Pulse Wave Contour Research Articles

O83 ESTIMATING CARDIAC OUTPUT FROM ARTERIAL BLOOD PRESSURE WITHOUT PRESSURE WAVEFORMS

Background and Objective: Noninvasive estimations of cardiac Output (CO) using pulse wave analysis have been studied for over a century, yielding contrasting results. Our research group has developed a novel method for the noninvasive estimation of CO based on brachial blood pressure (BP) measurements and total arterial compliance (Ct), eliminating the need for arterial pulse wave analysis. This study compares all reported methods for estimating CO without pulse wave contours using the same dataset to assess their accuracy. Methods: A cross-sectional study was conducted involving 447 adult patients who underwent ambulatory transthoracic Doppler echocardiograms. Stroke volume (SV) was calculated as the product of the cross-sectional area of the aortic annulus and the average velocity of the left ventricular outflow tract. Simultaneously, oscillometric BP measurements were obtained, and CO was derived from Ct utilizing anthropometric variables, BP, and heart rates (HR). Calibration was conducted with 75% of the data using the formula: CO=K0+K1×estimator. The remaining 25% of the data was used for validation, with Bland-Altman analysis and the intraclass correlation coefficient (ICC). Calibration involved the following CO estimators: i) mean arterial pressure; ii) HR; iii) pulse pressure (PP); iv) PPxHR; v) Warner time-correction; vi) Liljestrand-Zander; vii) Wesseling-Langewouters; and viii) the new Ct-based method. Results: Of the participants, 51.2% were men, with an average age of 51.0±15.0 years, weight of 75.0±14.0 kg, and height of 166.0±9.5 cm. The CO by echocardiography had an average of 4.9±1.0 L/min, with a range of 2.0 to 8.5 L/min. Among the compared methods, the new Ct-based method showed the smallest mean difference and error, as well as the largest ICC. The Bland-Altman analysis shows a normal distribution for the new Ct-based method, with agreement limits between -1.56 to 1.48 L/min (Figure). Conclusions: The new Ct-based method developed surpasses other published methods and exhibits practical accuracy suitable for ambulatory use, such as hemodynamic monitoring of pathophysiological or therapeutic outcomes.

Do Photopletysmographic Parameters of Arterial Stiffness Differ Depending on the Presence of Arterial Hypertension and/or Atherosclerosis?

Hypertension and atherosclerotic cardiovascular diseases (ASCVD) increase cardiovascular risk and worsen patients' prognoses. One early predictor of increased risk is a change in arterial stiffness. This study aimed to evaluate arterial stiffness parameters using the non-invasive photoplethysmography (PPG) method in Polish patients with arterial hypertension (AH) and/or atherosclerosis (AS). The study group consisted of 333 patients (Caucasians, both sexes, aged 30-85 years old). Patients were analyzed in four groups depending on AH and AS (Group I: patients without AH or AS, Group II: AH patients, Group III: AS patients, and Group IV: AH/AS patients) and, in addition, according to sex and history of SARS-CoV-2 infection. Arterial stiffness parameters, i.e., reflection index (RI), peak-to-peak time (PPT), and stiffness index (SI) were automatically calculated with PPG based on the analysis of the pulse wave contour. Mean values of RI and SI were higher in men than women (p < 0.001 each). Diastolic blood pressure (DBP) also differed between sexes (p = 0.010). Mean SI values differed between the study groups (p = 0.038) with the highest SI found in AS/AH patients and the lowest-in patients without AH or AS. The mean SI values were significantly lower in women compared to men in both Group I and Group II (p = 0.006 and p < 0.001, respectively). The mean values of RI were also greater in men than in women in Group I and Group II (p < 0.001 for each group). Regarding COVID-19 history, only HR values differed between patients with and without COVID-19 in AH patients (p = 0.012). In AH patients, men had higher values of RI and SI compared to women (p < 0.001 and p < 0.001). On the other hand, AS women with COVID-19 had significantly greater mean values of SI (9.66 m/s ± 1.61) than men with COVID-19 (7.98 m/s ± 1.09) (p = 0.045). The present study confirmed that sex had a significant impact on arterial stiffness parameters. Both AH and AS affected arterial stiffness. Heart rate was greater in hypertensive patients after COVID-19 compared to hypertensive patients without COVID-19.

