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The origin of the photoplethysmography (PPG) signal is a debatable topic, despite plausible models being addressed. One concern revolves around the correlation between the mechanical waveform's pulsatile nature and the associated biomechanism. The interface between these domains requires a clear mathematical or physical model that can explain physiological behavior. Describing the correct origin of the recorded optical waveform not only benefits the development of the next generation of biosensors but also defines novel health markers. In this study, the assumption of a pulsatile nature is based on the mechanism of blood microcirculation. At this level, two interconnected phenomena occur: variation in blood flow velocity through the capillary network and red blood cell (RBC) shape deformation. The latter effect was qualitatively investigated in synthetic capillaries to assess the experimental data needed for PPG model development. Erythrocytes passed through 10 µm and 6 µm microchannel widths with imposed velocities between 50 µm/s and 2000 µm/s, according to real scenarios. As a result, the length and area deformation of RBCs followed a logarithmic law function of the achieved traveling speeds. Applying radiometric expertise on top, mechanical-optical insights are obtained regarding PPG's pulsatile nature. The mathematical equations derived from experimental data correlate microcirculation physiologic with waveform behavior at a high confidence level. The transfer function between the biomechanics and the optical signal is primarily influenced by the vasomotor state, capillary network orientation, concentration, and deformation performance of erythrocytes. [ABSTRACT FROM AUTHOR]

Featured Application: Left ventricular ejection time estimation by analyzing the morphology of arterial blood pressure and photoplethysmography signal. Left ventricular ejection time (LVET) is an important parameter for assessing cardiovascular disorders. In a medical office, it is typically measured using the Tissue Doppler Imaging technique, but new wearable devices have led to a growing interest in integrating this parameter into them, increasing accessibility to personalized healthcare for users and patients. In the cardiovascular domain, photoplethysmography (PPG) is a promising technology that shares two distinctive features with invasive arterial blood pressure (ABP) tracing: the tidal wave (TDW) and the dicrotic wave (DCW). In the early years of cardiovascular research, the duration of the dicrotic point was initially linked to the ending phase of left ventricular ejection. Subsequent studies reported deviations from the initial association, suggesting that the ejection period is related to the tidal wave feature. In this current study, we measured left ventricular ejection time in both ABP and PPG waveforms, considering recent research results. A total of 27,000 cardiac cycles were analyzed for both afore-mentioned signals. The reference value for ejection time was computed based on the T-wave segment duration from the electrocardiogram waveform. In lower blood pressure, which is associated with decreased heart contractility, the results indicated an underestimation of −29 ± 19 ms in ABP and an overestimation of 18 ± 31 ms in PPG. On the other side of the spectrum, during increased contractility, the minimum errors were −3 ± 18 ms and 4 ± 33 ms, respectively. Since the tidal wave feature is strongly affected by arterial tree compliance, the population evaluation results indicate a Pearson's correlation factor of 0.58 in the ABP case, and 0.53 in PPG. These findings highlight the need for advanced compensation techniques, in particular for PPG assessment, to achieve clinical-grade accuracy. [ABSTRACT FROM AUTHOR]

Featured Application:  Hypertension detection analyzing the morphology of the PPG signal aided by Machine Learning Techniques.  In our modern digitalized world, hypertension detection represents a key feature that enables self-monitoring of cardiovascular parameters, using a wide range of smart devices. Heart rate and blood oxygen saturation rate are some of the most important ones, easily computed by wearable products that are provided by the photoplethysmography (PPG) technique. Therefore, this low-cost technology has opened a new horizon for health monitoring in the last decade. Another important parameter is blood pressure, a major predictor for cardiovascular characterization and health related events. Analyzing only PPG signal morphology and combining the medical observation with machine learning (ML) techniques, this paper develops a hypertension diagnosis tool, named the ANC Test™. During the development process, distinguishable characteristics have been observed among certain waveforms and certain types of patients that leads to an increased confidence level of the algorithm. The test was enchanted by machine learning models to improve blood pressure class detection between systolic normotensive and hypertensive patients. A total of 359 individual recordings were manually selected to build reference signals using open-source available databases. During the development and testing phases, different ML models accuracy of detecting systolic hypertension scored in many cases around 70% with a maximum value of 72.9%. This was resulted from original waveform classification into four main classes with an easy-to-understand nomenclature. An important limitation during the recording processing phase was given by a different PPG acquisition standard among the consulted free available databases. [ABSTRACT FROM AUTHOR]