Pulse Decomposition Analysis Algorithm using Central Arterial Blood Pressure
Validation of the Pulse Decomposition Analysis Algorithm using Central Arterial Blood Pressure Martin C Baruch PhD 1*, Kambiz Kalantarinia MD 2, Cynthia M. Petersen RN 2, David W Gerdt PhD 1, Charles M Adkins PhD 1 1 Empirical Technologies Corporation, PO Box 8175, 3046A Berkmar Drive, Charlottesville, Virginia, 22906, USA 2 Department of Nephrology, University of Virginia School of Medicine, Charlottesville , Virginia, 22901, USA Abstract Background: Pulse Decomposition Analysis (PDA) is based on the premise that the peripheral arterial pressure pulse is a superposition of five individual component pressure pulses, the first of which is due to the left ventricular ejection from the heart while the remaining component pressure pulses are reflections and re-reflections that originate from only two reflection sites within the central arteries. The hypothesis examined here is that the PDA parameter P2P1, the ratio of the amplitude of the renal reflection pulse P2 and the amplitude of the left ventricular ejection pulse P1 correlates with systolic blood pressure while T13, the timing delay between the first and third component pulses, correlates with pulse pressure. Central arterial blood pressures of patients (38 m/25 f, mean age: 62.7 y, SD: 11.5 y, mean height: 172.3 cm, SD: 9.7 cm, mean weight: 86.8 kg, SD: 20.1 kg) undergoing cardiac diagnostic treatment were monitored using central line catheters while P2P1 and T13 were simultaneously measured in the arterial periphery using the CareTaker physiological monitoring platform. Results: Validation of the PDA model was achieved with the direct observation of the five component pressure pulses (P1 through P5) in the central arteries using central line catheters. Statistically significant correlations between P2P1 and systole and T13 and pulse pressure were established. Bland-Altman comparisons between blood pressures obtained through the conversion of PDA parameters to blood pressures with catheter-obtained blood pressures fell within the trend guidelines of the AMII SP-10 standard (standard deviation: 8 mmHg). Conclusions: The results strongly support the comprehensive, simple, and physical picture proposed by the PDA model, in particular the notion that all of the features of the pressure pulse envelope, whether in the central arteries or in the arterial periphery, can be explained by the interaction of the left ventricular ejection pressure pulse with two centrally located reflection sites.