Pulse arrival time as a surrogate of blood pressure

Abstract Various models have been proposed for the estimation of blood pressure (BP) from pulse transit time (PTT). PTT is defined as the time delay of the pressure wave, produced by left ventricular contraction, measured between a proximal and a distal site along the arterial tree. Most researchers...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Eoin Finnegan, Shaun Davidson, Mirae Harford, João Jorge, Peter Watkinson, Duncan Young, Lionel Tarassenko, Mauricio Villarroel
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f45c502500634960b09a1369cc47c829
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:f45c502500634960b09a1369cc47c829
record_format	dspace
spelling	oai:doaj.org-article:f45c502500634960b09a1369cc47c8292021-11-28T12:21:46ZPulse arrival time as a surrogate of blood pressure10.1038/s41598-021-01358-42045-2322https://doaj.org/article/f45c502500634960b09a1369cc47c8292021-11-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-01358-4https://doaj.org/toc/2045-2322Abstract Various models have been proposed for the estimation of blood pressure (BP) from pulse transit time (PTT). PTT is defined as the time delay of the pressure wave, produced by left ventricular contraction, measured between a proximal and a distal site along the arterial tree. Most researchers, when they measure the time difference between the peak of the R-wave in the electrocardiogram signal (corresponding to left ventricular depolarisation) and a fiducial point in the photoplethysmogram waveform (as measured by a pulse oximeter attached to the fingertip), describe this erroneously as the PTT. In fact, this is the pulse arrival time (PAT), which includes not only PTT, but also the time delay between the electrical depolarisation of the heart’s left ventricle and the opening of the aortic valve, known as pre-ejection period (PEP). PEP has been suggested to present a significant limitation to BP estimation using PAT. This work investigates the impact of PEP on PAT, leading to a discussion on the best models for BP estimation using PAT or PTT. We conducted a clinical study involving 30 healthy volunteers (53.3% female, 30.9 ± 9.35 years old, with a body mass index of 22.7 ± 3.2 kg/m $$^{2}$$ 2 ). Each session lasted on average 27.9 ± 0.6 min and BP was varied by an infusion of phenylephrine (a medication that causes venous and arterial vasoconstriction). We introduced new processing steps for the analysis of PAT and PEP signals. Various population-based models (Poon, Gesche and Fung) and a posteriori models (inverse linear, inverse squared and logarithm) for estimation of BP from PTT or PAT were evaluated. Across the cohort, PEP was found to increase by 5.5 ms ± 4.5 ms from its baseline value. Variations in PTT were significantly larger in amplitude, − 16.8 ms ± 7.5 ms. We suggest, therefore, that for infusions of phenylephrine, the contribution of PEP on PAT can be neglected. All population-based models produced large BP estimation errors, suggesting that they are insufficient for modelling the complex pathways relating changes in PTT or PAT to changes in BP. Although PAT is inversely correlated with systolic blood pressure (SBP), the gradient of this relationship varies significantly from individual to individual, from − 2946 to − 470.64 mmHg/s in our dataset. For the a posteriori inverse squared model, the root mean squared errors (RMSE) for systolic and diastolic blood pressure (DBP) estimation from PAT were 5.49 mmHg and 3.82 mmHg, respectively. The RMSEs for SBP and DBP estimation by PTT were 4.51 mmHg and 3.53 mmHg, respectively. These models take into account individual calibration curves required for accurate blood pressure estimation. The best performing population-based model (Poon) reported error values around double that of the a posteriori inverse squared model, and so the use of population-based models is not justified.Eoin FinneganShaun DavidsonMirae HarfordJoão JorgePeter WatkinsonDuncan YoungLionel TarassenkoMauricio VillarroelNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-21 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Eoin Finnegan Shaun Davidson Mirae Harford João Jorge Peter Watkinson Duncan Young Lionel Tarassenko Mauricio Villarroel Pulse arrival time as a surrogate of blood pressure
