CLINICAL INVESTIGATIONS ES TECK PEMS SYSTEM
Assessment of Vasoactive Agents and Vascular Aging by the Second Derivative of Photoplethysmogram Waveform
Takazawa, Kenji; Tanaka, Nobuhiro; Fujita, Masami; Matsuoka, Osamu; Saiki, Tokuyu; Aikawa, Masaru;
Tamura, Sinobu; Ibukiyama, Chiharu Full Text
Hypertension: Volume 32(2) August 1998pp 365-370
Received January 24, 1998; first decision February 8, 1998; revision accepted April 7, 1998.
From The Second Department of Internal Medicine, Tokyo Medical College, Tokyo, Japan.
Correspondence to Kenji Takazawa, MD, The Second Department of Internal Medicine, Tokyo Medical
College Hospital, 6-7-1, Nishishinjuku Shinjuku Tokyo 160, Japan.
Abstract
To evaluate the clinical application of the second derivative of the fingertip photoplethysmogram waveform, we performed drug administration studies (study 1) and epidemiological studies (study 2). In study 1, ascending aortic pressure was recorded simultaneously with the fingertip photoplethysmogram and its second derivative in 39 patients with a mean +/- SD age of 54 +/- 11 years. The augmentation index was defined as the ratio of the height of the late systolic peak to that of the early systolic peak in the pulse. The second derivative consists of an a, b, c, and d wave in systole and an e wave in diastole.
Ascending aortic pressure increased after injection of 2.5 [micro sign]g angiotensin from 126/74 to 160/91 mm Hg and decreased after 0.3 mg sublingual nitroglycerin to 111/73 mm Hg. The d/a, the ratio of the height of the d wave to that of the a wave, decreased after angiotensin from -0.40 +/- 0.13 to -0.62 +/- 0.19 and increased after nitroglycerin to -0.25 +/- 0.12 (P<0.001 and P<0.001, respectively). The negative
d/a increased with increases in plethysmographic and ascending aortic augmentation indices (r=0.79, P<0.001, and r=0.80, P<0.001, respectively). The negative d/a reflects the late systolic pressure augmentation in the ascending aorta and may be useful for noninvasive evaluation of the effects of vasoactive agents. In study 2, the second derivative of the plethysmogram waveform was measured in a total of 600 subjects (50 men and 50 women in each decade from the 3rd to the 8th) in our health assessment center. The b/a ratio increased with age, and c/a, d/a, and e/a ratios decreased with age.
Thus, the second derivative aging index was defined as b-c-d-e/a. The second derivative wave aging index (y) increased with age (x) (r=0.80, P<0.001, y=0.023x-1.515). The second derivative aging index was higher in 126 subjects with any history of diabetes mellitus, hypertension, hypercholesterolemia, and ischemic heart disease than in age-matched subjects without such a history (-0.06 +/- 0.36 versus -0.22 +/- 0.41, P<0.01). Women had a higher aging index than men (P<0.01). The b-c-d-e/a ratio may be useful for evaluation of vascular aging and for screening of arteriosclerotic disease. (Hypertension. 1998; 32:365-370.)
Comparison of Invasive vs Noninvasive Pulse Wave Indices in Detection of Significant Coronary Artery Disease: Can We Use Noninvasive Pulse Wave Indices as Screening Test Full Text
Clinical Medicine: Cardiology 2008:2 153–160
Maddury Jyotsna, Alla Mahesh, Madhavapeddi Aditya, Pathapati Ram mohan and Maddireddy
Umameshwar Rao Naidu Department of Cardiology, Department of Clinical Pharmacology, Nizam’s
institute of medical sciences, Hyderabad, Andhra Pradesh, India.
Abstract:
Various non-invasive techniques to assess the indices of arterial stiffness, such as augmentation Index were used previously to detect coronary artery disease (CAD). We studied two indices of arterial stiffness analyzed from pulse contour analysis—reflection (RI) and stiffness index (SI)
both by non invasively using plethesmography and invasively from radial artery along with ECG to detect CAD and its severity.56 patients with a mean age of 52.62 ± 8.3 yrs undergoing coronary angiogram transradially either for the diagnosis or exclusion of CAD participated in this study. Significant coronary artery disease (CAD) is defi ned as greater than 50% stenosis in at least one epicardial coronary artery (ECA). Scores of 0, 1, 2, and 3 was given for normal (no CAD group), significant CAD in one ECA, two ECA and all three ECA respectively. 17 patients had normal ECA, 15 patients had score 1, 13 patients had score 2,and 11 patients had score 3. By noninvasive method, the mean value of RI for no-CAD group was 37.82% ± 7.3% vs CAD group73.09% ± 10.09% (p= 0.001) and the mean value of SI is 8.00 ± 0.9 m/s for no-CAD group vs 9.52 ± 1.05 m/for CAD group(P = 0.0055). There was no correlation in predicting the degree of CAD by RI (p 0.05) or SI (p 0.05). By invasive method RI (p = 0.0056) and SI (p = 0.0068) showed statistically significant correlation in detection of CAD but not for the severity.
