2007 International Symposium on Information Technology Convergence

Estimation of Central Blood Pressure using Radial Pulse Waveform

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Ran Wei1, Jae Joong Im1, Sung Ha Park2 and Nam Sik Jung2 Division of Electronics & Information Engineering, Chonbuk National University, Korea 2 Cardiology Division, College of Medicine, Yonsei University, Seoul, Korea weirancn@hotmail.com jjim@chonbuk.ac.kr Abstract
Arterial stiffness is known to be an important determinant for cardiovascular risk. Early researchers used the pulse contour analysis of the peripheral pressure waveforms to obtain information about arterial stiffness, but the pressure waveform at any point is a composite of the forward and reflected waves and, therefore, the aortic systolic pressure may differ from the brachial artery systolic pressure by more than 20 mmHg and, importantly, the relationship between the aortic pressure and peripheral pressure is not fixed. Such differences may be clinically important, because it is the central aortic, not the peripheral, pressure, that determines the left ventricular workload. Therefore, the measurement of the central aortic pressure, rather than that of peripheral arteries, such as the brachial artery, may provide a better prediction of cardiovascular risk [1]-[3].

Arterial stiffness is an important determinant of cardiovascular risk and, consequently, it is necessary to develop a system which measures the central aortic blood pressure noninvasively. Recently, the aortic augmentation index (AIx), which can be calculated from the estimated aortic waveform based on the radial pressure waveform, has been used as a quantitative index of systemic arterial stiffness. The pressure waveform at various body sites is a composite of the forward and reflected waves and, therefore, the relationship between the aortic pressure and peripheral pressure is not fixed. Consequently, it is necessary to establish an algorithm for obtaining the central aortic pressure waveforms from the radial pressure waveforms. Transfer functions were established using a 10th order ARX model by setting the radial pulse as the input and the aortic pulse as the output, and their stability was verified through residual analysis. The objective of this study was to compare the central blood pressure values estimated from the radial pressure waveform using the ARX model with the central pressure waveforms acquired invasively from patients undergoing angioplasty using a RADI pressure wire. Fifty subjects (35 males and 15 females) participated in the study. The central aortic pressure waveforms obtained using the RADI pressure wire system and the radial arterial pulse waves obtained using a pressure sensor were acquired simultaneously. The results show that there was a linear relationship between the systolic pressure measured by the RADI pressure wire and that estimated using the ARX transfer function (r = 0.848). Also, the pulse pressures measured by the RADI pressure wire were linearly related to those estimated using the ARX transfer function (r = 0.893). Keywords: central aortic pressure, arterial stiffness, augmentation index, ARX model

Figure 1. Central aortic pressure waveform. AIx (Augmentation Index) : AP / PP 100 % ED (Ejection Duration): time between the foot of the wave and the incisura (Pup ~ Pdicrotic notch) SEVR (Subendocardial Viability Ratio): Ad/As RA (reflection augmentation) VSAI (ventricular systole aortic impedance)

1. Introduction

SVR (Systemic vascular resistance) It has been demonstrated that pulse wave analysis (PWA) provides an indication of the ratio between the forward and reflected waves and is a good marker of

0-7695-3045-1/07 $25.00 2007 IEEE DOI 10.1109/ISITC.2007.61

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systemic arterial stiffness [2]-[5]. The measurement of the AIx provides a potentially clinically more useful method of assessing the effects of antihypertensive and other cardiovascular drugs than the measurement of the peripheral blood pressure alone. Figure 1 shows a central aortic pressure waveform. The augmentation index (AIx) is calculated as the ratio of the two systolic peaks (AP), expressed as a percentage of the pulse pressure (PP) (AP/PP100%). However, it is difficult to obtain central aortic pressure waveforms noninvasively. Therefore, the establishment of a transfer function offers a solution to this problem, and there have been many studies performed for various types of transfer functions, in which the central pressure waveform is estimated from the radial pressure waveforms. The objective of this study was to compare the central blood pressure values estimated from the radial pressure waveforms obtained using the ARX model with the central pressure waveforms acquired invasively using a RADI pressure wire.

The central aortic pressure waveforms obtained using a RADI pressure wire system (RADIAnalyzer, Vasocare) and radial arterial pulse waves obtained using a pressure sensor were acquired simultaneously.

2. Methods
2.1. Data collection
To establish the central blood pressure, input and output signals have to be obtained. The central aortic pressure waveform obtained using an invasive catheter was chosen as the input signal and the radial pressure waveform was chosen as the output signal. Clinical studies were performed at the Cardiovascular Center, Yonsei University.
Table 1. Subjects information

Figure 2. Placement of a RADI pressure wire for the measurement of the central aortic pressure.

