Sharif Digital Repository

Endothelial dysfunction, which can be noninvasively assessed by flow mediated vasodilation (FMD), predicts an increased rate of adverse cardiovascular events. The endothelial dysfunction is considered as a leading cause of development and progression of the atherosclerotic process. The main aim of this study is to review different non-invasive methods to assess the endothelial dysfunction and to propose enhancements to a new method based on photoplethysmography (PPG). First, non-invasive techniques developed for the evaluation of peripheral endothelial function (including the Doppler ultrasound (US)) will be reviewed. Although noninvasive, US -based techniques present a few disadvantages. To... 

Non-invasive measurement of flow-mediated dilation (FMD) in the brachial artery for assessing endothelial function is costly and operator-dependent, limiting its application to research cases. In this paper, an approach based on a physiological model between normalized central blood pressure and finger photoplethysmogram is presented. Baseline model parameters are estimated using a genetic algorithm in 30 subjects consisting of ten normal blood pressure (BP), ten high-BP and ten elderly volunteers. Beat-to-beat fitness values after reactive hyperaemia are calculated using baseline (before cuff occlusion) data. Results show that stimulus-induced changes are fairly described with a first order... 

Flow mediated dilation (FMD) is a non-invasive method for endothelial function assessment providing an index extracted from ultrasonic B-mode images. Although utilized in the research community, the difficulty of its application and high cost of ultrasonic devices prevent it from being widely used in clinical settings. In this study we show that substituting the ultrasonic device with more easily handled and low cost photoplethysmography and electrocardiography is possible. We introduce new indices based on the photoplethysmogram (PPG) and electrocardiogram (ECG) and show that they are correlated with the ultrasound-based FMD Index. To this end, a conventional ultrasound FMD test was carried... 

Noninvasive measurement of brachial artery (BA) flow mediated dilation (FMD), commonly measured by high resolution ultrasonography, has provided a non-invasive means for the evaluation of endothelial function. Recently, another technique based on finger photopletysmogram (PPG) analysis has been proposed by the authors. In this paper, simultaneous measurement of BA FMD and PPG signals data from 86 human subjects (43 healthy and 43 risk) is analyzed and a statistical model is proposed to estimate the BA FMD based on PPG signals, the BA diameter at baseline as well as other demographics factors such as age and gender. Linear regression by multivariate analysis was conducted to obtain the... 

Flow-mediated dilation measurement in the brachial artery using ultrasound imaging (FMD-US) is a common noninvasive procedure for endothelial function evaluation in the peripheral arteries. As FMD-US is operator-dependent and involves onerous equipment, its use has been mostly confined to research settings. In this paper, we propose to use the more accessible finger photoplethysmogram signal in conjunction with the FMD test (FMD-PPG) as a surrogate method. To this end, a tube-load physiological model of the upper arterial path in the arm is developed. Signals acquired from young and elderly subjects (N=20) are then investigated using model parameter estimation by the genetic algorithm. Our... 

Flow mediated dilation (FMD) measurement using ultrasound imaging (FMD-US) has been established as a standard method for assessing the endothelial function. Recently, a less skilled-operator demanding method has been proposed based on the photoplethysmogram (PPG) changes during reactive hyperemia. It was shown that the amplitude of the PPG pulse (FMD-PPG) changed in a quite similar manner to that of the artery diameter in the method of the FMD-US i.e. increases following releasing the cuff and then gradually returns to baseline. In this study PPG changes following reactive hyperaemia were modelled using time-varying passive electrical elements (R, L and C). The output of the electric analog... 

It is proved that the endothelial (artery inner lumen cells) function is associated with cardiovascular risk factors. Among all the common non-invasive methods employed in the research setting for assessing endothelial function, flow-mediated dilation is the most widely used one. This technique measures endothelial function by inducing reactive hyperemia using temporary arterial occlusion and measuring the resultant relative increase in blood vessel diameter via ultrasound. In this paper, the limitations associated with the ultrasound technique are overcome by using the photoplethysmogram (PPG) signal recorded during FMD. The correctness of this approach is investigated by modeling the AC...