description	Abstract Various models have been proposed for the estimation of blood pressure (BP) from pulse transit time (PTT). PTT is defined as the time delay of the pressure wave, produced by left ventricular contraction, measured between a proximal and a distal site along the arterial tree. Most researchers, when they measure the time difference between the peak of the R-wave in the electrocardiogram signal (corresponding to left ventricular depolarisation) and a fiducial point in the photoplethysmogram waveform (as measured by a pulse oximeter attached to the fingertip), describe this erroneously as the PTT. In fact, this is the pulse arrival time (PAT), which includes not only PTT, but also the time delay between the electrical depolarisation of the heart’s left ventricle and the opening of the aortic valve, known as pre-ejection period (PEP). PEP has been suggested to present a significant limitation to BP estimation using PAT. This work investigates the impact of PEP on PAT, leading to a discussion on the best models for BP estimation using PAT or PTT. We conducted a clinical study involving 30 healthy volunteers (53.3% female, 30.9 ± 9.35 years old, with a body mass index of 22.7 ± 3.2 kg/m $$^{2}$$ 2 ). Each session lasted on average 27.9 ± 0.6 min and BP was varied by an infusion of phenylephrine (a medication that causes venous and arterial vasoconstriction). We introduced new processing steps for the analysis of PAT and PEP signals. Various population-based models (Poon, Gesche and Fung) and a posteriori models (inverse linear, inverse squared and logarithm) for estimation of BP from PTT or PAT were evaluated. Across the cohort, PEP was found to increase by 5.5 ms ± 4.5 ms from its baseline value. Variations in PTT were significantly larger in amplitude, − 16.8 ms ± 7.5 ms. We suggest, therefore, that for infusions of phenylephrine, the contribution of PEP on PAT can be neglected. All population-based models produced large BP estimation errors, suggesting that they are insufficient for modelling the complex pathways relating changes in PTT or PAT to changes in BP. Although PAT is inversely correlated with systolic blood pressure (SBP), the gradient of this relationship varies significantly from individual to individual, from − 2946 to − 470.64 mmHg/s in our dataset. For the a posteriori inverse squared model, the root mean squared errors (RMSE) for systolic and diastolic blood pressure (DBP) estimation from PAT were 5.49 mmHg and 3.82 mmHg, respectively. The RMSEs for SBP and DBP estimation by PTT were 4.51 mmHg and 3.53 mmHg, respectively. These models take into account individual calibration curves required for accurate blood pressure estimation. The best performing population-based model (Poon) reported error values around double that of the a posteriori inverse squared model, and so the use of population-based models is not justified.
format	article
author	Eoin Finnegan Shaun Davidson Mirae Harford João Jorge Peter Watkinson Duncan Young Lionel Tarassenko Mauricio Villarroel
author_facet	Eoin Finnegan Shaun Davidson Mirae Harford João Jorge Peter Watkinson Duncan Young Lionel Tarassenko Mauricio Villarroel
author_sort	Eoin Finnegan
title	Pulse arrival time as a surrogate of blood pressure
title_short	Pulse arrival time as a surrogate of blood pressure
title_full	Pulse arrival time as a surrogate of blood pressure
title_fullStr	Pulse arrival time as a surrogate of blood pressure
title_full_unstemmed	Pulse arrival time as a surrogate of blood pressure
title_sort	pulse arrival time as a surrogate of blood pressure
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/f45c502500634960b09a1369cc47c829
work_keys_str_mv	AT eoinfinnegan pulsearrivaltimeasasurrogateofbloodpressure AT shaundavidson pulsearrivaltimeasasurrogateofbloodpressure AT miraeharford pulsearrivaltimeasasurrogateofbloodpressure AT joaojorge pulsearrivaltimeasasurrogateofbloodpressure AT peterwatkinson pulsearrivaltimeasasurrogateofbloodpressure AT duncanyoung pulsearrivaltimeasasurrogateofbloodpressure AT lioneltarassenko pulsearrivaltimeasasurrogateofbloodpressure AT mauriciovillarroel pulsearrivaltimeasasurrogateofbloodpressure
_version_	1718408054514384896

Pulse arrival time as a surrogate of blood pressure

Ejemplares similares