Dicrotic Notch (DN), one of the most significant and indicative features of the arterial blood pressure (ABP) waveform, becomes less pronounced and thus harder to identify as a matter of aging and pathological vascular stiffness. Generalizable and automatic DN identification for such edge cases is even more challenging in the presence of unexpected ABP waveform deformations that happen due to internal and external noise sources or pathological conditions that cause hemodynamic instability. We propose a physics-aware approach, named Physiowise (PW), that first employs a cardiovascular model to augment the original ABP waveform and reduce unexpected deformations, then apply a set of predefined rules on the augmented signal to find DN locations. We have tested the proposed method on in-vivo data gathered from 14 pigs under hemorrhage and sepsis study. Our result indicates 52% overall mean error improvement with 16% higher detection accuracy within the lowest permitted error range of 30ms. An additional hybrid methodology is also proposed to allow combining augmentation with any application-specific user-defined rule set.
Keywords: Dicrotic Notch identification; Hemorrhage; Model-based approaches; Rule-based approaches; Sepsis.