ISCHEMIA DETECTION USING PRESSURE SENSOR

• US 20080177156A1
• Filed: 01/19/2007
• Published: 07/24/2008
• Est. Priority Date: 01/19/2007
• Status: Abandoned Application

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Patangay, Abhilash, Zhang, Yi, Siejko, Krzysztof Z., Fogoros, Richard
• Application Number:
  US11/624,974
• Publication Number:
  US 20080177156A1
• Time in Patent Office: Days
• US Class Current: 600/301
• 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 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/145 Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissuemeasuring of blood pressure or blood flow A61B5/02; non-radiation detecting or locating of foreign bodies in blood A61B5/06

Abstract

This document discusses, among other things, a system and method for sensing a pulmonary artery pressure (“PAP”) signal of a pulmonary artery (“PA”) and computing an indication of a reduction of blood supply to at least a portion of a heart using information from the PAP signal. The reduction of blood supply to at least a portion of the heart can be detected using a PAP signal characteristic or measurement, using a change in the PAP, using an interval between multiple PAP signal features, using a mitral valve performance, or using information from the PAP and information from a different physiological signal, including a cardiac signal, a heart sound signal, right ventricular pressure signal, a left ventricular pressure signal, a blood pressure signal, and an oxygen saturation signal.

Claims

1. A system comprising:

an implantable chronic pulmonary artery (“

PA”

) pressure sensor, configured to chronically sense a pulmonary artery pressure (“

PAP”

) signal of a PA; and

an implantable or external processor, communicatively coupled to the PA pressure sensor to receive PAP information, wherein the processor is configured to use the PAP information to compute an indication of a reduction of blood supply to at least a portion of a heart.

2. The system of claim 1, wherein the PA pressure sensor is configured to be fixed to a location within the PA.

3. The system of claim 1, wherein the processor is configured to compute the indication of a reduction of blood supply using a change in the PAP.

4. The system of claim 1, wherein the processor is configured to detect at least one feature of the PAP signal;

wherein the processor includes a time interval detector that is configured to detect at least one interval between the at least one feature of the PAP signal occurring at a first time and the at least one feature of the PAP signal occurring at a second time; and

wherein the processor is configured to compute the indication of a reduction of blood supply to at least a portion of the heart using information from the at least one interval between the at least one feature of the PAP signal occurring at a first time and the at least one feature of the PAP signal occurring at a second time.

5. The system of claim 1, wherein the processor is configured to compute the indication of a reduction of blood supply to at least a portion of the heart using at least one measurement correlative to at least one of a change in left ventricle (“

LV”

) pressure, a change in LV diastolic pressure, a change in LV volume, and a rate of pressure change in the LV (“

LV dP/dt”

).

6. The system of claim 1, wherein the processor is configured to compute the indication of a reduction of blood supply to at least a portion of the heart using a detected change in a PA pressure characteristic, where the PA pressure characteristic includes at least one of a PA diastolic (“

PAD”

) pressure, a PA systolic (“

PAS”

) pressure, a mean PAP, and a rate of pressure change in the PA (“

PA dP/dt”

).

7. The system of claim 1, wherein the processor is configured to compute the indication of a reduction of blood supply to a myocardium of a left ventricle.

8. The system of claim 1, wherein the processor is configured to compute the indication of a reduction of blood supply to at least a portion of the heart by comparing at least a portion of the PAP information to a baseline.

9. The system of claim 1, wherein the processor is configured to use the PAP information to detect an indication of mitral valve performance, and wherein the processor is configured to compute an indication of a reduction of blood supply to at least a portion of the heart using the detected indication of mitral valve performance.

10. The system of claim 1, including:

an auxiliary physiological sensor, communicatively coupled to the processor, configured to sense a different physiological signal; and

wherein the processor is configured to compute the indication of a reduction of blood supply to at least a portion of the heart using the PAP information and information from the different physiological signal.

11. The system of claim 10, wherein the auxiliary physiological sensor is configured to sense a different physiological signal indicative of a reduction of blood supply to at least a portion of the heart.

12. The system of claim 10, wherein the processor is configured to detect at least one feature of the different physiological signal and at least one feature of the PAP signal;

wherein the processor includes a time interval detector that is configured to detect at least one interval between the at least one different physiological signal feature and the at least one PAP signal feature; and

wherein the processor is configured to compute the indication of a reduction of blood supply to at least a portion of the heart using the at least one interval between the at least one different physiological signal feature and the at least one PAP signal feature.

13. The system of claim 10, wherein the auxiliary physiological sensor includes a cardiac sensor, configured to sense a cardiac signal as the different physiological signal.

14. The system of claim 10, wherein the auxiliary physiological sensor includes a heart sound sensor, configured to sense a heart sound signal as the different physiological signal.

15. The system of claim 10, wherein the auxiliary physiological sensor includes at least one of a right ventricular pressure sensor, a left ventricular pressure sensor, a blood pressure sensor, and an oxygen saturation sensor.

16. The system of claim 10, wherein the processor is configured to compute the indication of a reduction of blood supply to at least a portion of the heart using the PAP signal, the different physiological signal, and at least one weighting factor for the PAP signal or the different physiological signal.

17. The system of claim 16, wherein the at least one weighting factor for the PAP signal or the different physiological signal includes at least one of a signal-to-noise ratio (“

SNR”

) and a performance metric, wherein the performance metric includes at least one of a sensitivity, a specificity, a positive prediction value (“

PPV”

), and a negative prediction value (“

NPV”

).