ORTHOSTATIC RESPONSE OF PERIPHERAL AND CENTRAL BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION AND ATHEROSCLEROTIC CAROTID STENOSIS

Objective: To determine the frequency and severity of orthostatic responses of central and peripheral blood pressure (BP) during the Active Stand Test (AST) in patients with arterial hypertension (HTN) and hemodynamically significant stenosis of the internal carotid artery (ICA). Design and method: The intervention group included patients aged 18 years and older with HTN and ICA stenosis &gt;50% (NASCET) of atherosclerotic origin. Patients with HTN without ICA lesions were considered as controls. In all patients AST was performed with the measurement of peripheral BP in the sitting and standing positions after 3 minutes. Orthostatic hypotension (OH) was diagnosed as per current Guidelines: fall of systolic (S)BP equal or more than 20 mmHg or diastolic BP equal or more than 10 mmHg during AST. In the intervention group, central BP assessment during AST and pulse wave contour analysis were also performed. Results: There were 77 patients in the intervention group (69±8 years, 44 men) and 77 patients in the control group (68±6 years, 43 men). According to the dynamics of peripheral BP, OH was diagnosed in 21 patients (27%) in the intervention group and in 17 patients (22%) in the control group (p=0,46), but systolic OH was more frequently observed in the former (21 vs. 9 patients; p=0.015). The reduction in central systolic (S)BP was more pronounced than delta peripheral SBP (p =0.001). Changes in peripheral SBP during AST were associated with the presence of a significant ICA lesion (beta in ICA =0.201, p=0.03) and baseline SBP (beta= -0.348, p=0.001). The same variables (the fact of ICA lesion and baseline SBP) mostly explained the development of systolic OH (OR 2.95 (95% CI [1.1-7.7], p=0.03 and beta= 0.437, p&lt;0.001, respectively). Conclusions: Asymptomatic OH occurred in 27% of patients with HTN and ICA stenosis, more frequently in the form of isolated systolic OH. The amplitude of central SBP reduction significantly exceeded the dynamics of peripheral SBP The presence of carotid stenosis and higher initial values of peripheral SBP associated with the dynamics of SBP in standing and the occurrence of OH.

Hypotension prediction index guided versus conventional goal directed therapy to reduce intraoperative hypotension during thoracic surgery: a randomized trial

PurposeIntraoperative hypotension is linked to increased incidence of perioperative adverse events such as myocardial and cerebrovascular infarction and acute kidney injury. Hypotension prediction index (HPI) is a novel machine learning guided algorithm which can predict hypotensive events using high fidelity analysis of pulse-wave contour. Goal of this trial is to determine whether use of HPI can reduce the number and duration of hypotensive events in patients undergoing major thoracic procedures.MethodsThirty four patients undergoing esophageal or lung resection were randomized into 2 groups -“machine learning algorithm” (AcumenIQ) and “conventional pulse contour analysis” (Flotrac). Analyzed variables were occurrence, severity and duration of hypotensive events (defined as a period of at least one minute of MAP below 65 mmHg), hemodynamic parameters at 9 different timepoints interesting from a hemodynamics viewpoint and laboratory (serum lactate levels, arterial blood gas) and clinical outcomes (duration of mechanical ventilation, ICU and hospital stay, occurrence of adverse events and in-hospital and 28-day mortality).ResultsPatients in the AcumenIQ group had significantly lower area below the hypotensive threshold (AUT, 2 vs 16.7 mmHg x minutes) and time-weighted AUT (TWA, 0.01 vs 0.08 mmHg). Also, there were less patients with hypotensive events and cumulative duration of hypotension in the AcumenIQ group. No significant difference between groups was found in terms of laboratory and clinical outcomes.ConclusionsHemodynamic optimization guided by machine learning algorithm leads to a significant decrease in number and duration of hypotensive events compared to traditional goal directed therapy using pulse-contour analysis hemodynamic monitoring in patients undergoing major thoracic procedures. Further, larger studies are needed to determine true clinical utility of HPI guided hemodynamic monitoring.Trial registrationDate of first registration: 14/11/2022Registration number: 04729481-3a96-4763-a9d5-23fc45fb722d

