Sains Malaysiana 47(10)(2018): 2481–2489

http://dx.doi.org/10.17576/jsm-2018-4710-25

 

Evaluation of Finger Photoplethysmography Fitness Index on Young Women with Cardiovascular Disease Risk Factors

(Penilaian Kesihatan Fotopletismografi Jari Telunjuk Wanita Muda dengan Risiko Faktor Penyakit Kardiovaskular)

 

MUSILAWATI MUHAJIR^1,2, AMILIA AMINUDDIN^1*, AZIZAH UGUSMAN¹, NORIZAM SALAMT¹, ZANARIYAH ASMAWI¹, AINI FARZANA ZULKEFLI¹, MUHAMMAD FIRDAUS AZMI¹, KALAIVANI CHELLAPPAN³ & NOR ANITA MEGAT MOHD NORDIN¹

 

¹Department of Physiology, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

 

²Department of Pathology, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

 

³Faculty of Engineering, Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor Darul Ehsan, Malaysia

 

Diserahkan: 17 Mac 2018/Diterima: 20 Jun 2018

 

ABSTRACT

The use of photoplethysmography (PPG) as one of cardiovascular disease (CVD) marker has got more attention due to its simplicity, noninvasive and portable characteristics. Two new markers had been developed from PPG namely PPG fitness index (PPGF) and vascular risk prediction index (VPRI). The aim of the present study was to compare PPGF level between young women with and without CVD risk factors, to investigate the relationship between PPGF with other CVD markers and to assess the sensitivity of VRPI in classifying young women that have CVD risk factors. A total of 148 young women aged 20-40 years old with and without CVD risk factors were involved in this study. CVD risk factors comprised of abdominal obesity, hypertension, dyslipidemia, smoking and family history of premature CVD. Subjects were categorized into healthy or having CVD risk factor. Measurements taken were anthropometric data, blood pressure, lipid profile, pulse wave velocity (PWV), augmentation index (AIx), high sensitivity C-Reactive Protein (hs-CRP), PPGF and VRPI. SPSS version 20 was used for data analysis with p<0.05 as significant value. The mean subjects’ age was 29.97±5.27 years old. There was no difference in PPGF level between groups (p>0.05). PPGF was independently determined by PWV (β=- 0.31, p<0.001) and height (β=0.16, p=0.04). VRPI had 77.9% sensitivity in identifying subjects with CVD risk factor. In conclusion, PPGF correlates with PWV and has potential to be an indicator of aortic stiffness while VRPI is sensitive to classify those with CVD risk factor.

 

Keywords: Cardiovascular disease; photoplethysmography; pulse wave velocity; women

 

 

ABSTRAK

Penggunaan fotopletismografi (PPG) sebagai salah satu penanda penyakit kardiovaskuar (CVD) semakin mendapat perhatian kerana ciri-cirinya yang ringkas, tidak invasif dan mudah alih. Dua penanda telah dibangunkan daripada PPG yang dinamakan indeks kecergasan PPG (PPGF) dan indeks jangkaan risiko saluran darah (VPRI). Tujuan kajian ini adalah untuk membandingkan tahap PPGF antara wanita muda yang sihat dan yang mempunyai faktor risiko CVD, menentukan hubungan antara PPGF dengan lain-lain penanda CVD dan menilai kesensitifan VRPI dalam mengenal pasti wanita muda yang mempunyai faktor risiko CVD. Seramai 148 orang wanita muda dengan julat umur 20-40 tahun yang sihat atau yang mempunyai faktor risiko CVD telah terlibat dalam kajian ini. Faktor risiko CVD adalah obesiti abdomen, hipertensi, dislipidemia, merokok dan sejarah keluarga dengan CVD pramatang. Subjek dikategorikan kepada kumpulan sihat atau mempunyai faktor risiko CVD. Pengukuran yang diambil ialah data antropometrik, tekanan darah, profil lipid, halaju gelombang nadi (PWV), indeks augmentasi (AIx), Protein C-Reaktif berkesensitifan tinggi (hs-CRP), PPGF dan VRPI. SPSS versi 20 telah digunakan untuk menganalisis data dengan p<0.05 sebagai had signifikan. Purata umur subjek ialah 29.97±5.27 tahun. Tiada perbezaan yang signifikan pada PPGF antara kumpulan (p>0.05). PPGF ditentukan secara bebas oleh PWV (Beta=-0.31, p<0.001) dan tinggi (Beta=0.16, p=0.04). VRPI mempunyai 77.9% kesensitifan dalam mengenal pasti subjek yang mempunyai faktor risiko CVD. Kesimpulannya, PPGF mempunyai hubungan dengan PWV dan mempunyai potensi sebagai indikator kekerasan aorta manakala VRPI adalah sensitif dalam mengesan faktor risiko CVD.

