Noninvasive cardiac output estimation using a novel photoplethysmogram index

Cardiac output (CO) monitoring is essential for indicating the perfusion status of the human cardiovascular system under different physiological conditions. However, it is currently limited to hospital use due to the need for either skilled operators or big, expensive measurement devices. Therefore, in this paper we devise a new CO indicator which can easily be incorporated into existing wearable devices. To this end, we propose an index, the inflection and harmonic area ratio (IHAR), from standard photoplethysmographic (PPG) signals, which can be used to continuously monitor CO. We evaluate the success of our index by testing on sixteen normotensive subjects before and after bicycle exercise. The results showed a strong intra-subject correlation between IHAR and CO_imp measured by the bio-impedance method in fifteen subjects (mean r = 3D 0.82, p<0.01). After least squares linear regression, the precision between CO_imp and CO estimated from IHAR (CO_IHAR) was 1.40 L/min. The total percentage error of the results was 16.2%, which was well below the clinical acceptance limit of 30%. The results suggest that IHAR is a promising indicator for wearable and noninvasive CO monitoring.