Apparatus, Systems and Methods Analyzing Pressure and Volume Waveforms in the Vasculature

• US 20130184594A1
• Filed: 07/12/2011
• Published: 07/18/2013
• Est. Priority Date: 07/12/2010
• Status: Abandoned Application

• Current Assignee: Yale University
• Original Assignee: Yale University
• Inventors: Shelley, Kirk H., Silverman, David G.
• Application Number:
  US13/809,687
• Publication Number:
  US 20130184594A1
• Time in Patent Office: Days
• US Class Current: 600/484
• CPC Class Codes: A61B 5/02007 Evaluating blood vessel condition, e.g. elasticity, compliance
• 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 5/02108 from analysis of pulse wave characteristics
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/02152 specially adapted for venous pressure
• CPC Class Codes: A61B 5/02416 using photoplethysmograph signals, e.g. generated by infrared radiation A61B5/14552 takes precedence
• CPC Class Codes: A61B 5/0295 using plethysmography, i.e. measuring the variations in the volume of a body part as modified by the circulation of blood therethrough, e.g. impedance plethysmography
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• 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

Abstract

Apparatus, systems and methods are provided for analyzing relative compliance in the peripheral vasculature. Such apparatus, systems and methods generally involve generating a plethysmograph (PG) signal, generating one or more pressure waveforms and comparing the pressure waveform(s) relative to the PG signal to determine compliance indexes associated particular regions of the vasculature. A relative compliance ratio may also be determined by comparing arterial and venous relative compliance indexes. Apparatus, systems and methods are also provided for analyzing a PG waveform. Such apparatus, systems and methods generally involve generating a plethysmograph (PG) signal and comparing amplitude modulation of the PG signal relative to baseline modulation of the PG signal to estimate a relationship between left ventricular end diastolic pressure and stroke volume. The estimated relationship may account for a phase offset for the time between when changes in venous return affect left ventricular end diastolic pressure and stroke volume.

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79. A method for analyzing relative compliance in the peripheral vasculature, the method comprising:

generating a plethysmograph (PG) signal;

generating one or more pressure waveforms;

comparing the one or more pressure waveforms relative to the PG signal to determine one or more relative compliance indexes, wherein each of the one or more relative compliance indexes is associated with a particular region of the vasculature.

80. The method of claim 79, further comprising detecting one of (i) changes in compliance in the associated particular region of the vasculature, and (ii) changes impedance in the associated particular region of the vasculature, wherein changes in one of the one or more relative compliance indexes are reflective of the changes in compliance or impedance in the associated particular region of the vasculature.

81. The method of claim 79, wherein the one or more relative compliance indexes include an arterial relative compliance index associated with an arterial region of the vasculature, and a venous relative compliance index associated with a venous region of the vasculature, the method further comprising determining a relative compliance ratio by comparing the arterial relative compliance index relative to the venous relative compliance index, wherein the relative compliance ratio represents relative compliance between the arterial region of the vasculature and the venous region of the vasculature.

82. The method of claim 81, further comprising comparing the relative compliance ratio relative to standard venous and arterial compliance curves.

83. The method of claim 81, further comprising using the relative compliance ratio to monitor cardiovascular events.

84. The method of claim 79, further comprising, using the one or more relative compliance indexes to facilitate administration of vasoconstrictors or vasodilators.

85. The method of claim 79, wherein the one or more pressure waveforms include an arterial pressure waveform and a venous pressure waveform, wherein one or more of the one or more relative compliance indexes are determined by comparing a combined waveform derived from the arterial pressure waveform and the venous pressure waveform relative to the PG signal, and wherein the comparing the combined waveform relative to the PG signal includes comparing at least one of (i) corresponding arterial components of the combined waveform and PG signal, and (ii) corresponding venous components of the combined waveform and PG signal.

86. The method of claim 85, wherein the corresponding arterial components include one of (i) an AC component for each of the arterial pressure waveform and the PG signal, (ii) amplitude modulation of a cardiac pulse for each of the arterial pressure waveform and the PG signal, (iii) cardiac peaks for each of the arterial pressure waveform and the PG signal, (iv) a systolic component for each of the arterial pressure waveform and the PG signal, (v) a difference between systolic and diastolic components for each of the arterial pressure waveform and the PG signal, (vi) an average amplitude of a cardiac pulse for each of the arterial pressure waveform and the PG signal, (vii) a cardiac signal strength for each of the each of the arterial pressure waveform and the PG signal, and (viii) one or more sidebands around a cardiac signal for each of the arterial pressure waveform and the PG signal.

87. The method of claim 85, wherein the corresponding venous components include one of (i) a DC component for each of the venous pressure waveform and the PG signal, (ii) baseline modulation for each of the venous pressure waveform and the PG signal, (iii) cardiac valleys for each of the venous pressure waveform and the PG signal, (iv) venous pulsations for each of the venous pressure waveform and the PG signal, (v) a diastolic component for each of the venous pressure waveform and the PG signal, (vi) a respiratory signal strength for each of the each of the venous pressure waveform and the PG signal, and (vii) one or more upper harmonics of a cardiac signal for each of the venous pressure waveform and the PG signal.

