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  • Mestrado Integrado em Engenharia Biomdica

    Faculdade de Cincia e Tecnologia da Universidade de Coimbra

    Validation of non invasive electromechanical

    sensors for cardiac monitoring

    Clinical trials and implementation of data mining techniques

    Joo Manuel de Olim Perestrelo Borba

    Coimbra, September 2012

  • Validation of non invasive electromechanical

    sensors for cardiac monitoring

    Clinical trials and implementation of data mining techniques

    Scientific Advisors:

    PhD Professor Carlos M. B. A. Correia

    PhD Joo Manuel Rendeiro Cardoso

    Scientific Supervisor:

    MsC Vnia Maria Gomes de Almeida

    Joo Manuel de Olim Perestrelo Borba

    Coimbra, September 2012

    Dissertation presented to the University of

    Coimbra to complete the necessary

    requirements to obtain the MSc degree in

    Biomedical Engineering

  • Esta cpia da tese fornecida na condio de que quem a consulta reconhece que os

    direitos de autor so pertena da Universidade de Coimbra e que nenhuma citao ou

    informao obtida a partir dela pode ser publicada sem a referncia apropriada.

    This copy of the thesis has been supplied on condition that anyone who consults it is

    understood to recognize that its copyright rests with University of Coimbra and that no

    quotation from the thesis and no information derived from it may be published without

    proper acknowledgement.

  • This work is funded by FEDER, through the Programa

    Operacional Factores de Competitividade - COMPETE and by

    National funds through FCT Fundao para a Cincia e

    Tecnologia in the frame of Centro de Instrumentao

    Unidade217.

  • The real voyage of discovery consists

    not in seeking new landscapes, but in

    having new eyes.

    - Marcel Proust

  • Ao meu pai, que continua

    a olhar por mim.

  • i

    Acknowledgements

    From all the lessons that life has taught me so far, there is one that will surely endure

    through my personal and professional future: that with hard work and perseverance, there is no

    goal that cannot be achieved. However, I would have not succeeded without the help and

    support of everyone who accompanied me along the road.

    First of all, I would like to thank my family, especially my mother, sister and

    grandparents, for all their constant love and support throughout my studies. A special thanks to

    my dear Carolina, for all her love and for helping me achieve a piece of mind when I most need

    it.

    I would like to express my great appreciation to Prof. Dr. Carlos Correia and Dr. Joo

    Cardoso, for all their guidance and support. I am grateful to my supervisor Vnia Almeida, for

    all her encouragement and mentoring, which was very important in achieving success in this

    project. I thank my work colleagues Ins Santos, Andr Cortez, Mariana Sequeira, Anurati

    Saha, Pedro Santos and Pedro Vaz, for all their help and companionship during these past ten

    months.

    I also want to thank to my apartment colleagues, Tiago and Andr, for their close

    friendship. Last, but not least, a special thanks to my university colleagues, Srgio Pinto and

    Susete Neiva, for helping me in overcoming all the obstacles along the course.

    To Nuno, a friend whom I will never forget.

    Thank you all.

    - Joo Borba

  • iii

    Abstract

    Nowadays, arterial stiffness assumes special importance as the result of being a marker

    of cardiovascular diseases (CVD), which are the leading cause of disability and worldwide. The

    development of diagnostic tools capable of performing an early and precise quantification of

    pathologic states such as arterial stiffness presents itself as a global strategy to reduce

    cardiovascular (CV) morbidity and mortality.

    A non invasive (PZ) technology for arterial distension waveform (ADW) monitoring

    in the carotid artery has been successfully developed and tested in the past few years. This

    piezoelectric (PZ) device allows the extraction of clinically important information concerning

    arterial stiffness, presenting itself as a practical solution in premature CV risk assessment.

    This project consisted not only in the first clinical trials of the previously developed

    device with the performance of repeatability tests, but also in the application of innovative data

    mining tools such as classification and clustering approaches, with the objective of developing

    innovate decision support systems for CV risk estimation. Finally, a case study was also carried

    out in patients that suffered from severe stenosis to prove the usefulness of this technology.

    Excellent repeatability results between trials were obtained. Furthermore, the ability to

    detect physiological variations after surgical procedures has demonstrated the clinical feasibility

    of this equipment. Data mining methodologies have also shown their effectiveness in premature

    CV risk determination.

    Keywords: Arterial Stiffness, Arterial Distension Waveform, Piezoelectric Sensor,

    Clinical Trials Data Mining.

  • v

    Resumo

    Atualmente, a rigidez arterial assume especial importncia pelo facto de ser um

    marcador de doenas cardiovasculares, que so a principal causa de incapacidade e morte no

    mundo. O desenvolvimento de ferramentas de diagnstico que so capazes de realizar uma

    quantificao exata e prematura de estados patolgicos como a rigidez arterial apresenta-se

    como uma estratgia global para reduzir a morbidade e mortalidade cardiovascular.

    Com o intuito de monitorizar a onda de distenso arterial na cartida, uma tecnologia

    no invasiva foi desenvolvida e testada com sucesso durante os ltimos anos. Esteve

    dispositivo piezoeltrico permite a extrao de informaes clinicamente importantes sobre a

    rigidez arterial, apresentando-se como uma soluo prtica na avaliao do risco cardiovascular

    prematuro.

    Este projeto consistiu no s no incio dos primeiros testes clnicos do dispositivo

    previamente desenvolvido com a realizao de testes de repetibilidade, mas tambm na

    aplicao de ferramentas inovadoras de minerao de dados atravs de abordagens

    classificativas e de agrupamento. Por ltimo, um caso de estudo foi realizado em doentes com

    estenose severa de forma a provar a utilidade desta tecnologia.

    Foram obtidos excelentes resultados em termos da repetibilidade entre ensaios

    consecutivos. Alm disso, a capacidade de detetar variaes fisiolgicas aps procedimentos

    cirrgicos demonstrou a aplicabilidade clnica deste equipamento. As metodologias de

    minerao de dados tambm mostraram a sua eficcia na determinao prematura de risco

    cardiovascular.

    Palavras Chave: Rigidez Arterial, Onda de Distenso Arterial, Sensor Piezoeltrico,

    Ensaios Clnicos, Minerao de Dados.

  • vii

    Contents

    Acknowledgements ..................................................................................................................i

    Abstract ................................................................................................................................. iii

    Resumo .................................................................................................................................... v

    Contents ................................................................................................................................ vii

    List of Figures ......................................................................................................................xiii

    List of Tables ....................................................................................................................... xvii

    Acronyms ............................................................................................................................. xxi

    List of Original Papers ....................................................................................................... xxiii

    1. Introduction ................................................................................................................ 1

    1.1 Motivation .................................................................................................................... 1

    1.2 Previous work............................................................................................................... 2

    1.3 Objectives .................................................................................................................... 3

    1.4 Project team composition .............................................................................................. 4

    1.5 Contents by chapter ...................................................................................................... 4

    2. Theoretical Background ............................................................................................. 7

    2.1 Cardiosvacular system .................................................................................................. 7

    2.1.1 The heart .......................................................................................................... 7

    2.1.2 Common carotid artery ..................................................................................... 8

    2.2 Arterial stiffness ........................................................................................................... 8

    2.2.1 Arterial structure .........................

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