脉搏波传导速度测量算法的研究及其进展

动脉弹性功能下降是心血管疾病的早期特征之一,而动脉脉搏波速度能够很好地反映动脉弹性,因此准确测量动脉脉搏波速度对预防和治疗心血管疾病有很大的帮助。测量脉搏波速度的方法主要有两种:基于容积脉搏波的检测方法和基于压力波的检测方法,其检测精度取决于波速参考点的提取。波速参考点的提取方法主要有切线法、最低点法、峰值法以及斜率最大值点法。本文分析了现有测量算法的优点和存在的不足之处,探讨了国内外的研究动向,提出测量算法的改进方案。     

人体脉搏波传播时差检测系统

脉搏波的波形和传播速度与血管的几何和物理性质有密切关系,可通过检测脉搏波形和传播速度的变异判别动脉血管的弹性功能。作者采用固体压阻式脉压传感器,脉搏信号预处理装置,TP—801单板机组成检测脉搏波及其传播时差的系统,可对脉搏信号进行无创提取,贮存及处理,以供临床分析应用。     

基于波形时域特征和动态差分阈值的脉搏波传导时间检测算法

针对传统脉搏波传导时间(PTT)检测方法对脉搏波(PPG)信号幅值变化敏感、计算量大等问题,提出了一种综合波形时域特征和动态差分阈值的PTT检测算法。采用动态差分阈值检测心电(ECG)信号R波,根据波形时域特征缩短脉搏波信号主波检测区间,利用R波检测脉搏波信号主波,从而计算PTT。利用美国麻省理工学院MIMIC数据库和实验室实测数据对上述算法进行验证。结果表明,该方法能够准确地提取特征点并检测出PTT,对实测和数据库样本的PTT检测准确率分别为99.1%和97.5%,效果优于传统检测方法。     

基于波形时域特征和动态差分阈值的脉搏波传导时间检测算法EI北大核心CSCD

针对传统脉搏波传导时间(PTT)检测方法对脉搏波(PPG)信号幅值变化敏感、计算量大等问题,提出了一种综合波形时域特征和动态差分阈值的PTT检测算法。采用动态差分阈值检测心电(ECG)信号R波,根据波形时域特征缩短脉搏波信号主波检测区间,利用R波检测脉搏波信号主波,从而计算PTT。利用美国麻省理工学院MIMIC数据库和实验室实测数据对上述算法进行验证。结果表明,该方法能够准确地提取特征点并检测出PTT,对实测和数据库样本的PTT检测准确率分别为99.1%和97.5%,效果优于传统检测方法。     

基于脉搏波传播时间测量的特征信号处理算法的研究

目的针对目前加速度脉搏波特征点检测研究少的问题,本文提出一系列处理算法,并对加速度脉搏波关键点中的a、c两点进行了重点研究。方法通过对加速度脉搏波采用防脉冲移动平均、小波滤波等方法预处理后,采取差分阈值与小波系数模极大值相结合的方法,对关键点位置进行检测。实验处理数据源于对15名在校学生采集的60组容积脉搏波,通过本文算法进行处理、检测和验证。结果对于加速度脉搏波中关键点a、c两点的正确识别率达92％以上。结论本文所述信号处理算法能够对脉搏波传播时间测量中的特征信号进行快速、准确的检出,为新型医疗监护设备的开发设计提供了技术支持。     

脉搏波的传播时差及自回归谱分析

作者利用脉搏波传播特性检测系统及APPLE-Ⅱ微型机在线信号处理系统对生理及病理状态下脉搏波传播的时差特性和频谱特性进行分析。脉搏波的传播时差反映了动脉血管的弹性特性,是检测动脉硬化症的一个重要指标,脉搏波的自回归谱特性分析可为心血管疾病的临床诊断提供新的辅助依据。     