In conclusion, reflection and stiffness index have a significant difference in patients with CAD and CAD patients receiving medication. However, the difference between these parameters in varying grades of CAD is not significant.
Keywords: reflection index, stiffness index, coronary artery disease
Independent Determinants of Second Derivative of the Finger Photoplethysmogram among Various Cardiovascular Risk Factors in Middle- Aged Men Full text
Toshiaki OTSUKA1) , Tomoyuki KAWADA1) , Masao KATSUMATA1) ,
Chikao IBUKI2) , and Yoshiki KUSAMA3)
Received June 8, 2007; Accepted in revised form July 25, 2007.
Hypertens Res Vol. 30, No. 12 (2007)
Abstract
The second derivative of the finger Photoplethysmogram (SDPTG) has been used as a non-invasive examination for arterial stiffness. The present study sought to elucidate independent determinants of the SDPTG among various cardiovascular risk factors in middle-aged Japanese men. The SDPTG was obtained from the cuticle of the left-hand forefinger in 973 male workers (mean age: 44±6 years) during a medical checkup data company. The SDPTG indices (b/a and d/a) were calculated from the height of the wave components. Multiple logistic regression analyses revealed that the independent determinants of an increased b/a (highest quartile of the b/a) were age (odds ratio [OR]: 1.12 per 1-year increase, 95%
confidence interval [CI]: 1.09–1.15), hypertension (OR: 1.65, 95% CI: 1.03–2.65), dyslipidemia (OR: 1.51, 95% CI: 1.09–2.09), impaired fasting glucose/diabetes mellitus (OR: 2.43, 95% CI: 1.16–5.07), and a lack of regular exercise (OR: 2.00, 95%CI: 1.29–3.08). Similarly, independent determinants of a decreased d/a (lowest quartile of the d/a) were age(OR: 1.11 per 1-year increase, 95% CI: 1.08–1.14), hypertension
(OR: 3.44, 95% CI: 2.20–5.38), and alcohol intake 6 or 7 days per week (OR: 2.70, 95% CI: 1.80–4.06).
No independent association was observed between the SDPTG indices and blood leukocyte count or serum C-reactive protein levels. In conclusion, the SDPTG indices reflect arterial properties affected by several cardiovascular risk factors in middle-aged Japanese men. The association between inflammation and the SDPTG should be evaluated in further studies. (Hypertens Res 2007; 30: 1211–1218)
Key Words: arterial stiffness, cardiovascular preventive medicine, finger Photoplethysmogram, risk factors
Utility of Second Derivative of the Finger Photoplethysmogram for the Estimation of the Risk of Coronary Heart Disease in the General Population
Toshiaki Otsuka, MD; Tomoyuki Kawada, MD; Masao Katsumata, PhD; Chikao Ibuki, MD*
Circulation Journal Vol.70, March 2006 304 – 310
Background:
Increased arterial stiffness has been shown to be associated with coronary heart disease (CHD).However; it remains unclear as to whether the second derivative of the finger Photoplethysmogram (SDPTG), anon-invasive method for the assessment of arterial stiffness, is useful for the estimation of risk of CHD in the general population.
Methods and Results:
The SDPTG in 211 subjects (age: 63±15 years, range: 21–91 years, 93 males)was recorded without apparent atherosclerotic disorders from a community. The relationship between the SDPTG indices (b/a and d/a) and coronary risk factors (n=211) or the Framingham risk score (n=158,
age: 60±12 years, range: 30–74 years, 63 males) were analyzed. The SDPTG indices significantly correlated with the Framingham risk score in both genders (b/a; male =0.43, r female =0.54 and d/a; male =–0.38, female =–0.58), as well as several coronary risk factors. In the receiver operating characteristics curve analyses, the b/a discriminated high-risk subjects for CHD, who were in the highest quintile of the
Framingham risk score in each gender, with a sensitivity and specificity of 0.85 and 0.58 in males and 0.83 and 0.72 in females, respectively.
Conclusions: these results suggest that the SDPTG is useful for the estimation of risk of CHD in the general population. (Circ J 2006; 70: 304 – 310)
Key Words: Arterial stiffness; cardiovascular preventive medicine; Coronary heart disease; Framingham risk score; Second derivative of the finger Photoplethysmogram
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