Prevalence of endothelial dysfunction and increased vascular stiffness in patients with solid malignancies

Background: Endothelial dysfunction is recognized as one of the early markers of cardiovascular disorders. It is supposed to be a potential predictor of cardiovascular complications in patients receiving adjuvant and neoadjuvant chemotherapy.&#x0D; Aim: To estimate the prevalence of endothelial dysfunction in solid cancer patients compared to that in individuals without any malignancies.&#x0D; Materials and methods: This observational study included 74 patients with solid malignancies, mostly gastrointestinal. Prior to polychemotherapy, all patients were examined for endothelial function of small and large arteries (AngioScan-01, Fiton, Russia) and peripheral artery stiffness (pulse wave contour analysis and occlusion test). The results were compared with those of the Russian population trials of endothelial dysfunction – Meridian-RO (Ryazan region) and trial in the rural population of the Krasnodar region.&#x0D; Results: Compromised vasodilation and smaller arteries tone were found in 64.9% (48/74) of the cancer patients, while impaired vasodilation of larger muscular arteries was present in 94.6% (70/74) of the patients. According to the Meridian-RO trial in the Ryazan region, endothelial dysfunction had been found in 51.2% (n = 341) of women and 52.4% (n = 300) of men, whereas the Krasnodar regional population data had shown it in 68.4% (n = 353) of women and 71.7% (n = 253) of men.&#x0D; Conclusion: The prevalence of endothelial dysfunction in the patients with solid malignancies, who have not undergone any chemo- or radiation therapy, is significantly higher than in the population of comparable age, conventional cardiovascular risk factors, and comorbidities. No significant increase of vascular stiffness was identified.

The Hemodynamic Parameters Values Prediction on the Non-Invasive Hydrocuff Technology Basis with a Neural Network Applying.

The task to develop a mechanism for predicting the hemodynamic parameters values based on non-invasive hydrocuff technology of a pulse wave signal fixation is described in this study. The advantages and disadvantages of existing methods of recording the ripple curve are noted in the published materials. This study proposes a new hydrocuff method for hemodynamic parameters and blood pressure values measuring. A block diagram of the device being developed is presented. Algorithms for processing the pulse wave contour are presented. A neural network applying necessity for the multiparametric feature space formation is substantiated. The pulse wave contours obtained using hydrocuff technology of oscillation formation for various age groups are presented. According to preliminary estimates, by the moment of the dicrotic surge formation, it is possible to judge the ratio of the heart and blood vessels work, which makes it possible to form an expanded feature space of significant parameters based on neural network classifiers. This study presents the characteristics accounted for creating a database for training a neural network.

Multiple factor analysis applied to calculation of blood pressure based on pulsometry data

Development of algorithms capable of determining arterial pressure (AP) according to the contour of a pulse wave (PW) remains a topical issue to be solved with long-time efforts by researchers who work for many years in the field of hemodynamics. There is no doubt that the PW contour contains the data on AP, however due to a great number of factors influencing AP to reveal the relationship between them is extremely complicated. Our paper offers an attempt to develop an algorithm to calculate AP with the use of a PW sensor with the desired medical accuracy which does not require preliminary calibration utilizing a reference sphygmomanometer.