基于脉搏波传导时间的血压测量方法

目的:设计一种连续血压测量方法,在无创的条件下能够实时监测受试者的血压。方法:对耳后动脉和趾背动脉的脉搏波进行特征识别,计算两个脉搏波之间的传播时间,并根据受试者的血液密度、血管内径、血管壁厚度等参数计算脉搏波传导速度,然后在传统脉搏波传导时间算法的基础上,增加受试者身高和体重,计算出人体的血压。结果:该算法得到的血压结果与真实值较为接近,并且实时性较好。结论:改进后的基于脉搏波传导时间的血压测量方法可用于血压的实时测量,为临床诊断提供帮助。     

体表心电图中T波交替现象的检测

T波交替（T-wave alternans,TWA）的检测对于预测室性心律失常有重要意义.本文首先利用基于经验模态分解（empirical mode decomposition,EMD）的降噪方法进行心电信号的降噪,然后采用小波变换进行心电信号特征点的识别,最后给出以T波峰值点为参考点提取T波窗口的方法.通过对连续的128个T波窗口进行功率谱分析证实,上述方法实现了微伏级TWA的检测,可用于TWA的临床诊断.     

基于心电-脉搏波的心血管疾病识别研究

为实现心血管疾病的早期筛查,降低心血管疾病临床检测的成本。本研究基于上肢脉搏波传导速度（PWV）及脉搏波相关血液动力学基础理论,采集了总计51人的脉搏波与心电信号数据,提取了包括3种PWV和脉搏波特征参数总计16个特征参数,将不同的PWV与脉搏波特征组成3个样本特征数据集,分别建立了基于K近邻学习（KNN）和支持向量机（SVM）的心血管疾病识别模型。KNN模型分类准确率为66.28%,SVM模型分类准确率为84.3%,并通过对比不同PWV对模型性能的影响,确定了用于血管评估的最优脉搏波传导速度pwvm。研究表明基于SVM建立的分类模型对心血管疾病识别有一定可靠性,为低成本的心血管疾病早期筛查提供了新思路,也为穿戴式心血管系统监测提供了基础。     

一种光电容积脉搏波的特征点自动识别算法

目的为弥补现有光电容积脉搏波特征点识别算法存在的需要人为设定阈值筛选门限和对复杂波形适应能力较差的缺陷,提出一种基于脉搏波上升支单调增加几何特性的特征点自动识别算法。方法通过两次Hilbert变换后过零点检测在每个脉搏周期内确定一个"基准点",在"基准点"前后搜索距离其最近的凹拐点即为波谷点、凸拐点即为主波峰点。结果利用MIT-BIH标准数据库中18组数据进行检测验证,平均值达到99.94%灵敏度、99.72%查准率和99.68%检测准确率。对比已有的4种算法,在查准率上有明显的提升,应对复杂的波形依然能准确识别特征点。结论提出的算法在搜索确定脉搏波波谷点和主波峰值点位置过程中取得较高的检测准确率,同时展现出对波形变化更强的适应力。研究结果为临床上通过脉搏波特征提取进行生理病理分析提供良好基础。     

An Arterial to Peripheral Pulse Wave Velocity Measure

Optical pulse transducers (photoplethysmographs) provide convenient measures of pulse wave velocity (PWV). If measured between arterial and arteriolar sites, PWV should be a sensitive index of sympathetic nervous system influences on the vasculature. Evidence of such a sensitivity was found in a study of rats in which vasoactive drug reactions simulated changes in sympathetic activity. Application of arterial to arteriolar PWV in humans further required the definition of optimal points on the two waveforms to be used in velocity calculations. An examination of different PWV indices supported use of a foot-to-foot index. Overall, our results support the promise of optical PWV techniques, but do not yet establish its validity as an index of peripheral sympathetic influences.     

