Hemodynamic analysis

• US 20040077953A1
• Filed: 10/18/2002
• Published: 04/22/2004
• Est. Priority Date: 10/18/2002
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Turcott, Robert G.
• Granted Patent: US 6,945,939 B2
• Time in Patent Office: Days
• US Class Current: 600/483
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/7207 of noise induced by motion artifacts
• CPC Class Codes: A61B 5/7285 for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal A61B6/5205, A61B6/541, A61B8/5207, A61B8/543 take precedence
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium

Abstract

To track significant changes in a hemodynamic variable of a living body regardless of measurement noise induced by cyclical functions of the body, the hemodynamic variable is measured at substantially the same instant during several cycles and the measured values compared to identify any statistically significant changes. The measurements may be discrete or continuous. The heart may be stimulated by a cardiac device during some of the cycles and parameters of the device such as the A-V delay of a pacemaker may be adjusted in accordance with the measured change in the hemodynamic variable, which may be, among others, blood pressure or blood volume.

Claims

1. A method of monitoring changes in a living body, the method comprising:

measuring a hemodynamic variable of a living body during two different cycles of a cyclical function of the body, the hemodynamic variable being measured at substantially the same instant in each cycle; and

comparing values of the hemodynamic variable measured during the two different cycles.

2. The method of claim 1, wherein measuring the hemodynamic variable comprises:

measuring the hemodynamic variable at a plurality of instants in each cycle.

3. The method of claim 1, wherein the cyclical function is respiration.

4. The method of claim 1, wherein the cyclical function is the heart beat.

5. The method of claim 1, wherein the cyclical function is selected from among the group of cyclical functions comprising circadian rhythm, digestion, and locomotion.

6. The method of claim 1, wherein the hemodynamic variable is blood flow rate.

7. The method of claim 1, wherein the hemodynamic variable is blood pressure.

8. The method of claim 1, wherein the hemodynamic variable is selected from among the group of hemodynamic variables comprising volume of vasculature, volume of cardiac chambers, stroke volume, oxygen consumption, heart sounds, respiration rate, tidal volume, blood gases, pH, and acceleration of the myocardium.

9. The method of claim 1, further comprising:

stimulating a heart beat of the living body during one of the two different cycles of the cyclical function with a cardiac stimulation device.

10. The method of claim 9, wherein the cardiac stimulation device is implanted in the body.

11. The method of claim 9, further comprising:

adjusting any one or more of an atrio-ventricular delay, an interchamber delay, and RV-LV delay, and an LA-LV delay of the cardiac stimulation device in accordance with a difference between the measured values.

12. The method of claim 1, further comprising:

controlling a cardiac stimulation device in accordance with a difference between the measured values.

13. The method of claim 12, wherein the cardiac stimulation device is implanted in the body.

14. The method of claim 1, wherein measuring the hemodynamic variable comprises:

measuring an average value of the hemodynamic variable for a length of time starting at substantially the same instant during each cycle.

15. The method of claim 14, wherein the cardiac device is selected from among the group of cardiac devices comprising pace makers, defibrillators, and cardioverters.

16. In an implantable cardiac stimulation device implanted in a patient'"'"'s body, a method comprising:

measuring a hemodynamic variable of the body at a first instant during a first cycle of a selected cyclical function of the body;

operating the cardiac device to stimulate the heart of the body during a second cycle of the function;

measuring the hemodynamic variable at an instant during the second cycle that is substantially the same as the first instant; and

adjusting an operating parameter of the cardiac device in accordance with a difference between values of the hemodynamic variable measured during the first and second cycles.

17. The method of claim 16, further comprising after adjusting the operating parameter:

measuring the hemodynamic variable at a second instant during a third cycle of the cyclical function;

operating the cardiac device to stimulate the heart during a fourth cycle of the function;

measuring the hemodynamic variable at an instant during the fourth cycle that is substantially the same as the second instant; and

adjusting the operating parameter a second time in accordance with a difference between values of the hemodynamic variable measured during the third and fourth cycles.

18. The method of claim 17, wherein adjusting the parameter a second time further comprises:

adjusting the operating parameter in accordance with a difference between values of the hemodynamic variable measured during the second cycle and the fourth cycle.

19. The method of claim 18, wherein the first and second instants are substantially the same.

20. The method of claim 18, wherein the parameter is an atrio-ventricular delay, an interchamber delay, and RV-LV delay, or an LA-LV delay.

