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Telemonitoring of patients
with cardiovascular
disorders by a pulse high
resolution oximetry
method.
R.Krzyminiewski, B.Dobosz, A.Szymil
Medical Physisc Division, Faculty of Physics, Adam
Mickiewicz University, [email protected]
Umultowska 85, 61-614 Poznan, Poland
TELEMEDICAL NETWORK MONTE
www.monte.amu.edu.pl
Group of experts
The AMU Foundation
The Medical University
Telecomunication TPSA
City and voivodship
authorities
First contact doctor,
Hospitals, Clinics
Centre for Medical
Analyses and Diagnoses
CADM
Doctor on duty, Nurse
DATABASE
The Faculty of Physics
Informatical Service
Computer Aid in Diagnosis
Individual
physicians,
patients
Patients requiring
continous monitoring
in a period of
convalescence
(data-video)
Patients requiring
monitoring for a
longer time
Patients monitoried
without the need of
video mode
Patients
monitored mainly
in the video mode
(data)
(video)
(data-video)
Wireless
communication
module
Patients
monitored by
wireless
communication
TelMedHome-Home care pulse
oximetry
CMS-50E digital pulse oximeter
Contec
OEM Pulse Oximeter
model 3150 Nonin
Home care pulse oximetry
A typical data recorded from pulse oximeter founded on
patient’s finger gives information how well the arterial
blood is oxygenated and pulse rate value.
The parameters of pulse wave, eventual pulse
disturbances etc. are usually not analysed.
Home care pulse oximetry
The study developed a computer analysis of
recorded digital pulse waves by linear
transformation method to enhance
resolution of pulse wave signal (high signal
resolution HSR PW).
Method of linear transformation
The shape of the signal can be described by:

F ( x) 
 K ( x  x ) ( x )dx 

K ( x  x )
 ( x )
- a function describing the shape and width of particular
spectral lines, e.g. Gauss
- a function describing positions and intensities of particular
components of the signal
The Fourier Transform of F(x)
~
1 / 2
F ( y )  2 

 F ( x ) exp  iyx dx

Determination of the function (x)
~( y)
F
 (x)  (2 )1/ 2  ~ exp(ixy)dy
K( y)


Computer Resolution Enhancement Method
1
The spectra consisting of
nine lines of different initial
resolution (1-3)
2
a) experimental spectra;
b) spectra after linear
transformation NURSE
3
a)
b)
HSR single pulse wave
Single pulse wave
Single pulse wave after
signal resolution
enhancement
HSR-PW can determine such parameters like: pulse rate,
oxygen saturation, parameter describing ventricle/aorta
volume ratio, pulsatility index, artery dynamic, index k1/k2
ventricle/aorta correlated with vascular resistance and much
more
Test of HSR PW analysis
Pulse wave recorded with pulse oximeter when the compression of palmar arch
arteries was performed
a) the standard record, b) record after HSR PW analysis.
a)
b)
HSR pulse wave analysis of the patient before a) and
after b) aortic valve surgery .
Results
The study involved twenty-four patients with hypertension and fifteen
healthy people as a control group. Registration of pulse wave involve a
standard CMS-50E digital pulse oximeter, placed on the left hand index
finger which allows measurement of oxygen saturation. The performed
tests, FMD (flow – mediated dilatation) and NID (nitroglycerin-induced
dilatation), describe temporary changes in the blood vessels.
The wireless OEM Pulse Oximeter model 3150 Nonin also has been
tested with finger sensor and an ear clip sensor to compare results of
HSR-PW from finger and ear pulse wave.
The standard pulse wave has been recorded, transferred by the Internet to
the analytical medical server and the HSR-PW analysis has been
performed. Computation time did not exceed 15 seconds so practically
analysis were done online.
Pulse wave after HSR PW analysis in the NID test: a) patients with
arterial hypertension, b)control group.
Pulse wave after HSR PW analysis in the FMD test; a) patients with
arterial hypertension, b)control group
HSR-PW analysis of an ear sensor of the pulse wave
a)
b)
HSR-PW of the healthy people recorded on finger sensor a) and an ear
sensor b) .
Left ear
Right ear
MONTE network in Poland
TelMedHome
Number of pulse wave examinations >8000 per month
It was found about
20% of the records with disruptions caused by the patients mobility or technical errors.
41% of recorded pulse waves were correct and all parameters were located in standard
range and
39% of obtained results were pathological
Pathological types of the records
49%
21%
14%
16%
Arrhythmia
Conclusions
It was concluded that High Signal Resolution Pulse
Wave (HSR-PW) and TelMedHome is a very good
system to the early detection of low cardiovascular
and the circulatory system abnormalities.
The increased resolution of HSR-PW enables to
observe a discrete pulse wave signal changes and
therefore may increase their clinical utility.
www.monte.net.pl
Thank You
Poznań
Hypertension group
Control group
HSR PW parameters
Before test
After 120s
After 240s
Before test
After 120s
After 240s
K1/K2
1,16 0,32
1,8 0,4
1,9 0,5
1,49 0,20
2,02
0,22
2,00 0,23
A1/AV
1,35 0,23
1,16
0,22
1,09 0,25
0,86 0,14
0,96
0,10
0,90 0,12
D1/AV
0,99 0,17
0,83
0,12
0,86 0,09
0,81 0,08
0,68
0,11
0,58 0,18
V/A
8,2 3,9
5,3 2,4
5,0 2,7
3,5 0,4
3,9 0,6
5,2 0,5
AV [a.u.]
PI [a.u.]
Before NTG
After NTG
Before NTG
After NTG
230 60
200 50
230 70
220 60
1,88 0,30
2,12 0,14
2,06 0,11
2,23 0,18
71 9
85 15
79 14
98 18
140 19
121 17
113 9
71 7
81 11
76 12
105 14
67 7
Pulse [BPM]
Systolic blond pressures [mmHg]
Diastolic blood pressures [mmHg]
Results
41%
20%
39%
Influence of drug
a)
b)
Pulse wave analysis result of HSR (numerically increased) a healthy
person a) and qualified for a heart transplantation b).
Standard pulse wave looks like the same in both cases.

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