to hypertension were repeatedly measured at rest and with induced changes in blood pressure (BP), and thus PWV. ECG was recorded simultaneously with ultrasound-based carotid distension waveforms, a photoplethysmography-based peripheral waveform, noninvasive continuous and intermittent cuff BP. Central PAT was segmented into cardiac and vascular time intervals using a fiducial point in the carotid distension waveform that reflects the IVC onset. Central and peripheral PWVs were computed from (segmented) intervals and estimated arterial path lengths. Correlations with Bramwell-Hill PWV, systolic and diastolic BP (SBP/DBP) were analyzed by linear regression. Results: Central PWV explained more than twice the variability (R 2 ) in Bramwell-Hill PWV compared to peripheral PWV (0.56 vs. 0.27). SBP estimated from central PWV undercuts the IEEE mean absolute deviation threshold of 5 mmHg, significantly lower than peripheral PWV or PAT (4.2 vs. 7.1 vs. 10.1 mmHg). Conclusion: Cardiac IVC onset signaled in carotid distension waveforms enables PAT segmentation to obtain unbiased vascular pulse transit time. Corresponding PWV estimates provide the basis for single-site assessment of central arterial stiffness, confirmed by significant correlations with Bramwell-Hill PWV and SBP. Significance: In a small-scale cohort, we present proof-of-concept for a novel method to estimate central PWV and BP, bearing potential to improve the practicality of cardiovascular risk assessment in clinical routines.