Medium-term Effects of Enhanced External Counterpulsation in the Structural and Functional Parameters of Blood Vessels in Patients with Coronary Artery Disease

Aim. To study the mid-term effects of enhanced external counterpulsation (EECP) in the structural and functional parameters of blood vessels, exercise tolerance and quality of life indicators in patients with verified coronary artery disease (CAD).Material and methods. Patients (n=70) with verified stable CAD (angina pectoris class II-III) complicated by chronic heart faillure class II-III (NYHA) were included in the study. Data from 65 patients (48 to 74 years old; 45 men and 20 women) are included in the final analysis. All patients had a course of EECP (35 hours procedures with a compression pressure of 220-280 mm Hg). All patients at baseline, 3 and 6 months later had a 6 walk minute test (6WMT), an assessment of the clinical status, quality of life of patients (Minnesota Living with Heart Failure Questionnaire, SF-36). Computer nailfold video capillaroscopy, photoplethysmography with pulse wave recording and contour analysis, applanation tonometry to assess central aortic systolic pressure and radial augmentation index were performed to assess the structural and functional state of large and microcirculatory vessels.Results. Significant improvement in exercise tolerance both after 3 and after 6 months (increase in distance in 6WMT by 44.6% after 3 months and 34.3% after 6 months, p &lt;0.05), improved quality of life (increased overall score on the SF-36 questionnaire from 50.3±8.1 to 59.8±8.8, p&lt;0.05), an increase in the left ventricular ejection fraction were found. Significant improvement in indicators showing the function of the endothelium of both large vessels (phase shift: from 5.6 [2.45; 7.3] to 6.8 [3.1; 8.1] m / s) and microcirculatory vessels (occlusion index: from 1.51 [1.21; 1.7] to 1.66 [1.2; 1.9]), as well as a decrease in functional disorders of the capillary bed of the skin (% of perfused capillaries, density of the capillary network in the test with reactive hyperemia) were found after 3 months. However, after 6 months, there were no significant changes in these parameters compared to the baseline value. No significant change in indicators showing structural remodeling of both large vessels and microcirculatory vessels was found.Conclusion. The positive effect of the EECP course on the functional status (exercise tolerance) and quality of life in patients with stable coronary artery disease complicated by chronic heart faillure was found both after 3 and 6 months. Positive dynamics of the functional state of large vessels and microvasculature was found only after 3 months.

EFFECTS OF 3 MONTH COMBINED THERAPY WITH PERINDOPRIL AND INDAPAMIDE ON ENDOTHELIAL FUNCTION AND ARTERIAL STIFNESS IN OBESE HYPERTENSIVE WOMEN IN PERIMENOPAUSE

Abstract Objective: To evaluate effects of 3-month combined therapy with Perindopril 10 mg and Indapamide 2.5 mg on endothelial function and arterial stiffness in obese hypertensive women in perimenopause. Design and method: Fifty perimenopause women with EAH and Obesity were enrolled in the study (average age 48,5 (40,75;48,00) years old; average body mass index 31,6 (31,2; 32,7) kg/sqm), SBP 139,0 (137,8;146,3) mm Hg., DBP 84 (78,8;89,0) mm Hg. Investigation of endothelial function and arterial stiffness based on the pulse wave contour analysis and reactive hyperemia test (“Angioscan-01” device used) was conducted before and after 3 month treatment with 10 mg/day perindopril A and 2,5 mg/day indapamide. The following parameters were evaluated: SI (stifness index), PS (phase shift) which caraterise structural and functional changes in large arteries and RI (resistance index), IO (occlusion index) which caracterise structural and functional changes in arteriols. Results: After 3-month combined treatment with 10 mg/day perindopril A and 2.5 mg/day indapamide significant decrease of SBP and DBP were observed: SBP from 139,0 (137,8;146,3) mm Hg. to 123.0 (120,75;128,75), DBP from 84 (78,8;89,0) mm Hg. to 75,5 (70;81,5) mm Hg (p &lt; 0.05); while SI significantly decrease from 9,4 (8,58;11,33) m/s to 8,4 (8,0;9,23) m/s (p &lt; 0.05); as well as RI from 35,0 (31,0;48,5) to 30 (26,75; 34,25)% (p &lt; 0.05); SF significantly increased up to 8,90 (7,4;10,02)ms from 7,45 (6,55;9,15)ms (p &lt; 0.05), as well as IO up to 1,85 (1,7;2,1) from 1,6 (1,3;1,9) Conclusions: 3-month therapy with perindopril A 10 mg/day and 2,5 mg/day indapamide was associated with not only significat decrease of SBP and DBP but significant improving of endothelial function and structural parameters in large muscular arteries (increase of phase shift between channels, decrease of stiffness of large arteries) as well as in arteriols (decrease of RI and increase of IO).