 

Kata kunci: Fotopletismografi; halaju gelombang nadi; penyakit kardiovaskular; wanita

RUJUKAN

Allen, J. 2007. Photoplethysmography and its application in clinical physiological measurement. Physiological Measurement 28: R1-R39.

Al-Naamani, N., Chirinos, J.A., Zamani, P., Ruthazer, R., Paulus, J.K., Roberts, K.E., Barr, R.G., Lima, J.A., Bluemke, D.A., Kronmal, R. & Kawut, S.M. 2016. Association of systemic arterial properties with right ventricular morphology: The multi-ethnic study of atherosclerosis (MESA)-right ventricle study. Journal of the American Heart Association 5(12): 11. doi:10.1161/jaha.116.004162[17.10.2016].

Aminuddin, A., Zaiton, Z., Chellappan, K., Azizah, U., Norizam, S. & Anita, N.M. 2016. The assessment of finger photoplethysmography fitness index (PPGF) among young men with cardiovascular disease risk factors: A cross sectional study. Medicine and Health-Kuala Lumpur 11(2): 218-231.

Aminuddin, A., Chellappan, K., Maskon, O., Zakaria, Z., Karim, A.A., Ngah, W.Z. & Nordin, N.A.M. 2014. Augmentation index is a better marker for cardiovascular risk in young Malaysian males. A comparison of involvement of pulse wave velocity, augmentation index, and C-reactive protein. Saudi Medical Journal 35(2): 138-146.

Aminuddin, A., Zakaria, Z., Fuad, A.F., Kamsiah, J., Othman, F., Das, S., Kamisah, Y., Qodriyah, H.S., Jubri, Z., Nordin, N.A.M. & Ngah, W.Z. 2013. High C reactive protein associated with increased pulse wave velocity among urban men with metabolic syndrome in Malaysia. Saudi Medical Journal 34(3): 266-275.

Arnold, N., Gori, T., Schnabel, R.B., Schulz, A., Prochaska, J.H., Zeller, T., Binder, H., Pfeiffer, N., Beutel, M., Espinola-Klein, C. & Lackner, K.J. 2017. Relation between arterial stiffness and markers of inflammation and hemostasis-data from the population-based Gutenberg Health Study. Scientific Reports (7)10: 6346. doi:10.1038/s41598-017-06175-2.

Balci, H., Demirkok, S.S., Yildiz, M., Metin, G., Hacibekiroglu, M. & Simsek, G. 2010. The relationship between the inflammatory markers and arterial distensibility in patients with sarcoidosis. Medical Journal of Trakya University 27(1): 44-50.

Bell, K., Twiggs, J. & Olin, B.R. 2015. Hypertension: The Silent Killer: Updated JNC-8 Guideline Recommendations. United State. Alabama Pharmacy Association.

Borhanuddin, B., Ahmad, N., Shah, S.A., Murad, N.A.A., Zakaria, S.Z.S., Kamaruddin, M.A., Jalal, N.A., Yusuf, N.A.M., Patah, A.E.A., Dauni, A., Sallam, W.A.F.W. & Jamal, R. 2018. Association of job sectors with type 2 diabetes mellitus, hypercholesterolemia and obesity: A cross-sectional study from the Malaysian Cohort (TMC) project. International Health. 9. doi:10.1093/inthealth/ihx075.

Brillante, D.G., O’sullivan, A.J. & Howes, L.G. 2008. Arterial stiffness indices in healthy volunteers using non-invasive digital photoplethysmography. Blood Pressure 17(2): 116- 123.

Chellappan, K. 2009. Noninvasive vascular risk prediction by photophlethymogram analysis. Thesis Ph.D. Universiti Kebangsaan Malaysia (Unpublished).

Chellappan, K., Mohd Ali, M.A. & Zahedi, E. 2008. An age index for vascular system based on photoplethysmogram pulse contour analysis. In 4th Kuala Lumpur International Conference on Biomedical Engineering 2008(21): 125-128.

Chellappan, K., Zahedi, E. & Ali, M.A.M. 2007. Age-related upper limb vascular system windkessel model using photoplethysmography. In 3rd Kuala Lumpur International Conference on Biomedical Engineering 2006. Springer, Berlin: Heidelberg. pp. 563-566.

Chin, C.Y. & Pengal, S. 2009. Cardiovascular disease risk in a semirural community in Malaysia. Asia Pacific Journal of Public Health 21(4): 410-420.

Chirinos, J.A., Kips, J.G., Jacobs Jr., D.R., Brumback, L., Duprez, D.A., Kronmal, R., Bluemke, D.A., Townsend, R.R., Vermeersch, S. & Segers, P. 2012. Arterial wave reflections and incident cardiovascular events and heart failure: MESA (Multiethnic study of atherosclerosis). Journal of the American College of Cardiology 60(21): 2170-2177.

