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Assessment of Subtle Changes in Diabetes-Associated Arteriosclerosis using Photoplethysmographic Pulse Wave from Index Finger

  • Image & Signal Processing
  • Published:
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Abstract

Distortions in macro- and microcirculation are principal contributors to diabetes-associated complications. This study aimed at investigating the validity of applying non-invasive photoplethysmographic (PPG) waveform parameters in detecting diabetes-induced subtitle changes in arterial stiffness. Between July 2009 and October 2010, totally 94 middle-aged and elderly subjects were recruited including 48 without diabetes (Group 1) and 46 with the disease (Group 2). Demographic (i.e., age, gender), anthropometric (body-mass index), biochemical (i.e., glycated hemoglobin concentration), and hemodynamic (i.e., systolic blood pressure, heart rate) parameters were obtained. Crest time (CT) and crest time ratio (CTR) computed from PPG signals acquired from left index finger were compared with left index finger pulse wave velocity (PWVfinger) obtained from six-channel ECG-PWV system to investigate the differences between the two groups and the associations of these indices with the parameters of testing subjects. Significant difference was only noted in CTR between the two groups (P < 0.005). Despite correlation of both CT and CTR with age, only CTR demonstrated significant associations with hemodynamic parameters. CTR could differentiate diabetic patients from healthy individuals despite absence of difference in arterial stiffness assessed by conventional PWV, highlighting its superior sensitivity to subtle changes in diabetes-associated arteriosclerosis.

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References

  1. Vaidya, V., Gangan, N., and Sheehan, J., Impact of cardiovascular complications among patients with Type 2 diabetes mellitus: a systematic review. Expert Rev. Pharmacoecon. Outcomes Res. 15(3):487–497, 2015.

    Article  PubMed  Google Scholar 

  2. Gladdish, S., Manawadu, D., Banya, W., Cameron, J., Bulpitt, C.J., and Rajkumar, C., Repeatability of non-invasive measurement of intracerebral pulse wave velocity using transcranial Doppler. Clin. Sci. 108(5):433–439, 2005.

    Article  PubMed  Google Scholar 

  3. Allen, J., and Murray, A., Age-related changes in the characteristics of the photoplethysmographic pulse shape at various body sites. Physiol. Meas. 24(2):297, 2003.

    Article  PubMed  Google Scholar 

  4. Alty, S.R., Angarita-Jaimes, N., Millasseau, S.C., and Chowienczyk, P.J., Predicting arterial stiffness from the digital volume pulse waveform. IEEE Trans. Biomed. Eng. 54(12):2268–2275, 2007.

    Article  PubMed  Google Scholar 

  5. Millasseau, S., Kelly, R., Ritter, J., and Chowienczyk, P., Determination of age-related increases in large artery stiffness by digital pulse contour analysis. Clin. Sci. 103(4):371–377, 2002.

    Article  CAS  PubMed  Google Scholar 

  6. Tsai, W.-C., Chen, J.-Y., Wang, M.-C., Wu, H.-T., Chi, C.-K., Chen, Y.-K., Chen, J.-H., and Lin, L.-J., Association of risk factors with increased pulse wave velocity detected by a novel method using dual-channel photoplethysmography. Am. J. Hypertens. 18(8):1118–1122, 2005.

    Article  PubMed  Google Scholar 

  7. Liu, A.-B., Hsu, P.-C., Chen, Z.-L., and Wu, H.-T., Measuring pulse wave velocity using ECG and photoplethysmography. J. Med. Syst. 35(5):771–777, 2011.

    Article  PubMed  Google Scholar 

  8. Wu, H.-T., Hsu, P.-C., Liu, A.-B., Chen, Z.-L., Huang, R.-M., Chen, C.-P., Tang, C.-J., and Sun, C.-K., Six-channel ECG-based pulse wave velocity for assessing whole-body arterial stiffness. Blood Press. 21(3):167–176, 2012.

    Article  PubMed  Google Scholar 

  9. Flammer, A.J., Anderson, T., Celermajer, D.S., Creager, M.A., Deanfield, J., Ganz, P., Hamburg, N.M., Lüscher, T.F., Shechter, M., and Taddei, S., The assessment of endothelial function from research into clinical practice. Circulation. 126(6):753–767, 2012.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Reus, W.F., Robson, M.C., Zachary, L., and Heggers, J.P., Acute effects of tobacco smoking on blood flow in the cutaneous micro-circulation. Br. J. Plast. Surg. 37(2):213–215, 1984.

    Article  CAS  PubMed  Google Scholar 

  11. Guy, R.H., Tur, E., and Maibach, H.I., Optical techniques for monitoring cutaneous microcirculation. Int. J. Dermatol. 24(2):88–94, 1985.

    Article  CAS  PubMed  Google Scholar 

  12. Spigulis, J., Erts, R., Rubins, U., Micro-circulation of skin blood: optical monitoring by advanced photoplethysmography techniques. In: Microtechnologies for the New Millennium 2003. International Society for Optics and Photonics, 2003, pp 219–225.

  13. K-I, K., Fukutake, T., and Hattori, T., Fingertip photoplethysmography and migraine. J. Neurol. Sci. 216(1):17–21, 2003.

    Article  Google Scholar 

  14. Korhonen, I., and Yli-Hankala, A., Photoplethysmography and nociception. Acta Anaesthesiol. Scand. 53(8):975–985, 2009.