Pulse Arrival Time Is Associated With Hemorrhagic Volume in a Porcine Model: A Pilot Study.

Hemorrhage is a major cause of preventable death worldwide, and early identification can be lifesaving. Pulse wave contour analysis has previously been used to infer hemodynamic variables in a variety of settings. We hypothesized that pulse arrival time (PAT), a form of pulse wave contour analysis which is assessed via electrocardiography (ECG) and photoplethysmography (PPG), is associated with hemorrhage volume. Yorkshire-Cross swine were randomized to hemorrhage (30 mL/kg over 20 minutes) vs. control. Continuous ECG and PPG waveforms were recorded with a novel monitoring device, and algorithms were developed to calculate PAT and PAT variability throughout the respiratory cycle, termed "PAT index" or "PAT_I." Mixed effects models were used to determine associations between blood loss and PAT and between blood loss and PAT_I to account for clustering within subjects and investigate inter-subject variability in these relationships. PAT and PAT_I data were determined for ∼150 distinct intervals from five subjects. PAT and PAT_I were strongly associated with blood loss. Mixed effects modeling with PAT alone was substantially better than PAT_I alone (R2 0.93 vs. 0.57 and Akaike information criterion (AIC) 421.1 vs. 475.5, respectively). Modeling blood loss with PAT and PAT_I together resulted in slightly improved fit compared to PAT alone (R2 0.96, AIC 419.1). Mixed effects models demonstrated significant inter-subject variability in the relationships between blood loss and PAT. Findings from this pilot study suggest that PAT and PAT_I may be used to detect blood loss. Because of the simple design of a single-lead ECG and PPG, the technology could be packaged into a very small form factor device for use in austere or resource-constrained environments. Significant inter-subject variability in the relationship between blood loss and PAT highlights the importance of individualized hemodynamic monitoring.

Few-shot pulse wave contour classification based on multi-scale feature extraction

The annotation procedure of pulse wave contour (PWC) is expensive and time-consuming, thereby hindering the formation of large-scale datasets to match the requirements of deep learning. To obtain better results under the condition of few-shot PWC, a small-parameter unit structure and a multi-scale feature-extraction model are proposed. In the small-parameter unit structure, information of adjacent cells is transmitted through state variables. Simultaneously, a forgetting gate is used to update the information and retain long-term dependence of PWC in the form of unit series. The multi-scale feature-extraction model is an integrated model containing three parts. Convolution neural networks are used to extract spatial features of single-period PWC and rhythm features of multi-period PWC. Recursive neural networks are used to retain the long-term dependence features of PWC. Finally, an inference layer is used for classification through extracted features. Classification experiments of cardiovascular diseases are performed on photoplethysmography dataset and continuous non-invasive blood pressure dataset. Results show that the classification accuracy of the multi-scale feature-extraction model on the two datasets respectively can reach 80% and 96%, respectively.

Pulse Wave Contour Analysis in Healthy Volunteers, and its Relation to Clinical Phenotyping in Unani Philosophy

Pulse Wave Contour Analysis in Healthy Volunteers, and its Relation to Clinical Phenotyping in Unani Philosophy

Tracking of brachial and central aortic systolic pressure over the normal human lifespan: insight from the arterial pulse waveforms.

Despite multiple studies, it has not been possible to account for the normal changes of blood pressure that occur from infancy to old age. We sought a comprehensive explanation, by linking brachial pressure with the well documented changes in the arterial pulse waveform, whose peak and nadir determine systolic, diastolic and pulse pressure in brachial arteries. Changes in humans arterial pulse wave contour from birth to old age can be readily explained on (i) growth, with increasing length of the body from birth to adolescence, and adult height maintained thereafter, and (ii) degeneration and dilation of the aorta from elastic fibre fracture throughout life, causing progressive increase in aortic pressure wave amplitude from early return of wave reflection, and summation of incident with reflected waves in systole. These changes throughout life complement arterial pulse waveform analysis and explain brachial cuff pressure values, with optimal pulse wave pattern for cardiac interaction apparent in adolescence.