DeFilippis, A.P., Blaha, M.J., Ndumele, C.E., Budoff, M.J., Lloyd- Jones, D.M., McClelland, R.L., Lakoski, S.G., Cushman, M., Wong, N.D., Blumenthal, R.S., Lima, J. & Nasir, K. 2011. The association of Framingham and Reynolds risk scores with incidence and progression of coronary artery calcification in MESA (Multi-ethnic study of atherosclerosis). Journal of the American College of Cardiology 58(20): 2076-2083.

Elgendi, M. 2012. On the analysis of fingertip photoplethysmogram signals. Current Cardiology Reviews 8(1): 14-25.

Eng, J. 2003. Sample size estimation: How many individuals should be studied? Radiology 227(2): 309-313.

Gafor, A.H.A., Mohd, R., Cader, R., Yen, K.W., Mohamad, M., Shah, S.A., Bain, A. & Kong, N.C. 2018. Evaluating cardiovascular risk in chronic kidney disease patients: A biomarker approach. Sains Malaysiana 47(1): 149-155.

Gamil, S.S., Adam, M.E. & Bakheit, K.H. 2014. Plasma levels of C-reactive protein a cardiovascular risk factor indicator in Sudanese overweight and obese adults. Journal of Endocrinology, Diabetes & Obesity 3(1): 1063.

Gunarathne, A., Patel, J.V., Hughes, E.A. & Lip, G.Y. 2008. Measurement of stiffness index by digital volume pulse analysis technique: Clinical utility in cardiovascular disease risk stratification. American Journal of Hypertension 21(8): 866-872.

Gupta, S., Gudapati, R., Gaurav, K. & Bhise, M. 2013. Emerging risk factors for cardiovascular diseases: Indian context. Indian Journal of Endocrinology and Metabolism 17(5): 806-814.

Grabovskis, A., Marcinkevics, Z., Lukstina, Z., Majauska, M., Aivars, J., Lusa, V. & Kalinina, A. 2011. Usability of photoplethysmography method in estimation of conduit artery stiffness. In European Conference on Biomedical Optics (p. 80900X). Optical Society of America.

Hashimoto, J., Watabe, D., Kimura, A., Takahashi, H., Ohkubo, T., Totsune, K. & Imai, Y. 2005. Determinants of the second derivative of the finger photoplethysmogram and brachial-ankle pulse-wave velocity: The Ohasama study. American Journal of Hypertension 18(4): 477-485.

Institute for Public Health (IPH). 2015. National Health and Morbidity Survey 2015 (NHMS 2015). Vol. II: Non- Communicable Diseases, Risk Factors & Other Health Problems.2. Kuala Lumpur. Ministry of Health Malaysia.

Institut Penyelidikan Pembangunan Belia Malaysia. 2011. Indeks Belia Malaysia 2011.96 https://www.ippbm.gov.my/ dokumen/IBM2011.pdf.

Janner, J.H., Godtfredsen, N.S., Ladelund, S., Vestbo, J. & Prescott, E. 2012. The association between aortic augmentation index and cardiovascular risk factors in a large unselected population. Journal of Human Hypertension 26(8): 476-484.

Johansen, N.B., Vistisen, D., Brunner, E.J., Tabák, A.G., Shipley, M.J., Wilkinson, I.B., McEniery, C.M., Roden, M., Herder, C., Kivimäki, M. & Witte, D.R. 2012. Determinants of aortic stiffness: 16-year follow-up of the Whitehall II study. PloS One 7(5). doi.org/10.1371/journal.pone.0037165.

Jones, S.R., Carley, S. & Harrison, M. 2003. An introduction to power and sample size estimation. Emergency Medicine Journal 20(5): 453-458.

Kawada, T. & Otsuka, T. 2013. Factor structure of indices of the second derivative of the finger photoplethysmogram with metabolic components and other cardiovascular risk indicators. Diabetes & Metabolism Journal 37(1): 40-45.

Kuklina, E.V., Yoon, P.W. & Keenan, N.L. 2010. Prevalence of coronary heart disease risk factors and screening for high cholesterol levels among young adults, United States, 1999- 2006. The Annals of Family Medicine 8(4): 327-333.

Kuznetsova, T., Vlierberghe, E.V., Knez, J., Szczesny, G., Thijs, L., Jozeau, D., Balestra, C. & Staessen, J.A. 2014. Association of digital vascular function with cardiovascular risk factors: A population study. British Medical Journal 4(3): 1-9. doi:10.1136/bmjopen-2013-004399.

Laurent, S., Cockcroft, J., Van Bortel, L., Boutouyrie, P., Giannattasio, C., Hayoz, D., Pannier, B., Vlachopoulos, C., Wilkinson, I. & Struijker-Boudier, H. 2007. Abridged version of the expert consensus document on arterial stiffness. Artery Research 1(1): 2-12.

