POSTURE-INDUCED CHANGES TO PHYSIOLOGICAL PARAMETERS

• US 20120108915A1
• Filed: 10/29/2010
• Published: 05/03/2012
• Est. Priority Date: 10/29/2010
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Corbucci, Giorgio, Lee, Brian B.
• Granted Patent: US 8,428,720 B2
• 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 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 5/02438 with portable devices, e.g. worn by the patient
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/1116 Determining posture transitions
• CPC Class Codes: A61B 5/4878 Evaluating oedema
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/7246 using correlation, e.g. template matching or determination of similarity
• CPC Class Codes: A61B 5/7282 Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/349, A61B5/0823 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 1/36535 controlled by body position or posture
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means

Abstract

Methods and devices for analyzing posture-induced changes to physiological parameters of a patient (e.g., ejection time, heart rate, etc.) to provide an assessment of one or more conditions of the patient.

Claims

1. An implantable medical device for use in assessment of one or more conditions of a patient comprising:

sensing apparatus to monitor physiological parameters of the patient, wherein the physiological parameters comprise the patient'"'"'s posture and ejection time, wherein the patient'"'"'s ejection time comprises at least one of the patient'"'"'s left ventricular ejection time and right ventricular ejection time;

a sensing module coupled to the sensing apparatus and configured to receive the monitored physiological parameters; and

a control module coupled to the sensing module and configured to;

detect a change in the patient'"'"'s posture between a lying position and an upright position using the monitored physiological parameters,

determine a posture-induced change to the patient'"'"'s ejection time using the monitored physiological parameters, wherein the posture-induced change to the patient'"'"'s ejection time comprises a difference between the patient'"'"'s ejection time before the detected change in the patient'"'"'s posture and the patient'"'"'s ejection time after the detected change in the patient'"'"'s posture,

store the posture-induced change to the patient'"'"'s ejection time, and

analyze the posture-induced change to the patient'"'"'s ejection time to provide an assessment of one or more conditions of the patient, wherein the one or more conditions of the patient comprise fluid overload.

2. The device of claim 1, wherein the posture-induced change to the patient'"'"'s ejection time further comprises a difference between the patient'"'"'s average ejection time over a first plurality of heart beats before the detected change in the patient'"'"'s posture and the patient'"'"'s average ejection time over a second plurality of heart beats after the detected change in the patient'"'"'s posture.

3. The device of claim 1, wherein the posture-induced change to the patient'"'"'s ejection time further comprises a difference between the patient'"'"'s average ejection time over a first predetermined period of time before the detected change in the patient'"'"'s posture and the patient'"'"'s average ejection time over a second predetermined period of time after the detected change in the patient'"'"'s posture.

4. The device of claim 1, wherein the control module is configured to analyze the posture-induced change to the patient'"'"'s ejection time by comparing the posture-induced change to the patient'"'"'s ejection time to a baseline value.

5. The device of claim 1, wherein the control module is configured to analyze the posture-induced change to the patient'"'"'s ejection time by comparing the posture-induced change to the patient'"'"'s ejection time to a plurality of previous posture-induced changes to the patient'"'"'s ejection time prior to the posture-induced change to the patient'"'"'s ejection time to provide one or more trends to be used in the assessment of one or more conditions of the patient.

6. The device of claim 1, wherein the analysis of the posture-induced change to the patient'"'"'s ejection time provides an assessment that indicates that the patient is afflicted with fluid overload if the posture-induced change to the patient'"'"'s ejection time is less than a 10 percent change.

7. The device of claim 1 further comprising at least one of:

a therapy delivery module coupled to the control module and configured to deliver cardiac therapy to the patient, wherein the control module is further configured to initiate or adjust cardiac therapy using the therapy delivery module based on the assessment of one or more conditions of the patient, and

a notification module coupled to the control module and configured to alert the patient, wherein the control module is configured to initiate an alert using the notification module based on the assessment of one or more conditions of the patient.

8. An implantable medical device for use in assessment of one or more conditions of a patient comprising:

sensing apparatus to monitor physiological parameters of the patient, wherein the physiological parameters comprise the patient'"'"'s posture and ejection time, wherein the patient'"'"'s ejection time comprises at least one of the patient'"'"'s left ventricular ejection time and right ventricular ejection time;

a sensing module coupled to the sensing apparatus and configured to receive the monitored physiological parameters; and

a control module coupled to the sensing module and configured to;

detect changes in the patient'"'"'s posture between a lying position and an upright position using the monitored physiological parameters,

determine a plurality of posture-induced changes to the patient'"'"'s ejection time over time using the monitored physiological parameters, wherein each of the plurality of posture-induced changes to the patient'"'"'s ejection time comprise a difference between the patient'"'"'s ejection time before a detected change in the patient'"'"'s posture and the patient'"'"'s ejection time after the detected change in the patient'"'"'s posture,

store each of the plurality posture-induced changes to the patient'"'"'s ejection time, and

analyze the plurality of posture-induced changes to the patient'"'"'s ejection time over time to provide one or more trends to be used in an assessment of one or more conditions of the patient, wherein the one or more conditions of the patient comprises fluid overload.

9. The device of claim 8, wherein each of the plurality of posture-induced changes to the patient'"'"'s ejection time comprise a difference between the patient'"'"'s average ejection time over a first plurality of heart beats before the detected change in the patient'"'"'s posture and the patient'"'"'s average ejection time over a second plurality of heart beats after the detected change in the patient'"'"'s posture.

10. The device of claim 8, wherein the control module is configured to analyze the one or more trends in the plurality of posture-induced changes to the patient'"'"'s ejection time over time by determining whether the posture-induced changes to the patient'"'"'s ejection time have been decreasing over time, wherein the control module is further configure to provide an assessment that indicates that the patient'"'"'s heart is progressing towards heart failure if the posture-induced changes to the patient'"'"'s ejection time have been decreasing over time.