Biometric identification and authentication based on a new method of a pulse wave contour forming

The paper considers authentication methods, including biometric. The advantages, disadvantages and limitations of the known authentication methods are considered, and for the first time it is proposed to use hydrocuff pulse wave technology for biometric identification. A parameters set characterizing the pulse wave contour and its derivatives is defined. As the pulse wave mathematical processing result, a multiparametric feature space is formed. The paper considers the main problems that arise when collecting source data. To solve legal and ethical issues, as well as reduce the cost of forming a database, the possibility of applying algorithms for generating synthetic biometric images has been proved. Synthetic biometric images are designed to use neural network technologies for identification and authentication based on the large databases analysis.

The Use of Enhanced External Counterpulsation in the Treatment of Patients with Coronary Artery Disease

Enhanced external counterpulsation (EECP) is one of the most effective and safe non-invasive methods of treatment for patients with coronary artery disease (CAD), including complicated chronic heart failure (CHF). This method of therapeutic neoangiogenesis, used in conjunction with traditional drug therapy and myocardial revascularization, can significantly improve the quality of management of these patients.Aim. To study the effect of the EECP course on exercise tolerance, quality of life, structural and functional parameters of blood vessels in patients with verified stable CAD complicated by CHF.Material and methods. Patients (n=70) with verified stable CAD (angina pectoris class II-III) complicated by CHF class II-III (NYHA) were included in non-randomized uncontrolled study. Data from 67 patients (48 to 74 years old; 47 men and 20 women) were included in the final analysis. All patients had a course of EECP (35 one-hour procedures with a compression pressure of 220-280 mm Hg). All patients initially and 1.5 months after the EECP course had a 6-minute walk test (6MWT), an assessment of the clinical status, quality of life of patients (MLHFQ; Minnesota Living with Heart Failure Questionnaire). Computer nailfold video capillaroscopy, photoplethysmography with pulse wave recording and contour analysis, applanation tonometry to assess central aortic systolic pressure and radial augmentation index (RAI) were performed to assess the structural and functional state of large and microcirculatory vessels.Results. A statistically significant improvement in exercise tolerance (increase in distance in 6MWT from 212 [189; 273] to 308 [251; 336] m), improvement in the clinical status of patients (decrease in points on the rating scale of clinical state from 6.5±1.8 to 4.4±1,2), improvement in the quality of life according to the MLHFQ questionnaire (from 51.9±6.2 to 38.6±7.1), increase in the left ventricle ejection fraction (from 41.6 [36.6;47.1] to 44.8 [39.5;50.7]%) were found. A statistically significant improvement in endothelial function indices of both large vessels (phase shift: from 5.6 [2.4;7.2] to 6.8 [3.3;8] m/s) and microcirculatory vessels (occlusion index: from 1.5 [1.2;1.7] to 1.66 [1.3;1.9]), as well as a decrease in functional disorders of nailfold capillaries (percent of perfused capillaries, capillary network density in the reactive hyperemia test) also were found. But no statistically significant changes in the structural remodeling indices of both large and microcirculatory vessels were found.Conclusion. A positive effect of the EECP course both on the functional status with an increase in exercise tolerance and improvement in the quality of life, and on the functional state of large vessels and microvasculature was found in patients with stable CAD complicated by CHF.

Possibilities of Pulse Wave Contour Analysis in Diagnostics of Early Vascular Aging

