Measurement of cardiac cycle length and pressure metrics from pulmonary arterial pressure

• US 10,226,630 B2
• Filed: 01/25/2016
• Issued: 03/12/2019
• Est. Priority Date: 07/28/2010
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Greenhut, Saul E, Taepke, Robert T, Bloem, David R, Cho, Yong K, Salmi, Donna M
• Primary Examiner(s): Natnithithadha, Navin
• Assistant Examiner(s): Messersmith, Eric
• Application Number:
  US15/005,533
• Publication Number:
  US 20160220825A1
• Time in Patent Office: 1,142 Days
• Field of Search: None
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/6847 mounted on an invasive device
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/6869 Heart
• CPC Class Codes: A61B 5/6876 Blood vessel
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61M 2205/054 with electrotherapy
• CPC Class Codes: A61M 2210/125 Heart
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

Various techniques for measuring cardiac cycle length and pressure metrics based on pulmonary artery pressures are described. One example method described includes identifying a point within a derivative signal of a cardiovascular pressure signal without reference to electrical activity of a heart, initiating a time window from the identified point in the derivative signal, identifying a point within the cardiovascular signal within the time window, and determining at least one of a systolic pressure or diastolic pressure based on the identified point.

Claims

1. A method of monitoring a cardiovascular pressure signal in a medical device, the method comprising:

identifying, by a medical device, a point within a derivative signal of the cardiovascular pressure signal without reference to electrical activity of a heart;

initiating, by the medical device, a time window extending backward in time from the identified point in the derivative signal;

identifying, by the medical device, a point within the cardiovascular pressure signal and within the time window; and

determining, by the medical device, a diastolic pressure based on the identified point within the cardiovascular pressure signal.

2. The method of claim 1, wherein the derivative signal is a first derivative signal, and wherein identifying, by the medical device, a point within the derivative signal of the cardiovascular pressure signal without reference to electrical activity of the heart comprises:

identifying a maximum value of the first derivative signal.

3. The method of claim 2, wherein the time window extends backward in time from the identified maximum value of the first derivative signal, the method further comprising:

identifying, by the medical device, a point within a second derivative signal of the cardiovascular pressure signal within the time window without reference to electrical activity of the heart.

4. The method of claim 3,

wherein the point within the second derivative signal of the cardiovascular pressure signal is a point of a maximum value of the second derivative signal within the window,

wherein identifying, by the medical device, the point within the cardiovascular pressure signal within the time window extending backward in time comprises identifying the point within the cardiovascular pressure signal within the time window that corresponds in time to the identified point of the maximum value of the second derivative signal, and

wherein determining the diastolic pressure comprises determining the diastolic pressure based on the identified point within the cardiovascular pressure signal within the time window that corresponds in time to the identified point of the maximum value of the second derivative signal.

5. The method of claim 1, wherein the time window comprises a variable temporal length.

6. The method of claim 1, wherein the time window comprises a fixed temporal length.

7. The method of claim 1, further comprising:

controlling, based on the determination of the diastolic pressure, delivery of at least one of electrical stimulation or a therapeutic agent.

18. The method of claim 5, wherein the variable temporal length is determined based on a plurality of cardiac cycle lengths.

19. The method of claim 1, further comprising:

receiving, by a processor of the medical device and from a pressure sensor implanted in a pulmonary artery, the cardiovascular pressure signal generated by the pressure sensor; and

determining, by the processor, the derivative signal of the cardiovascular pressure signal.

29. The method of claim 1, wherein the time window comprises a length less than a cardiac cycle length.

8. A medical device system for monitoring a cardiovascular pressure signal, the system comprising:

at least one pressure sensor to generate the cardiovascular pressure signal; and

processing circuitry configured to;

identify a point within a derivative signal of the cardiovascular pressure signal without reference to electrical activity of a heart;

initiate a time window extending backward in time from the identified point in the derivative signal;

identify a point within the cardiovascular pressure signal and within the time window; and

determine a diastolic pressure based on the identified point within the cardiovascular pressure signal.

9. The system of claim 8, wherein the derivative signal is a first derivative signal, and wherein the processing circuitry is configured to identify the point within the derivative signal of the cardiovascular pressure signal without reference to electrical activity of a heart by at least:

identifying a maximum value of the first derivative signal.

10. The system of claim 9, wherein the time window extends backward in time from the identified maximum value of the first derivative signal, the processing circuitry further configured to:

identify a point within a second derivative signal of the cardiovascular pressure signal within the time window extending backward in time without reference to electrical activity of the heart.

11. The system of claim 10,

wherein the point within the second derivative signal of the cardiovascular pressure signal is a point of a maximum value of the second derivative signal within the time window,

wherein the processing circuitry is configured to identify the point within the cardiovascular pressure signal within the time window extending backward in time by identifying the point within the cardiovascular pressure signal within the time window that corresponds in time to the identified point of the maximum value of the second derivative signal, and

wherein the processing circuitry is configured to determine the diastolic pressure based on the identified point within the cardiovascular pressure signal within the time window that corresponds in time to the identified point of the maximum value of the second derivative signal.

12. The system of claim 8, wherein the time window comprises a variable temporal length.

13. The system of claim 8, wherein the time window comprises a fixed temporal length.

14. The system of claim 8, further comprising:

at least one medical device configured to deliver, based on the determination of the diastolic pressure, at least one of electrical stimulation or a therapeutic agent.

20. The system of claim 8, further comprising a telemetry module configured to receive the cardiovascular pressure signal from the at least one pressure sensor via wireless communication.

