Managing preload reserve by tracking the ventricular operating point with heart sounds

• US 20070027400A1
• Filed: 07/26/2005
• Published: 02/01/2007
• Est. Priority Date: 07/26/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Wariar, Ramesh, Siejko, Krzysztof, Carlson, Gerrard
• Granted Patent: US 7,585,279 B2
• Time in Patent Office: Days
• US Class Current: 600/528
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• 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 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/37 Monitoring; Protecting

Abstract

A system and method for managing preload reserve and tracking the inotropic state of a patient'"'"'s heart. The S1 heart sound is measured as a proxy for direct measurement of stroke volume. The S3 heart sound may be measured as a proxy for direct measurement of preload level. The S1-S3 pair yield a point on a Frank Starling type of curve, and reveal information regarding the patient'"'"'s ventricular operating point and inotropic state. As an alternative, or in addition to, measurement of the S3 heart sound, the S4 heart sound may be measured or a direct pressure measurement may be made for the sake of determining the patient'"'"'s preload level. The aforementioned measurements may be made by a cardiac rhythm management device, such as a pacemaker or implantable defibrillator.

Claims

1. A method comprising:

monitoring an S1 heart sound emitted by a heart of a patient;

monitoring a proxy variable indicating preload exhibited by the heart;

determining whether the heart has exhibited an inotropic state change, using at least the S1 heart sound and the proxy variable.

2. The method of claim 1, wherein monitoring a proxy variable comprises monitoring an S3 heart sound.

3. The method of claim 1, wherein monitoring a proxy variable comprises monitoring an S4 heart sound.

4. The method of claim 1, wherein monitoring a proxy variable comprises measuring blood pressure in the right ventricle.

5. The method of claim 1, wherein monitoring a proxy variable comprises measuring blood pressure in the pulmonary artery.

6. The method of claim 1, further comprising:

administering an inotrope to the patient; and

controlling administration of the inotrope to obtain a desired inotropic state change.

7. The method of claim 1, further comprising adjusting cardiac resynchronization therapy (CRT) using information about the inotropic state change.

8. The method of claim 1, further comprising:

adjusting the preload exhibited by the heart to obtain a desired preload level.

9. The method of claim 8, wherein adjusting the preload comprises delivering a substance to the patient.

10. The method of claim 8, wherein adjusting the preload comprises administering salt to the patient.

11. The method of claim 8, wherein adjusting the preload comprises adjusting a diuretic level administered to the patient.

12. The method of claim 1, wherein determining that the heart has exhibited an inotropic state change comprises identifying an occurrence in which the S1 heart sound indicates an elevation in stroke volume and the proxy variable indicates a decline in preload.

13. The method of claim 1, wherein determining that the heart has exhibited an inotropic state change comprises identifying an occurrence in which the proxy variable indicates an elevation in preload and the S1 heart sound indicates a decline in stroke volume.

14. A method comprising:

sensing a plurality of S3 or S4 heart sounds emitted by a heart of a patient, each of which is represented as a time-varying signal with at least one maxima and minima;

finding a greatest difference between a minima and maxima that are consecutive for each of the time-varying signals representing the plurality of S3 or S4 heart sounds, yielding a set of peak-to-peak differences; and

monitoring an inotropic state of the heart, using the set of peak-to-peak differences and an indicator of stroke volume.

15. The method of claim 14, further comprising finding a measure of central tendency of the set of peak-to-peak differences.

16. The method of claim 14, wherein the indicator of stroke volume is an S1 heart sound.

17. The method of claim 14, further comprising:

filtering the time-varying signals representing the plurality of S3 or S4 heart sounds, so as to attenuate noise contained in the time varying signals, prior to finding a greatest difference between consecutive minima and maxima.

18. The method of claim 17, wherein the act of filtering the time-varying signals comprises ensemble averaging the time-varying signals.

19. A system comprising:

a preload altering device;

an implantable device including

a transducer;

a control circuit coupled to the transducer, the control circuit configured to cooperate with the transducer to monitor an S1 heart sound emitted by a heart of a patient, monitor a proxy variable indicating preload exhibited by the heart, and communicate a control signal to the preload altering device.

20. The system of claim 19, wherein the preload altering device includes a substance dispenser.

21. The system of claim 19, wherein the control circuit monitors a proxy variable indicating preload by monitoring an S3 heart sound.

22. The system of claim 19, wherein the control circuit monitors a proxy variable indicating preload by monitoring an S4 heart sound.

23. The system of claim 19, wherein the implantable device further includes a pressure sensor in data communication with the control circuit, and wherein the control circuit monitors a proxy variable indicating preload by monitoring blood pressure.

24. The system of claim 23, wherein the pressure sensor is located in a right ventricle.

25. The system of claim 19, wherein the implantable device further includes a pressure sensor in data communication with the control circuit, and wherein the control circuit monitors a proxy variable indicating preload by monitoring blood pressure in the pulmonary artery.

26. A system comprising:

an inotropic state altering device; and

an implantable device including

a transducer; and

a control circuit coupled to the transducer, the control circuit configured to cooperate with the transducer to monitor an S1 heart sound emitted by a heart of a patient, monitor a proxy variable indicating preload exhibited by the heart, and communicate a control signal to the inotropic state altering device using the inotropic state.

27. The system of claim 26, wherein the control circuit is further configured to determine that the heart has exhibited an inotropic state change by identifying an occurrence in which the S1 heart sound indicates an elevation in stroke volume and the proxy variable indicates a decline in preload.

28. The system of claim 26, wherein the control circuit is further configured to determine that the heart has exhibited an inotropic state change by identifying an occurrence in which the proxy variable indicates an elevation in preload and the S1 heart sound indicates a decline in stroke volume.

29. An implantable device comprising:

a transducer; and

a control circuit coupled to the transducer, the control circuit configured to cooperate with the transducer to monitor an S1 heart sound emitted by a heart of a patient, and monitor a proxy variable indicating preload exhibited by the heart.

30. The implantable device of claim 29, further comprising:

stimulation and sensing circuitry interposed between the control circuit and an electrode system configured to make electrical contact with the heart;

wherein the control circuit is further configured to apply cardiac resynchronization therapy to the heart, based upon a set of parameters.

31. The implantable device of claim 30, wherein the control circuit is further configured to adjust one or more of the set of parameters based upon the inotropic state or preload level exhibited by the heart.

32. The implantable device of claim 29, wherein:

the device further comprises an activity sensor coupled to the control circuit, the activity sensor generating a signal exhibiting an time-varying characteristic indicating an activity level of the patient; and

the control circuit is further configured to determine ventricular function, based upon the S1 heart sound, the proxy variable, and the signal generated by the activity sensor.