Luo, K.Q., Feng, X.W., Xu, B.C. & Long, H.B. 2014. Association between arterial stiffness and risk of coronary artery disease. Pakistan Journal of Medical Sciences 30(6): 1314-1318.

National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (ATP III). 2001. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). The Journal of the American Medical Association 285(19): 2486-2497.

Negri, E., La Vecchia, C., D’Avanzo, B., Nobili, A. & La Malfa, R.G. 1994. Acute myocardial infarction: Association with time since stopping smoking in Italy. GISSI-EFRIM Investigators. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto. Epidemiologia dei Fattori di Rischio dell’Infarto Miocardico. Journal of Epidemiology & Community Health 48(2): 129-133.

Pilt, K., Meigas, K., Ferenets, R., Temitski, K. & Viigimaa, M. 2014. Photoplethysmographic signal waveform index for detection of increased arterial stiffness. Physiological Measurement 35(10): 2027-2036.

Pietri, P., Vyssoulis, G., Vlachopoulos, C., Zervoudaki, A., Gialernios, T., Aznaouridis, K. & Stefanadis, C. 2006. Relationship between low-grade inflammation and arterial stiffness in patients with essential hypertension. Journal of Hypertension 24(11): 2231-2238.

Ring, M., Eriksson, M.J., Zierath, J.R. & Caidahl, K. 2014. Arterial stiffness estimation in healthy subjects: A validation of oscillometric (Arteriograph) and tonometric (SphygmoCor) techniques. Hypertension Research 37(11): 999-1007.

Rubins, U., Grabovskis, A., Grube, J. & Kukulis, I. 2008. Photoplethysmography analysis of artery properties in patients with cardiovascular diseases. 14th Nordic-Baltic Conference on Biomedical Engineering and Medical Physics 20: 319-322.

Stone, N.J., Bilek, S. & Rosenbaum, S. 2005. Recent national cholesterol education program adult treatment panel III update: Adjustments and options. The American Journal of Cardiology 96(4): 53-59.

Shyam, S., Arshad, F., Ghani, R.A., Wahab, N.A., Chinna, K., Safii, N.S., Nisak Y.B. & Kamaruddin, N.A. 2014. Metabolic syndrome, abnormal glucose tolerance and high sensitivity-C-Reactive protein among women with a history of gestational diabetes mellitus. Journal of Diabetes & Metabolism 5(9): 6. doi: 10.4172/2155-6156.1000424.

Tabara, Y., Igase, M., Okada, Y., Nagai, T., Miki, T., Ohyagi, Y., Matsuda, F. & Kohara, K. 2016. Usefulness of the second derivative of the finger photoplethysmogram for assessment of end-organ damage: The J-SHIPP study. Hypertension Research 39(7): 552-556.

Tan, C.E., Ma, S., Wai, D., Chew, S.K. & Tai, E.S. 2004. Can we apply the national cholesterol education program adult treatment panel definition of the metabolic syndrome to Asians? Diabetes Care 27(5): 1182-1186.

Tsai, W.C., Chen, J.Y., Wang, M.C., Wu, H.T., Chi, C.K., Chen, Y.K., Chen, J.H. & Lin, L.J. 2005. Association of risk factors with increased pulse wave velocity detected by a novel method using dual-channel photoplethysmography. American Journal of Hypertension 18(8): 1118-1122.

Usman, S., Reaz, M.I. & Ali, M.M. 2014. Measuring arterial stiffness using photoplethysmogram. Acta Scientiarum Technology 36(1): 123-128.

World Health Organization (WHO). 2017. Cardiovascular diseases (CVDs): Fact sheet. World Health Organization http://www.who.int/mediacentre/factsheets/fs317/en/.

World Health Organization (WHO). 2014. Noncommunicable Diseases Country Profiles 2014. Geneva: World Health Organization.

World Health Organization (WHO). 2011. Global Atlas on Cardiovascular Disease Prevention and Control, edited by Mendis, S., Puska, P. & Norrving, B. France: WHO Press.

Wowern, V.E., Östling, G., Nilsson, P.M. & Olofsson, P. 2015. Digital photoplethysmography for assessment of arterial stiffness: Repeatability and comparison with applanation tonometry. PloS One 10(8): 19. doi:10.1371/journal. pone.0135659.

Yanai, H. 2016. Correlations of arterial stiffness and augmentation index with metabolic risk factors in patients with type 2 diabetes. The Journal of Clinical Hypertension 18(6): 593- 594.

Veeranna, V., Pradhan, J., Niraj, A., Fakhry, H. & Afonso, L. 2010. Traditional cardiovascular risk factors and severity of angiographic coronary artery disease in the elderly. Preventive Cardiology 13(3): 135-140.

 

*Pengarang untuk surat-menyurat; email: amyyra1234@yahoo.com.my