Age Gender Height (cm) Weight (kg) Systolic Pressure (mmHg) Diastolic Pressure (mmHg)

61.14 9.00 35males, 15 females 164.3 8.6 67.9 9.4

Figure 3. Analysis of RADI pressure wire system.

139.9 24.5 70.4 11.0

Heart Rate 69.5 21.7 (mmHg) Fifty subjects (35 males and 15 females) participated in this study, and table 1 shows the information concerning them.

Figure 3 shows the analysis of the RADI pressure wire system. With the help of this system, the systolic pressure, diastolic pressure, and heart rates were all acquired.

2.2. Data Conditioning and transfer function

The pre-processing of the acquired signals was performed prior to their utilization for establishing the transfer function. Pre-processing removes the

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unwanted noises and trends included in the raw data using a 20Hz low pass filter, trend removal, and normalization. Furthermore, the brachial blood pressure was measured and used to convert the radial pressure pulses into units of mmHg. This is achieved by setting the brachial blood pressure, diastolic values of the radial pulse, and pulse pressure to the same values. In this study, the order of the ARX (autoregressive exogenous) model was set to 10 based on the FPE (Final Prediction Error) method by analyzing the relationship between the order and prediction error. Figure 4 shows the ARX model [8].

Figure 5. Transfer function establishment process

A(q)y(n) = qk B(q)u(n) + e(n) = B(q)u(n k) + e(n)

T F ARX = B (q ) q 1 + + bnb q nb = b1 1 A ( q ) 1 + a 1q + + a n a q n b

3. Results and Discussion

There was a linear relationship between the systolic pressure measured by the RADI pressure wire and that estimated using the ARX transfer function (r = 0.848), as shown in Figure 6. The pulse pressure measured by the RADI pressure wire was also linearly related to that estimated using the ARX transfer function (r = 0.893), as shown in Figure 7.

Figure 4. ARX model.

Figure 5 shows the processing block diagram used for establishing the transfer function. In this study, the transfer function based on the ARX model was used to estimate the central pulse pressure waveforms from the radial arterial pulse waveforms [6]-[8].

Figure 6. Correlation between systolic pressure measured by RADI pressure wire and that estimated using ARX transfer function.

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Figure 7. Correlation between pulse pressure measured by RADI pressure wire and that estimated using ARX transfer function.

[4] K. Sutton-Tyrrell, A. Newman, EM. Simonsick, et al, "Aortic stiffness is associated with visceral adiposity in older adults enrolled in the study of health, aging, and body composition," Hypertension, vol. 38, pp. 4, 2001. [5] P. Boutouyrie, AI. Tropeano, R. Asmar, et al, "Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients," Hypertension, vol. 39, pp. 10-15, 2002. [6] M. Karamanoglu, MF. ORourke, et al, An analysis of the relationship between central aortic and peripheral upper limb pressure waves in man, European Heart Journal, vol. 14, pp. 160-167, 1993. [7] CH. Chen, E, Nevo, et al, Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure, Circulation, vol. 95, pp. 1827-1836, 1997. [8] B. Fetics, E. Nevo, et al, Parametric model derivation of transfer function for noninvasive estimation of aortic pressure by radial tonometry, IEEE Transactions on Biomedical Engineering, vol. 46, pp. 698-706, 1999.

The observed correlation, not only between the RADI SBP and estimated SBP, but also between the pulse pressure measured by the RADI pressure wire and estimated pulse pressure, proved the usefulness of the estimated central blood pressure obtained from the radial pressure pulse waveform using the ARX model.

4. Conclusion
It was concluded that once the peripheral pulse waveforms were obtained accurately from various sites, the central aortic pressure waveforms could be derived. Many types of central pressure waveforms were synthesized for the purpose of evaluation, however, since the physiological signal varies a lot from person to person, further in-depth studies are necessary to the accuracy of the parameter extraction process.

5. Acknowledgement
This study was supported by the Ministry of Commerce, Industry and Energy. (10020884-200501)

6. References
[1] Ian B. Wilkinson, Helen MacCallum, et al, The influence of heart rate on augmentation index and central arterial pressure in humans, Physiology, vol. 525, no.1, pp. 263-270, 2000. [2] MF. O'Rourke, DE. Gallagher, Pulse wave analysis, Hypertension, vol. 14 (suppl 5), pp. S147-S157, 1996. [3] RP. Kelly, SC. Millasseau, et al, Vasoactive drugs influence aortic augmentation index independently of pulsewave velocity in healthy men, Hypertension, vol. 37, pp. 1429-1433, 2001.

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