15. A computer-readable storage medium comprising instructions that, when executed, cause a processor of a medical device to:

identify a point within a derivative signal of the cardiovascular pressure signal without reference to electrical activity of a heart;

initiate a time window extending backward in time from the identified point in the derivative signal;

identify a point within the cardiovascular pressure signal and within the time window; and

determine a diastolic pressure based on the identified point within the cardiovascular pressure signal.

16. The computer-readable storage medium of claim 15, wherein the derivative signal is a first derivative signal, and wherein the instructions that, when executed, cause the processor to identify the point within the derivative signal of the cardiovascular pressure signal without reference to electrical activity of the heart comprise instructions that, when executed, cause the processor to:

identify a maximum value of the first derivative signal.

17. The computer-readable storage medium of claim 15, further comprising instructions that, when executed, cause the processor to control, based on the determination of the diastolic pressure, delivery of at least one of electrical stimulation or a therapeutic agent.

21. A system for monitoring a cardiovascular pressure signal, the system comprising:

at least one implantable pressure sensor configured to be implanted within a pulmonary artery and generate the cardiovascular pressure signal indicative of fluid pressure in the pulmonary artery; and

an implantable medical device distinct from the at least one implantable pressure sensor and comprising processing circuitry configured to;

receive the cardiovascular pressure signal from the at least one implantable pressure sensor;

identify a point within a derivative signal of the cardiovascular pressure signal without reference to electrical activity of a heart;

initiate a time window extending backward in time from the identified point in the derivative signal;

identify a point within the cardiovascular pressure signal and within the time window; and

determine a diastolic pressure based on the identified point within the cardiovascular pressure signal.

22. The system of claim 21, wherein the implantable medical device is configured to deliver, based on the determination of the diastolic pressure, at least one of electrical stimulation or a therapeutic agent.

23. A method of monitoring a pulmonary artery pressure signal, the method comprising:

receiving, by an implantable medical device and via wireless communication, the pulmonary artery pressure signal from an implantable pressure sensor implanted within a pulmonary artery;

identifying, by the implantable medical device, a point within a derivative signal of a pulmonary artery pressure signal without reference to electrical activity of a heart;

initiating, by the implantable medical device, a time window extending backward in time from the identified point in the derivative signal;

identifying, by the implantable medical device, a point within the pulmonary artery pressure signal and within the time window; and

determining, by the implantable medical device, diastolic pressure based on the identified point within the pulmonary artery pressure signal.

24. The method of claim 23, wherein:

the derivative signal is a first derivative signal, and wherein identifying, by the implantable medical device, the point within the derivative signal of the pulmonary artery pressure signal without reference to electrical activity of the heart comprises identifying a maximum value of the first derivative signal,

the time window extends backward in time from the identified maximum value of the first derivative signal, the method further comprising identifying, by the medical device, a point within a second derivative signal of the pulmonary artery pressure signal within the time window without reference to electrical activity of the heart,

the point within the second derivative signal of the pulmonary artery pressure signal is a point of a maximum value of the second derivative signal within the window,

identifying, by the implantable medical device, the point within the pulmonary artery signal within the time window extending backward in time comprises identifying the point within the pulmonary artery pressure signal within the time window that corresponds in time to the identified point of the maximum value of the second derivative signal, and

determining the diastolic pressure comprises determining the diastolic pressure based on the identified point within the pulmonary artery pressure signal within the time window that corresponds in time to the identified point of the maximum value of the second derivative signal.

25. A method of monitoring a pulmonary artery pressure signal, the method comprising:

identifying, by a medical device, a point within a derivative signal of the pulmonary artery pressure signal without reference to electrical activity of a heart, the pulmonary artery pressure generated by an implantable pressure sensor comprising a processor and disposed within the pulmonary artery, wherein the implantable pressure sensor is distinct from the medical device;

initiating, by the medical device, a time window from the identified point in the derivative signal;

identifying, by the medical device, a point within the pulmonary artery pressure signal and within the time window; and

determining, by the medical device, at least one of a systolic pressure or diastolic pressure based on the identified point within the pulmonary artery pressure signal.

26. The method of claim 25, wherein the derivative signal is a first derivative signal, and wherein identifying, by the medical device, the point within the derivative signal of the pulmonary artery pressure signal without reference to electrical activity of the heart comprises identifying a maximum value of the first derivative signal.

27. The method of claim 26,

wherein the time window extends forward in time from the identified maximum value of the first derivative signal,

wherein identifying, with the medical device, the point within the pulmonary artery signal within the time window comprises identifying a point of maximum value within the cardiovascular pressure signal within the time window, and

wherein determining, with the medical device, the at least one of systolic pressure or diastolic pressure comprises determining the systolic pressure based on the identified point of maximum value within the pulmonary artery signal within the time window.

28. The method of claim 26, wherein:

the time window extends backward in time from the identified maximum value of the first derivative signal, the method further comprising identifying, by the medical device, a point within a second derivative signal of the pulmonary artery pressure signal within the time window without reference to electrical activity of the heart,

the point within the second derivative signal of the pulmonary artery pressure signal is a point of a maximum value of the second derivative signal within the window,

identifying, by the medical device, the point within the pulmonary artery signal within the time window extending backward in time comprises identifying the point within the pulmonary artery signal within the time window that corresponds in time to the identified point of the maximum value of the second derivative signal, and

determining the diastolic pressure comprises determining the diastolic pressure based on the identified point within the pulmonary artery pressure signal within the time window that corresponds in time to the identified point of the maximum value of the second derivative signal.