11. The device of claim 8, wherein the physiological parameters further comprise the patient'"'"'s heart rate, wherein the control module is further configured to:

determine a posture-induced change to the patient'"'"'s heart rate using the monitored physiological parameters, wherein the posture-induced change to the patient'"'"'s heart rate comprises a difference between the patient'"'"'s heart rate before the detected change in the patient'"'"'s posture and the patient'"'"'s heart rate after the detected change in the patient'"'"'s posture,

store the posture-induced change to the patient'"'"'s heart rate, and

analyze the posture-induced change to the patient'"'"'s heart rate to verify the assessment of one or more conditions of the patient.

12. A method for use in assessing one or more conditions of a patient comprising:

monitoring physiological parameters of the patient, wherein the physiological parameters comprise the patient'"'"'s posture and ejection time, wherein the patient'"'"'s ejection time comprises at least one of the patient'"'"'s left ventricular ejection time and right ventricular ejection time;

detecting a change in the patient'"'"'s posture between a lying position and an upright position using the monitored physiological parameters;

determining a posture-induced change to the patient'"'"'s ejection time using the monitored physiological parameters, wherein the posture-induced change to the patient'"'"'s ejection time comprises a difference between the patient'"'"'s ejection time before the detected change in the patient'"'"'s posture and the patient'"'"'s ejection time after the detected change in the patient'"'"'s posture;

storing the posture-induced change to the patient'"'"'s ejection time; and

analyzing the posture-induced change to the patient'"'"'s ejection time to provide an assessment of one or more conditions of the patient, wherein the one or more conditions of the patient comprise fluid overload.

13. The method of claim 12, wherein the posture-induced change to the patient'"'"'s ejection time further comprises a difference between the patient'"'"'s average ejection time over a first plurality of heart beats before the detected change in the patient'"'"'s posture and the patient'"'"'s average ejection time over a second plurality of heart beats after the detected change in the patient'"'"'s posture.

14. The method of claim 12, wherein the posture-induced change to the patient'"'"'s ejection time further comprises a difference between the patient'"'"'s average ejection time over a first predetermined period of time before the detected change in the patient'"'"'s posture and the patient'"'"'s average ejection time over a second predetermined period of time after the detected change in the patient'"'"'s posture.

15. The method of claim 12, wherein analyzing the posture-induced change to the patient'"'"'s ejection time comprises comparing the posture-induced change to the patient'"'"'s ejection time to a baseline value.

16. The method of claim 12, wherein analyzing the posture-induced change to the patient'"'"'s ejection time comprises comparing the posture-induced change to the patient'"'"'s ejection time to a plurality of previous posture-induced changes to the patient'"'"'s ejection time prior to the posture-induced change to the patient'"'"'s ejection time to provide one or more trends to be used in the assessment of one or more conditions of the patient.

17. The method of claim 12 further comprising at least one of:

initiating or adjusting cardiac therapy to the patient based on the assessment of one or more conditions of the patient; and

alerting the patient based on the assessment of one or more conditions of the patient.

18. A method for use in assessment of one or more conditions of a patient comprising:

monitoring physiological parameters of the patient, wherein the physiological parameters comprise the patient'"'"'s posture and ejection tithe, wherein the patient'"'"'s ejection time comprises at least one of the patient'"'"'s left ventricular ejection time and right ventricular ejection time;

detecting changes in the patient'"'"'s posture between a lying position and an upright position using the monitored physiological parameters,

determining a plurality of posture-induced changes to the patient'"'"'s ejection time over time using the monitored physiological parameters, wherein each of the plurality of posture-induced changes to the patient'"'"'s ejection time comprise a difference between the patient'"'"'s ejection time before a detected change in the patient'"'"'s posture and the patient'"'"'s ejection time after the detected change in the patient'"'"'s posture,

storing each of the plurality posture-induced changes to the patient'"'"'s ejection time, and

analyzing one or more trends in the plurality of posture-induced changes to the patient'"'"'s ejection time over time to provide an assessment of one or more conditions of the patient, wherein the one or more conditions of the patient comprises fluid overload.

19. The method of claim 18, wherein each of the plurality of posture-induced changes to the patient'"'"'s ejection time comprise a difference between the patient'"'"'s average ejection time over a first plurality of heart beats before the detected change in the patient'"'"'s posture and the patient'"'"'s average ejection time over a second plurality of heart beats after the detected change in the patient'"'"'s posture.

20. The method of claim 18, wherein analyzing the one or more trends in the plurality of posture-induced changes to the patient'"'"'s ejection time over time comprises:

determining whether the posture-induced changes to the patient'"'"'s ejection time have been decreasing over time, and

providing an assessment that indicates that the patient'"'"'s heart is progressing towards heart failure if the posture-induced changes to the patient'"'"'s ejection time have been decreasing over time.

21. The method of claim 18 further comprising:

determining a posture-induced change to the patient'"'"'s heart rate time using the monitored physiological parameters, wherein the posture-induced change to the patient'"'"'s heart rate comprises a difference between the patient'"'"'s heart rate before the detected change in the patient'"'"'s posture and the patient'"'"'s heart rate after the detected change in the patient'"'"'s posture,

storing the posture-induced change to the patient'"'"'s heart rate, and

analyzing the posture-induced change to the patient'"'"'s heart rate to verify the assessment of one or more conditions of the patient.

22. The method of claim 18, wherein analyzing one or more trends in the plurality of posture-induced changes to the patient'"'"'s ejection time over time comprises analyzing one or more trends in the plurality of posture-induced changes to the patient'"'"'s ejection time that occur at the same time of the day.