Saritas Turgay, Greber Ruth, Venema Boudewijn, Puelles Victor G, Ernst Sabine, Blazek Vladimir, Floege Jürgen, Leonhardt Steffen, Schlieper Georg
Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Germany.
Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany.
Clin Kidney J. 2019 Jan 25;12(4):538-545. doi: 10.1093/ckj/sfy135. eCollection 2019 Aug.
Chronic kidney disease (CKD) patients have an increased risk for coronary artery disease (CAD) and myocardial infarction. Therefore, there is a need to identify CKD patients at high risk of CAD. Coronary angiography, the gold standard for detecting CAD, carries a risk of serious adverse events.
Here, we assessed the validity of a novel non-invasive reflectance mode photoplethysmography (PPG) sensor for the evaluation of CAD in patients with advanced CKD. PPG signals were generated using green and infrared wavelengths and recorded from fingers of 98 patients. The detected signal has the shape of the pulse wave contour carrying information about the vascular system, that is, arterial stiffness. We studied four patient groups: (i) controls-patients without CKD or CAD; (ii) CKD alone; (iii) CAD alone (confirmed by coronary angiography); and (iv) CKD and CAD combined.
With advancing age, we observed a steeper ascending signal during systole and greater signal decline during diastole (infrared wavelength: Slopes 4-6, P = 0.002, P = 0.003 and P = 0.014, respectively; green wavelength: Slopes 2-3, P = 0.006 and P = 0.005, respectively). Presence of CAD was associated with a slower signal decline during diastole in CKD patients compared with those without CAD (infrared wavelength: Slope 1, P = 0.012). CKD was associated with lower blood volume amplitude during each cardiac cycle compared with those without CKD (R-value, P = 0.022).
PPG signal analyses showed significant differences between our groups, and it may be a potentially useful tool for the detection of CAD in CKD patients.
慢性肾脏病（CKD）患者患冠状动脉疾病（CAD）和心肌梗死的风险增加。因此，有必要识别出CAD高危的CKD患者。冠状动脉造影作为检测CAD的金标准，存在严重不良事件风险。
在此，我们评估了一种新型无创反射模式光电容积脉搏波描记法（PPG）传感器在评估晚期CKD患者CAD方面的有效性。使用绿色和红外波长生成PPG信号，并从98例患者的手指记录信号。检测到的信号具有携带血管系统信息即动脉僵硬度的脉搏波轮廓形状。我们研究了四组患者：（i）对照组——无CKD或CAD的患者；（ii）单纯CKD患者；（iii）单纯CAD患者（经冠状动脉造影确诊）；以及（iv）CKD合并CAD患者。
随着年龄增长，我们观察到收缩期信号上升更陡峭，舒张期信号下降更明显（红外波长：斜率分别为4 - 6，P = 0.002、P = 0.003和P = 0.014；绿色波长：斜率分别为2 - 3，P = 0.006和P = 0.005）。与无CAD的CKD患者相比，CAD的存在与CKD患者舒张期信号下降较慢有关（红外波长：斜率1，P = 0.012）。与无CKD的患者相比，CKD与每个心动周期中较低的血容量振幅有关（R值，P = 0.022）。
PPG信号分析显示我们的研究组之间存在显著差异，它可能是检测CKD患者CAD的潜在有用工具。
