Purpose. The aim of the paper is to evaluate skin microcirculation in patients with lower extremity PAD before and after conservative therapy and endovascular revascularization by originally developed technique of wavelet analyses of skin temperature together with biochemical markers of endothelial dysfunction. Methods. The study included 17 healthy (44-61 years) and 38 pathological subjects (58-75 years). Patients with PAD were divided into four groups according to the stage of chronic limb ischemia. The study protocol contained biochemical and instrumental methods for the assessment of the functional state of the microcirculation. Results. Significant differences in biochemical and instrumental markers of endothelial dysfunction were observed in the pathological group in comparison with the control group. Examination of patients with PAD two weeks after treatment showed that the levels of inflammation and endothelial dysfunction markers, namely homocysteine, von Willebrand factor and endothelin, became lower. Conclusion. The results of the wavelet analysis of skin temperature applied together with the local heating test indicated the adequate responses of the microcirculation system to physiological stimuli. The outcome of medical PAD treatment is improvement of the microcirculatory function and specific biochemical markers of endothelial function.
Laser Doppler flowmetry (LDF) was utilized for blood ow measurements. Wavelet analysis was used to identify spectral characteristics of the LDF signal in patients with rheumatic diseases and diabetes mellitus. Baseline measurements were applied for both pathological groups. Blood flow oscillations analyses were performed by means of the wavelet transform.
Higher baseline perfusion was observed in both pathological groups in comparison to controls. Differences in the spectral properties between the groups studied were revealed. The results obtained demonstrated that spectral properties of the LDF signal collected in basal conditions may be the signature of microvasculature functional state.
Laser Doppler flowmetry (LDF) has been applied for the assessment of variation in blood microflows in patients with rheumatic diseases and healthy volunteers. Oscillations of peripheral blood microcirculation observed by LDF have been analyzed utilizing a wavelet transform. A higher amplitude of blood microflow oscillations has been observed in a high frequency band (over 0.1 Hz) in patients with rheumatic diseases. Oscillations in the high frequency band decreased in healthy volunteers in response to the cold pressor test, whereas lower frequency pulsations prevailed in patients with rheumatic diseases. A higher perfusion rate at normal conditions was observed in patients, and a weaker response to cold stimulation was observed in healthy volunteers. Analysis of blood microflow oscillations has a high potential for evaluation of mechanisms of blood flow regulation and diagnosis of vascular abnormalities associated with rheumatic diseases.
Nowadays together with known optic techniques of microcirculation blood flow monitoring, skin temperature measurements are developed as well. In this paper, a simple one-dimensional bioheat transfer model was developed to analyse the heat wave transport in biological tissue, where an arteriole vessel with pulsatile blood is located. The simulated results show that the skin temperature oscillation amplitudes attenuate with the increase of blood flow oscillation frequency which gives the same tendency as that in the experiments. The parameter analyses further show that the amplitude of oscillation is also influenced by oscillation amplitude of blood and effective thermal conductivity. When oscillation amplitude of blood flow and effective thermal conductivity increase, the amplitude of skin temperature oscillation increases nonlinearly. Variation of effective thermal convective influence to the time delay of the thermal wave on the skin surface and distort it. Combination of two measurement techniques: one for estimation blood flow oscillations in the microvessels and other to the skin temperature measurement can produce additional information about the skin properties.
Signals from laser Doppler flowmeters widely used in intravital studies of skin blood flow include, along with a slowly varying average component, an oscillating part. However, in most clinical studies, pulsations are usually smoothed by data preprocessing and only the mean blood flow is analyzed. To reveal the relationship between average and oscillating perfusion components measured by a laser Doppler flowmeter, we examined the microvascular response to the contralateral cold pressor test recorded at two different sites of the hand: dorsal part of the arm and finger pad. Such a protocol makes it possible to provide a wide range of perfusion. The average perfusion always decreases during cooling, while the oscillating component demonstrates a differently directed response. The wavelet analysis of laser Doppler flowmetry (LDF) signals shows that the pulsatile component is nonlinearly related to the average perfusion. Under low perfusion, the amplitude of pulsations is proportional to its mean value, but, as perfusion increases, the amplitude of pulsations becomes lower. The type of response is defined by the basal perfusion and the degree of vasoconstriction caused by cooling. Interpretation of the results is complicated by the nonlinear transfer function of the LDF device, the contribution of which is studied using artificial examples.
Photoplethysmography (PPG) and laser Doppler flowmetry (LDF) are two recognized optical techniques that can track low-frequency perfusion changes in microcirculation. The aim of this study was to determine, in healthy subjects, the correlation between the techniques for specific low-frequency bands previously defined for microcirculation. Twelve healthy male subjects (age range 18 to 50 years) were studied, with PPG and LDF signals recorded for 20 min from their right and left index (PPG) and middle (LDF) fingers. Wavelet analysis comprised dividing the low-frequency integral wavelet spectrum (IWS) into five established physiological bands relating to cardiac, respiratory, myogenic, neurogenic, and endothelial activities. The correlation between PPG and LDF was quantified using wavelet correlation analysis and Spearman correlation analysis of the median IWS amplitude. The median wavelet correlation between signals (right-left side average) was 0.45 (cardiac), 0.49 (respiratory), 0.86 (myogenic), 0.91 (neurogenic), and 0.91 (endothelial). The correlation of IWS amplitude values (right-left side average) was statistically significant for the cardiac (ρ=0.64, p<0.05) and endothelial (ρ=0.62, p<0.05) bands. This pilot study has shown good correlation between PPG and LDF for specific physiological frequency bands. In particular, the results suggest that PPG has the potential to be a low-cost replacement for LDF for endothelial activity assessments.
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