Percussion Entropy Analysis of Synchronized ECG and PPG Signals as a Prognostic Indicator for Future Peripheral Neuropathy in Type 2 Diabetic Subjects

Hai-Cheng Wei; Na Ta; Wen-Rui Hu; Sheng-Ying Wang; Ming-Xia Xiao; Xiao-Jing Tang; Jian-Jung Chen; Hsien-Tsai Wu

doi:10.3390/diagnostics10010032

Percussion Entropy Analysis of Synchronized ECG and PPG Signals as a Prognostic Indicator for Future Peripheral Neuropathy in Type 2 Diabetic Subjects

Diagnostics (Basel). 2020 Jan 9;10(1):32. doi: 10.3390/diagnostics10010032.

Authors

Hai-Cheng Wei^{1

2}, Na Ta¹, Wen-Rui Hu¹, Sheng-Ying Wang¹, Ming-Xia Xiao¹, Xiao-Jing Tang³, Jian-Jung Chen⁴, Hsien-Tsai Wu⁵

Affiliations

¹ School of Electrical and Information Engineering, North Minzu University, No. 204 North Wenchang Street, Yinchuan 750021, Ningxia, China.
² Basic Experimental Teaching and Engineering Training Center, North Minzu University, No. 204 North Wenchang Street, Yinchuan 750021, Ningxia, China.
³ School of Science, Ningxia Medical University, No. 1160 Shengli Street, Yinchuan 750004, Ningxia, China.
⁴ Taichung Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taichung 42743, Taiwan.
⁵ Department of Electrical Engineering, Dong Hwa University, No. 1, Sec. 2, Da Hsueh Rd., Shoufeng, Hualien 97401, Taiwan.

Abstract

Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes. It has become an essential public health crisis, especially for care in the home. Synchronized electrocardiogram (ECG) and photoplethysmography (PPG) signals were obtained from healthy non-diabetic (n = 37) and diabetic (n = 85) subjects without peripheral neuropathy, recruited from the diabetic outpatient clinic. The conventional parameters, including low-/high-frequency power ratio (LHR), small-scale multiscale entropy index (MEI_SS), large-scale multiscale entropy index (MEI_LS), electrocardiogram-based pulse wave velocity (PWV_mean), and percussion entropy index (PEI), were computed as baseline and were then followed for six years after the initial PEI measurement. Three new diabetic subgroups with different PEI values were identified for the goodness-of-fit test and Cox proportional Hazards model for relative risks analysis. Finally, Cox regression analysis showed that the PEI value was significantly and independently associated with the risk of developing DPN after adjustment for some traditional risk factors for diabetes (relative risks = 4.77, 95% confidence interval = 1.87 to 6.31, p = 0.015). These findings suggest that the PEI is an important risk parameter for new-onset DPN as a result of a chronic complication of diabetes and, thus, a smaller PEI value can provide valid information that may help identify type 2 diabetic patients at a greater risk of future DPN.

Keywords: diabetic peripheral neuropathy (DPN); electrocardiogram (ECG); percussion entropy index (PEI); photoplethysmography (PPG); type 2 diabetes.