Aim . To study the possibilities of photoplethysmography (PPG) in evaluation of arterial stiffness, arterial age and early vascular aging (EVA) in healthy individuals and patients with cardiovascular risk factors. Material and methods . The material of the study was the data from a survey of large teams undergoing medical examination in a group of clinics of Medical Center “SOGAZ”. A total of 783 men aged from 20 to 92 years were examined. The mean age was 48.2±10.32 years. PPG was used as a special research method, performed using the AngioScan-01 diagnostic complex. The following indicators were evaluated: stiffness index (SI), reflection index (RI), augmentation index (Alp75), age index (AGI) and pulse wave types (PV-type). For determining the vascular age (VA), correlation field of the dependence of AGI on the age of the subject was built, and then the VA was calculated by the value of the AGI. Results . The greatest correlation with passport age was revealed for the AGI indicator (r=0.54) at the first stage of the study. EVA-syndrome criteria were considered as values of the AGI, beyond the 90th percentile (n=65), and the criteria for “young vascular age” (n=87) were AGI values below 10 percentile with age correction. Comparison of these two alternative subgroups (in men aged from 40 to 59) in terms of arterial stiffness showed significant differences in SI (8.2±0.99 vs 7.6±0.89, respectively, p=0.001), Alp75 (-0.2±14.54 vs 20.5±10.31, respectively, p=0.0001), PV-type. The frequency of detection of multiple risk factors according to the results of questionnaires and laboratory diagnostics in patients with EVA-syndrome was also significantly higher. Assessment of the contribution of vascular risk factors to vascular aging showed that the leading positions are occupied by hypertension, hypertriglyceridemia, abdominal obesity, hyperglycemia, and smoking. Conclusion . PPG is a simple, fast, and informative method that allows to evaluate the parameters of the vascular wall stiffness. It can be assumed that its use in screening examinations of middle-aged men can help in identifying patients requiring observation and intensive prevention.

Status of cardiovascular system in patients with chronic obstructive pulmonary disease according to the results of a pulse wave contour analysis

The combination of chronic obstructive pulmonary disease and cardiovascular disease is an urgent public health problem, that determines more severe disease progression, worse prognosis for the patient. The aim of the work was to evaluate the status of the cardiovascular system performing a pulse wave contour analysis in patients with chronic obstructive pulmonary disease depending on the severity of bronchial obstruction. Material and Methods. Applanation tonometry was performed in 60 patients (56 men, age 63.5 [IQR 59; 70] years) with chronic obstructive pulmonary disease to assess central hemodynamic parameters. The severity of obstructive disorders was determined by spirometry after taking bronchodilator. Results. In case of progression of bronchial obstruction, a decrease in parameters characterizing coronary blood flow was detected, mainly determined by an increase in heart rate and by a decrease in the duration of diastole. In addition, higher values of augmentation pressure, corrected by heart rate of 75 bpm, pulse pressure, central pulse height at the point of maximum rise of direct pulse wave were determined in patients with more severe bronchial obstruction. These parameters indicate higher values of arterial stiffness in this group of patients. Conclusion. In patients with chronic obstructive pulmonary disease and high values of bronchial obstruction there is an imbalance in the ratio of myocardial load and actual blood supply, and increased arterial stiffness with impaired aortic damping function, that contributes to the development of cardiovascular disease in this group of patients. These factors may explain high prevalence of cardiovascular disease in this group of patients.

CORRELATIONS BETWEEN PHYSICAL AND MENTAL LIFE QUALITY COMPONENTS WITH PSYCHOSOMATIC PARAMETERS IN WOMEN WORKING IN THE OIL INDUSTRY

Aim. The article deals with assessing professional risk factors and establishing the correlation between mental life quality components and psychosomatic parameters, which is a relevant issue of the psychophysiology of professional activity. Materials and methods. 102 female engineers participated in the study. All women belonged to two various age groups and possessed a different experience of living in the North. Obtaining the informed consent of all female participants was a mandatory requirement for inclusion in the study. MOS-SF-36 questionnaire was used for analyzing subjective assessment of physical and mental life quality components. Heart rate variability was studied with the VNS-spectrum equipment; body composition was analyzed with the VS-601 analyzer; the vascular wall was quantified with the Angioscan-01 device. Correlation analysis was conducted with the non-parametric Spearman coefficient. The level of significance was established at P &lt; 0.05. The data obtained were processed with the Statistica v. 10.0 software. Results. It was revealed that adaptation to the climatic and ecological conditions of the North changed the character and number of intersystem correlations between mental life quality components and psychosomatic parameters. In young female engineers living in the North for less than 10 years, functional correlations between the physical function, pulse wave contour analysis data, and psychosomatic indicators were revealed. With the increase in the duration of living in northern conditions, the number of correlations with physical and mental life components decreased. Conclusion. The change in physical and mental life quality components during adaptation to northern conditions is determined by the physiological reactions of the body.