高血压患者外周血管壁腔比与脉搏传导速度的探讨

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Hormone replacement therapy improves arterial stiffness in normotensive postmenopausal women

Objectives: Aortic stiffness, determined by the pulse wave velocity (PWV), is an independent marker of cardiovascular risk. PWV is mainly influenced by age-associated alterations of arterial wall structure and blood pressure (BP). To determine the impact of hormone replacement therapy (HRT) on arterial compliance in normotensive, postmenopausal women, we examined the effects of HRT on PWV. Methods: Fifty-six postmenopausal women aged 50–70 years were recruited into the present retrospective study from the patients visiting our menopause clinic. Twenty-seven women who were prescribed HRT (14 on estrogen alone and 13 on estrogen plus progestogen) for several months to 6 years and an age-matched group of 29 women not on HRT were studied (Study 1). Nine postmenopausal women were also studied before and at 4 weeks of the treatment of estrogen replacement therapy (ERT) (Study 2). Brachial to ankle PWV (baPWV), which is correlated with aortic PWV, was determined using an automatic device, BP-203PRE. Results: In Study 1, PWV was significantly correlated with age in both groups (controls: r=0.392, P=0.035; HRT group: r=0.471, P=0.013), and HRT significantly lowered the PWV value at all ages examined (Mean±S.D. of baPWV in controls: 1382.2±114.1; HRT: 1245.3±124.8, P=0.0001). In Study 2, baPWV decreased significantly after ERT (P<0.05), without a significant change in systolic BP (P=0.851). Conclusions: Estrogen appears to improve arterial compliance independently of BP within 4 weeks.     

基于脉搏波的新型血压与血管硬度测量仪的研制

目的：根据脉搏波理论研制出一种新型血压与血管硬度测量仪。方法：利用示波法原理在波形特征法和幅度系数法的基础上提出一种系数差分比值法来间接测量血压的新方法，通过采集肱动脉和桡动脉两处波形，获得了脉搏波传播速度（PWv）、动脉顺应性（C1、C2）和动脉硬化指数（ASI）三个反映受试者动脉弹性的参数指标。结果：通过大量病例分析和临床测试证实了算法的有效性和可靠性，而且此算法已经应用LabVIEW开发成软件并在医院进行临床应用。结论：血压与血管硬度检测仪能判断心血管病患者与正常人的差异性，对我国心血管病方面流行病学的调查、疾病预防、疾病早期发现都具有很大的意义。     

A Technical Assessment of Pulse Wave Velocity Algorithms Applied to Non-invasive Arterial Waveforms

Non-invasive assessment of arterial stiffness through pulse wave velocity (PWV) analysis is becoming common clinical practice. However, the effects of measurement noise, temporal resolution and similarity of the two waveforms used for PWV calculation upon accuracy and variability are unknown. We studied these effects upon PWV estimates given by foot-to-foot, least squared difference, and cross-correlation algorithms. We assessed accuracy using numerically generated blood pressure and flow waveforms for which the theoretical PWV was known to compare with the algorithm estimates. We assessed variability using clinical measurements in 28 human subjects. Wave shape similarity was quantified using a cross correlation-coefficient (CC_Coefficient), which decreases with increasing distance between waveform measurements sites. Based on our results, we propose the following criteria to identify the most accurate and least variable algorithm given the noise, resolution and CC_Coefficient of the measured waveforms. (1) Use foot-to-foot when the noise-to-signal ratio ≤10%, and/or temporal resolution ≥100 Hz. Otherwise (2) use a least squares differencing method applied to the systolic upstroke.     

Influence of the Angiotensin II Type I Receptor Gene 1166A > C Polymorphism on BP and Aortic Pulse Wave Velocity Among Malays

Angiotensin II type 1 receptor ( AGT1R ) gene 1166A > C polymorphism has been shown to be associated with essential hypertension and aortic stiffness as measured by carotid femoral pulse wave velocity (PWV). This study was carried out to investigate the association of the 1166A > C polymorphism with blood pressure (BP) and PWV among Malay hypertensive and normotensive subjects.
Two hundred and one hypertensive subjects without evidence of cardiovascular (CV) complications and 201 age- and sex-matched normotensive subjects were studied in a cross-sectional design. Blood pressures (BP) and PWV were measured, and 1166A > C genotype was determined by polymerase chain reaction followed by restriction enzyme digestion.
The 1166C allele frequency was 7.96% and 7.73% among Malay hypertensive and normotensive subjects, respectively. There was no association of the 1166A > C polymorphism with BP in the hypertensive, normotensive or overall Malay populations. PWV was significantly higher among 1166C allele carriers as compared to non-carriers (10.52 ± 1.82 vs. 10.15 ± 1.80, p = 0.040) in the overall population, but not in the hypertensive and normotensive populations separately. In conclusion, the frequency of 1166C polymorphism is similar among Malay hypertensive and normotensive subjects. This polymorphism has no association with BP but may have an influence on PWV in Malays, which needs further investigation.     