    Article  CAS  PubMed  Google Scholar 

  15. Hile, C., and Veves, A., Diabetic neuropathy and microcirculation. Curr. Diab. Rep. 3(6):446–451, 2003.

    Article  PubMed  Google Scholar 

  16. McMillan, D., The microcirculation in diabetes. Microcirc. Endothel. Lymphat. 1(1):3–24, 1984.

    CAS  Google Scholar 

  17. Tooke, J.E., Sandeman, D.D., and Shore, A.C., Microvascular hemodynamics in hypertension and diabetes. J. Cardiovasc. Pharmacol. 18:S51–S53, 1991.

    Article  PubMed  Google Scholar 

  18. Wu, H.-T., Lee, C.-H., Liu, A.-B., Chung, W.-S., Tang, C.-J., Sun, C.-K., and Yip, H.-K., Arterial stiffness using radial arterial waveforms measured at the wrist as an indicator of diabetic control in the elderly. IEEE Trans. Biomed. Eng. 58(2):243–252, 2011.

    Article  PubMed  Google Scholar 

  19. Wu, H.-T., Liu, C.-C., Lin, P.-H., Chung, H.-M., Liu, M.-C., Yip, H.-K., Liu, A.-B., and Sun, C.-K., Novel application of parameters in waveform contour analysis for assessing arterial stiffness in aged and atherosclerotic subjects. Atherosclerosis. 213(1):173–177, 2010.

    Article  CAS  PubMed  Google Scholar 

  20. Huff, S.E., Taylor, H.L., and Keys, A., Observations on the peripheral blood flow in chronic lupus erythematosus. J. Invest. Dermatol. 14(1):21–36, 1950.

    Article  CAS  PubMed  Google Scholar 

  21. Dillon, J.B., and Hertzman, A.B., The form of the volume pulse in the finger pad in health, arteriosclerosis, and hypertension. Am. Heart J. 21(2):172–190, 1941.

    Article  Google Scholar 

  22. Allen, J., Photoplethysmography and its application in clinical physiological measurement. Physiol. Meas. 28(3):R1, 2007.

    Article  PubMed  Google Scholar 

  23. Kronenberg, F., Genome-wide association studies in aging-related processes such as diabetes mellitus, atherosclerosis and cancer. Exp. Gerontol. 43(1):39–43, 2008. https://doi.org/10.1016/j.exger.2007.09.005.

    Article  CAS  PubMed  Google Scholar 

  24. Steiner, G., The dyslipoproteinemias of diabetes. Atherosclerosis. 110(Suppl):S27–S33, 1994.

    Article  CAS  PubMed  Google Scholar 

  25. Li, L., Mac-Mary, S., Sainthillier, J.-M., Nouveau, S., De Lacharriere, O., and Humbert, P., Age-related changes of the cutaneous microcirculation in vivo. Gerontology. 52(3):142–153, 2006.

    Article  PubMed  Google Scholar 

  26. Klein, R., Clegg, L., Cooper, L.S., Hubbard, L.D., Klein, B.E., King, W.N., and Folsom, A.R., Prevalence of age-related maculopathy in the Atherosclerosis Risk in Communities Study. Arch. Ophthalmol. 117(9):1203–1210, 1999.

    Article  CAS  PubMed  Google Scholar 

  27. Rose, K.M., Tyroler, H.A., Nardo, C.J., Arnett, D.K., Light, K.C., Rosamond, W., Sharrett, A.R., and Szklo, M., Orthostatic hypotension and the incidence of coronary heart disease: the Atherosclerosis Risk in Communities study. Am. J. Hypertens. 13(6 Pt 1):571–578, 2000.

    Article  CAS  PubMed  Google Scholar 

  28. Palatini, P., and Julius, S., Elevated heart rate: a major risk factor for cardiovascular disease. Clin. Exp. Hypertens. 26(7–8):637–644, 2004.

    Article  CAS  PubMed  Google Scholar 

  29. Chen, Y., Huang, Y., Li, X., Xu, M., Bi, Y., Zhang, Y., Gu, W., and Ning, G., Association of arterial stiffness with HbA1c in 1,000 type 2 diabetic patients with or without hypertension. Endocrine. 36(2):262–267, 2009.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank S.-M. Wen, who worked as Acting Head Nurse in the Outpatient Department of Hualien Hospital, for her clinical support and the volunteers involved in this study for allowing us to collect and analyze their data.

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Author notes

  1. Hsien-Tsai Wu and Cheuk-Kwan Sun contributed equally to this work.

Authors and Affiliations

  1. Department of Electrical Engineering, National Dong-Hwa University, Hualien, 974, Taiwan

    Po-Chun Hsu & Hsien-Tsai Wu

  2. Department of Emergency Medicine, School of Medicine for International Students, E-Da Hospital, I-Shou University, No. 1, Yi-Da Road, Jiao-Su Village, Yan-Chao District, Kaohsiung City, 824, Taiwan

    Cheuk-Kwan Sun

Authors
  1. Po-Chun Hsu
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Correspondence to Cheuk-Kwan Sun.

Ethics declarations

This study was funded by the research grants from the Ministry of Science and Technology, Taiwan (Grant No: MOST 104–2221-E-259-014 and MOST 105–2221-E259–007). All authors declare that they have no conflict of interest. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments. The study was approved by the Institutional Review Board (IRB) of Hualien Hospital and National Dong Hwa University. Informed consent was obtained from all individual participants recruited in the present study.

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This article is part of the Topical Collection on Image & Signal Processing

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Hsu, PC., Wu, HT. & Sun, CK. Assessment of Subtle Changes in Diabetes-Associated Arteriosclerosis using Photoplethysmographic Pulse Wave from Index Finger. J Med Syst 42, 43 (2018). https://doi.org/10.1007/s10916-018-0901-1

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  • DOI: https://doi.org/10.1007/s10916-018-0901-1

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