18. The system of claim 10, wherein the processor is configured to compute the indication of a reduction of blood supply to at least a portion of the heart using a temporal profile, wherein the temporal profile includes using the PAP information and information from the different physiological signal in a sequential manner.

19. The system of claim 1, including:

an implantable respiration sensor, configured to sense a respiration signal;

an implantable or external respiration phase detector, coupled to the respiration sensor, configured to detect at least one phase of the respiration signal; and

wherein the processor is communicatively coupled to the respiration phase detector to receive respiration information, and wherein the processor is configured to use the PAP information and the respiration information to compute the indication of the reduction of blood supply to at least a portion of the heart, including at least one of;

the processor being configured to form a composite signal using at least a portion of the PAP signal over at least a portion of the at least one phase of the respiration signal;

the processor being configured to obtain a gated PAP signal using information from the respiration phase detector; and

the processor being configured to enable or disable the PA pressure sensor during at least a portion of at least one phase of the respiration signal.

20. A system comprising:

means for chronically implantably sensing a pulmonary artery pressure (“

PAP”

) signal of a pulmonary artery (“

PA”

); and

means for using the PAP signal to compute an indication of a reduction of blood supply to at least a portion of a heart.

21. A method comprising:

chronically implantably sensing a pulmonary artery pressure (“

PAP”

) signal of a pulmonary artery (“

PA”

); and

using the PAP signal for computing an indication of a reduction of blood supply to at least a portion of a heart.

22. The method of claim 21, wherein the sensing includes using an implantable chronic PA pressure sensor configured to be fixed within the PA.

23. The method of claim 21, wherein the using the PAP signal includes using a change in the PAP.

24. The method of claim 21, including:

detecting at least one feature of the PAP signal;

detecting at least one interval between the at least one feature of the PAP signal occurring at a first time and the at least one feature of the PAP signal occurring at a second time; and

wherein computing the indication of a reduction of blood supply to at least a portion of the heart includes using information from the at least one interval between the at least one feature of the PAP signal occurring at a first time and the at least one feature of the PAP signal occurring at a second time.

25. The method of claim 21, wherein computing the indication of a reduction of blood supply to at least a portion of the heart includes using at least one measurement correlative to at least one of a change in left ventricle (“

LV”

) pressure, a change in LV diastolic pressure, a change in LV volume, and a rate of pressure change in the LV (“

LV dP/dt”

).

26. The method of claim 21, wherein computing the indication of a reduction of blood supply to at least a portion of the heart includes using a detected change in a PA pressure characteristic, where the PA pressure characteristic includes at least one of a PA diastolic (“

PAD”

) pressure, a PA systolic (“

PAS”

) pressure, a mean PAP, and a rate of pressure change in the PA (“

PA dP/dt”

).

27. The method of claim 21, wherein computing the indication of a reduction of blood supply to at least a portion of the heart includes using at least one measurement of the PAP signal to compute an indication of a reduction of blood supply to a myocardium of a left ventricle.

28. The method of claim 21, wherein computing the indication of a reduction of blood supply to at least a portion of the heart includes comparing at least one measurement of the PAP signal to a baseline.

29. The method of claim 21, including using the PAP signal for detecting an indication of mitral valve performance;

and

wherein computing the indication of a reduction of blood supple to at least a portion of the heart includes using the detected indication of mitral valve performance.

30. The method of claim 21, including:

sensing a different physiological signal; and

computing the indication of a reduction of blood supply to at least a portion of the heart using the PAP signal and the different physiological signal.

31. The method of claim 30, wherein sensing a different physiological signal includes sensing a different physiological signal that is indicative of a reduction of blood supply to at least a portion of the heart.

32. The method of claim 30, including:

detecting at least one feature of the different physiological signal;

detecting at least one feature of the PAP signal;

detecting at least one interval between the at least one different physiological signal feature and the at least one PAP signal feature; and

wherein computing the indication of a reduction of blood supply to at least a portion of the heart includes using the at least one interval between the at least one different physiological signal feature and the at least one PAP signal feature.

33. The method of claim 30, wherein sensing a different physiological signal includes sensing a cardiac signal as the different physiological signal.

34. The method of claim 30, wherein sensing the different physiological signal includes sensing a heart sound signal as the different physiological signal.

35. The method of claim 30, wherein sensing the different physiological signal includes sensing at least one of a right ventricular pressure signal, a left ventricular pressure signal, a blood pressure signal, and an oxygen saturation signal as the different physiological signal.

36. The method of claim 30, wherein computing the indication of a reduction of blood supply to at least a portion of the heart includes using the PAP signal, the different physiological signal, and at least one weighting factor for the PAP signal or the different physiological signal.

37. The method of claim 36, wherein using the at least one weighting factor for the PAP signal or the different physiological signal includes using at least one of a signal-to-noise ratio (“

SNR”

) and a performance metric, wherein using the performance metric includes using at least one of a sensitivity, a specificity, a positive prediction value (“

PPV”

), and a negative prediction value (“

NPV”

).

38. The method of claim 30, wherein computing the indication of a reduction of blood supply to at least a portion of the heart includes using a temporal profile, wherein using the temporal profile includes using the PAP signal and the different physiological signal in a sequential manner.

39. The method of claim 21, including:

sensing a respiration signal;

detecting at least a portion of at least one phase of the respiration signal; and

using the PAP signal and respiration signal information for computing the indication of the reduction of blood supply to at least a portion of the heart, including at least one of;

forming a composite signal using at least a portion of the PAP signal over at least a portion of at least one phase of the respiration signal;

obtaining a gated PAP signal using information from the respiration signal; and

enabling or disabling the sensing the PAP signal using at least a portion of at least one phase of the respiration signal.