Pulse Wave Velocity as a Measure of Blood Pressure Change

The use of arterial pulse wave velocity (PWV) as a continuous measure of blood pressure changes is outlined. Theoretical considerations indicate that changes in PWV reflect changes in blood pressure, and an experiment was carried out to assess this relationship. PWV along an arm artery was monitored in 26 subjects at a time when the arterial distending pressure of the limb was altered over a wide range by means of externally applied positive and negative pressures. The results show that changes in PWV reliably follow changes in blood pressure. This method can be considered suitable for studies requiring changes rather than absolute values of blood pressure.     

Numerical Validation of a New Method to Assess Aortic Pulse Wave Velocity from a Single Recording of a Brachial Artery Waveform with an Occluding Cuff

Recently a new method has been proposed as a tool to measure arterial pulse wave velocity (PWV), a measure of the stiffness of the large arteries and an emerging parameter used as indicator of clinical cardiovascular risk. The method is based on measurement of brachial blood pressure during supra-systolic pressure inflation of a simple brachial cuff [the device is known as the Arteriograph (Tensiomed, Budapest, Hungary)]. This occlusion yields pronounced first and secondary peaks in the pressure waveform, the latter ascribed to a reflection from the aortic bifurcation, and PWV is calculated as the ratio of twice the jugulum-symphysis distance and the time difference between the two peaks. To test the validity of this working principle, we used a numerical model of the arterial tree to simulate pressures and flows in the normal configuration, and in a configuration with an occluded brachial artery. A pronounced secondary peak was indeed found in the brachial pressure signal of the occluded model, but its timing was only related to brachial stiffness and not to aortic stiffness. We also compared PWV’s calculated with three different methods: PWV_ATG (~Arteriograph principle), PWV_car–fem (~carotid–femoral PWV, the current clinical gold standard method), and PWV_theor (~Bramwell–Hill equation). Both PWV_ATG (R ² = 0.94) and PWV_car–fem (R ² = 0.95) correlated well with PWV_theor, but their numerical values were lower (by 2.17 ± 0.42 and 1.08 ± 0.70 m/s for PWV_ATG and PWV_car–fem, respectively). In conclusion, our simulations question the working principle of the Arteriograph. Our data indicate that the method picks up wave reflection phenomena confined to the brachial artery, and derived values of PWV rather reflect the stiffness of the brachial arteries.     

Intima-media thickness and pulse wave velocity in hypertensive adolescents

Increased intima-media thickness (IMT) and pulse wave velocity (PWV) are noninvasive markers of early arterial wall alteration and are more widely used in adult clinical research. We investigated whether IMT and PWV are useful predictors of cardiovascular risk in hypertensive adolescents. Fifteen hypertensive adolescents (13-18 yr old, systolic BP > or = 140 mmHg, diastolic BP > or = 90 mmHg) and seventeen normotensive subjects were included. Height, weight, obesity index, body mass index (BMI), and fat distribution were obtained from each group. Serum lipid, insulin, vitamine B12, folate, renin, aldosterone, angiotensin-converting enzyme (ACE), and homocysteine levels were compared. The carotid IMT and PWV were measured. Arterial wall compliance and distensibility were calculated with the equation. High systolic blood pressure significantly correlated with height, weight, BMI, obesity index, arm circumference, fat mass, and fat distribution. Hypertensive adolescents had significantly greater cIMT (carotid intima-media thickness) and lower elastic properties such as cross-sectional compliance and distensibility of the carotid artery. The carotid IMT significantly correlated with brachial-ankle PWV. In conclusion, the measurement of carotid IMT and brachial-ankle PWV might be useful to predict the development of atherosclerosis in hypertensive adolescents.