Investigations of photoplethysmography in the assessment of haemodynamics, vascular mechanics and haemorheology

Real‐time cardiovascular assessment is vital for monitoring patients at an early stage of cardiovascular diseases (CVDs), at risk of reoccurrence of heart attacks and strokes and during pharmacological and non‐pharmacological treatments. Blood Pressure (BP), Arterial Stiffness (AS) and Blood Viscosity (BV) are three essential parameters that can provide a reliable assessment of hypertension, atherosclerosis, and hyperviscosity associated with the development and progression of cardiovascular pathologies to complex stages. The currently available methods designed for evaluation of such parameters incur limitations and challenges that stand as an obstacle to the development of non‐invasive, portable and reliable all‐in‐one device intended for personal use. This project engaged in novel fundamental and rigorous in vivo and in vitro investigations in an effort to shed more light on the photoplethysmographic signals (AC and DC) during induced changes of BP, AS, and BV. The underlying hypothesis is to show for the first time that Photoplethysmography (PPG) has the potential to non‐invasively assess, in a qualifying and quantifying manner, the above parameters. Positives outcomes from such approach will establish the potential of the PPG as a preferential monitoring (screening and possible diagnosis) technique for the assessment of CVDs. Novel miniature PPG sensors were developed along with a state of the art PPG processing unit, a data acquisition system and a customised manuscript for offline signal analyses. ECG and temperature processing systems were also designed and developed for use in the in vivo investigations. State of the art in vitro experimental rig was developed to mimic the human circulation under a wide range of flow conditions. A pilot volunteer investigation highlighted the effect of a cold pressor test in one hand on the PPG signals from both hands. The results indicated that there are changes in flow regulation mechanisms and hemodynamics besides the expected vasoconstriction effects of local cooling. These findings led to the controlled in vitro experiments. The in vitro investigations were completed in four stages where the potential of the PPG to provide a measure of blood pressure values, volume elastic modulus (Ev) and to detect fluid viscosity and haemorheological changes. Results from the in vitro investigations highlighted that Adjusted Pulse Volume (APV) was found to be the optimum method for measuring BP values using Red (R) and Infrared (IR) wavelengths as validated under a range of BP values simulating hypotensive to hypertensive scenarios. The correlation was significant with Rsquare ranging between 0.96 and 0.99 for different arterial models and circulating fluids. Moreover, a proposed mathematical derivation allowed the PPG to provide a direct measure of AS using Ev. The method showed strong agreement with the gold standard measurement of material testings, the Instron device, with a percent error of 0.26% and 1.9% for different arterial models. Furthermore, the PPG signals also responded to changes in rheological characteristics in relation to fluid viscosities, the presence of the red blood cells, changes in shear rates and blood clotting. These results strongly suggest that PPG has the potential to be used as a non‐invasive and continuous method for the assessment of cardiovascular disease markers such as blood pressure, arterial stiffness and blood viscosity.