21. The method of claim 16, wherein the cyclical function is respiration.

22. The method of claim 16, wherein the cyclical function is the heart beat.

23. The method of claim 16, wherein the cyclical function is selected from among the group of functions comprising circadian rhythm, digestion, and locomotion.

24. The method of claim 16, wherein the hemodynamic variable is blood flow rate.

25. The method of claim 16, wherein the hemodynamic variable is blood pressure.

26. The method of claim 16, wherein the hemodynamic variable is selected from among the group of hemodynamic variables comprising volume of vasculature, volume of cardiac chambers, stroke volume, oxygen consumption, heart sounds, respiration rate, tidal volume, blood gases, pH, and acceleration of the myocardium.

27. The method of claim 16, wherein measuring the hemodynamic variable during each of the cycles comprises:

measuring the average value of the hemodynamic variable over substantially the same length of time during each cycle.

28. A method of operating a cardiac stimulation device implanted in a patient and configured to provide pacing pulses to the heart of the patient, the method comprising:

measuring a hemodynamic variable of the patient at a first instant during a first respiratory cycle of the patient;

operating the cardiac device to stimulate the heart of the patient during a second respiratory cycle of the patient;

measuring the hemodynamic variable at an instant during the second respiratory cycle that is substantially the same as the first instant; and

adjusting any one or more of an atrio-ventricular delay, an interchamber delay, and RV-LV delay, and an LA-LV delay of the cardiac device in accordance with a difference between values of the hemodynamic variable measured during the first and second respiratory cycles.

29. The method of claim 28, further comprising after adjusting one or more delays:

measuring the hemodynamic variable at a second instant during a third respiratory cycle of the patient;

operating the cardiac device to stimulate the heart of the patient during a fourth respiratory cycle of the patient;

measuring the hemodynamic variable at an instant during the fourth respiratory cycle that is substantially the same as the second instant; and

adjusting the one or more delays a second time in accordance with a difference between values of the hemodynamic variable measured during the third and fourth cycles.

30. The method of claim 29, wherein the first and second instants are substantially the same.

31. The method of claim 29, wherein adjusting the one or more delays comprises:

adjusting the one or more delays to maximize the value of the hemodynamic variable.

32. The method of claim 29, wherein adjusting the one or more delays comprises:

adjusting the one or more delays to minimize the value of the hemodynamic variable.

33. The method of claim 28, wherein the hemodynamic variable is blood flow rate.

34. The method of claim 28, wherein the hemodynamic variable is blood pressure.

35. The method of claim 28, wherein the hemodynamic variable is selected from among the group of hemodynamic variables comprising volume of vasculature, volume of cardiac chambers, stroke volume, oxygen consumption, heart sounds, respiration rate, tidal volume, blood gases, pH, and acceleration of the myocardium.

36. An apparatus for monitoring changes in a living body, comprising:

a detector configured to measure a hemodynamic variable of a living body during two different cycles of a cyclical function of the body and at substantially the same instant in each cycle; and

a controller configured to compare values of the hemodynamic variable measured during the two different cycles.

37. The apparatus of claim 36, wherein the detector is configured for measuring the hemodynamic variable at a plurality of instants in each cycle.

38. The apparatus of claim 36, wherein the detector is configured for measuring the hemodynamic variable during cycles of any one or more of the heart beat, respiration, circadian rhythm, digestion, and locomotion of the patient.

39. The apparatus of claim 36, wherein the detector is configured for measuring any one or more of the blood flow rate, blood pressure, volume of vasculature, volume of cardiac chambers, stroke volume, oxygen consumption, heart sounds, respiration rate, tidal volume, blood gases, pH, and acceleration of the myocardium of the patient.

40. The apparatus of claim 36, wherein the controller is configured for selecting an operating parameter of the apparatus in accordance with a difference between values of the hemodynamic variable measured during the two different cycles.

41. The apparatus of claim 40, wherein the apparatus is a cardiac stimulation device configured for stimulating the heart beat of the patient.

42. The apparatus of claim 41, wherein the controller is configured for selecting a pacing parameter of the apparatus in accordance with a difference between values of the hemodynamic variable measured during the two different cycles.

43. The apparatus of claim 42, wherein the pacing parameter is an atrio-ventricular delay, an interchamber delay, and RV-LV delay, or an LA-LV delay of the apparatus.

44. The apparatus of claim 41, wherein the apparatus is configured to be implanted in the body.

45. The apparatus of claim 36, wherein the detector is configured for measuring an average value of the hemodynamic variable for a length of time starting at substantially the same instant during each cycle.