Effect of golimumab on endothelial vasomotor function and arterial stiffness in ankylosing spondylitis

Objective: to evaluate the effect of golimumab (GLM) on endothelial vasomotor function and arterial stiffness in patients with ankylosing spondylitis (AS).Subjects and methods. A total of 42 patients with advanced-stage AS, who were older than 18 years and met the 1984 modified New York criteria with a disease duration of ≤5 years, were examined. The investigators visualized carotid arteries to determine local vascular wall stiffness, studied regional arterial stiffness to assess a pulse wave contour analysis, and a reactive hyperemia test before and after 104-week therapy.Results and discussion. RA patients without cardiovascular comorbidity were found to have signs of subclinical great artery involvement accompanied by endothelial vasoregulatory dysfunction in both the small resistance and large muscular arteries; by increases in common carotid artery (CCA) intima-media thickness (IMT) and stiffness index (SI); by rises in peripheral augmentation index (AIp), SI and reflection index (RI), the intensity of a change in which correlated with disease duration and activity assessed by ASDAS; as well as with the modified Schober test value, cervical rotation, and tragus-to-wall distance. In addition to a decrease in the Ankylosing Spondylitis Disease Activity Score (ASDAS), GML treatment in patients with AS caused a statistically significant increase in the amplitude occlusion index to the control values and a rise in the phase shift between the channels by an average of 2 times (p&lt;0.01) as compared to the baseline values; a decrease in CCA IMT by an average by 20% (p=0.01) and in the local stiffness of the (carotid) vascular bed by 31% (p=0.01). The pulse wave contour analysis after 104-week GLM therapy revealed that AIp, SI and RI decreased by an average of 5 (р&lt;0.001), 1.3 (р&lt;0.01), and 2 (p&lt;0.05) times, respectively, with the remaining statistically significant differences from the control values.Conclusion. In addition to the effectively reduced inflammatory activity, GLM therapy in patients with AS provides restoration of endothelial function in both the small resistance vessels (an increase in the amplitude occlusion index) and the large muscular arteries (a rise in the phase shift between the channels) and also has a vasoprotective effect on the wall of large elastic vessels (reductions in CCA IMT, SI, AIp, and SI) and small muscular arteries (a decrease in RI).

Non-invasive evaluation of coronary heart disease in patients with chronic kidney disease using photoplethysmography.

BackgroundChronic kidney disease (CKD) patients have an increased risk for coronary artery disease (CAD) and myocardial infarction. Therefore, there is a need to identify CKD patients at high risk of CAD. Coronary angiography, the gold standard for detecting CAD, carries a risk of serious adverse events.MethodsHere, we assessed the validity of a novel non-invasive reflectance mode photoplethysmography (PPG) sensor for the evaluation of CAD in patients with advanced CKD. PPG signals were generated using green and infrared wavelengths and recorded from fingers of 98 patients. The detected signal has the shape of the pulse wave contour carrying information about the vascular system, that is, arterial stiffness. We studied four patient groups: (i) controls—patients without CKD or CAD; (ii) CKD alone; (iii) CAD alone (confirmed by coronary angiography); and (iv) CKD and CAD combined.ResultsWith advancing age, we observed a steeper ascending signal during systole and greater signal decline during diastole (infrared wavelength: Slopes 4–6, P = 0.002, P = 0.003 and P = 0.014, respectively; green wavelength: Slopes 2–3, P = 0.006 and P = 0.005, respectively). Presence of CAD was associated with a slower signal decline during diastole in CKD patients compared with those without CAD (infrared wavelength: Slope 1, P = 0.012). CKD was associated with lower blood volume amplitude during each cardiac cycle compared with those without CKD (R-value, P = 0.022).ConclusionsPPG signal analyses showed significant differences between our groups, and it may be a potentially useful tool for the detection of CAD in CKD patients.