88. The method of claim 79, wherein one or more of the one or more relative compliance indexes are determined by individually comparing one of the one or more pressure waveforms relative to the PG signal, wherein the one of the one or more pressure waveforms is an arterial pressure waveform responsive to changes in arterial pressure.

89. The method of claim 88, wherein the comparing the arterial pressure waveform relative to the PG signal includes comparing the arterial pressure waveform relative to an AC component of the PG signal.

90. The method of claim 88, wherein the comparing the arterial pressure waveform relative to the PG signal includes comparing corresponding arterial components of the arterial pressure waveform and the PG signal.

91. The method of claim 90, wherein the corresponding arterial components include one of (i) an AC component for each of the arterial pressure waveform and the PG signal, (ii) amplitude modulation of a cardiac pulse for each of the arterial pressure waveform and the PG signal, (iii) cardiac peaks for each of the arterial pressure waveform and the PG signal, (iv) a systolic component for each of the arterial pressure waveform and the PG signal, (v) a difference between systolic and diastolic components for each of the arterial pressure waveform and the PG signal, (vi) an average amplitude of a cardiac pulse for each of the arterial pressure waveform and the PG signal, (vii) a cardiac signal strength for each of the each of the arterial pressure waveform and the PG signal, and (viii) one or more sidebands around a cardiac signal for each of the arterial pressure waveform and the PG signal.

92. The method of claim 88, wherein the arterial pressure waveform is generated using one of (i) a pulmonary artery catheter, and (ii) a blood pressure cuff.

93. The method of claim 79, wherein one or more of the one or more relative compliance indexes are determined by individually comparing one of the one or more pressure waveforms relative to the PG signal, wherein the one of the one or more pressure waveforms is a venous pressure waveform, responsive to changes in venous pressure.

94. The method of claim 93, wherein the comparing the venous pressure waveform relative to the PG signal includes comparing the venous pressure waveform relative to a DC component of the PG signal.

95. The method of claim 93, wherein the comparing the venous pressure waveform relative to the PG signal includes comparing corresponding venous components of the venous pressure waveform and the PG signal.

96. The method of claim 95, wherein the corresponding venous components include one of (i) a DC component for each of the venous pressure waveform and the PG signal, (ii) baseline modulation for each of the venous pressure waveform and the PG signal, (iii) cardiac valleys for each of the venous pressure waveform and the PG signal, (iv) venous pulsations for each of the venous pressure waveform and the PG signal, (v) a diastolic component for each of the venous pressure waveform and the PG signal, (vi) a respiratory signal strength for each of the each of the venous pressure waveform and the PG signal, and (vii) one or more upper harmonics of a cardiac signal for each of the venous pressure waveform and the PG signal.

97. The method of claim 93, wherein the venous pressure waveform is generated using a central venous catheter or a peripheral venous catheter.

98. The method of claim 79, wherein the one or more pressure waveforms include a venous pressure waveform and an arterial pressure waveform, wherein the comparing the venous pressure waveform and the arterial pressure waveform relative to the PG signal includes determining relative scaling factors for the arterial and venous pressure waveforms such that a combined waveform derived from the relative scaling factors and the arterial and venous pressure waveform best matches the PG signal.

99. The method of claim 98, wherein the combined waveform is represented by one of (i) the formula (n*arterial pressure)+(m*venous pressure), wherein, n and m represent relative compliance indexes for the arterial and venous pressure waveforms, respectively, and (ii) the formula x*((arterial pressure/y)+(venous pressure)), wherein y represents a relative compliance ratio.

100. The method of claim 98, further comprising comparing the combined waveform relative to the PG signal and determining a cardiac condition, wherein comparing the combined waveform relative to the PG signal includes comparing respiratory-induced variations, wherein similar respiratory-induced variations are indicative of the cardiac condition.

101. The method of claim 79, wherein the one or more pressure waveforms include an arterial pressure waveform and a venous pressure waveforms, wherein a relative arterial compliance index is determined by comparing cardiac signal strength for the arterial pressure waveform relative to cardiac signal strength for the PG signal according to the formula:

relative arterial compliance=PPG_{cardiac freq.}/Arterial pressure_{cardiac freq.}

and wherein a relative venous compliance index is determined by comparing respiratory signal strength for the venous pressure waveform relative to respiratory signal strength for the PG signal according to the formula;

relative venous compliance=PPG_{resp freq.}/Venous pressure_{Resp freq.}

102. The method of claim 101, further comprising determining a relative compliance ratio according to the formula:

(PPG_{resp freq.}/Venous pressure_{Resp freq.})/(PPG_{cardiac freq.}/Arterial pressure_{cardiac freq.})

103. A system for analyzing relative compliance in the peripheral vasculature, the system comprising:

means for generating a plethysmograph (PG) signal;

means for generating one or more pressure waveforms; and

means for comparing the one or more pressure waveform relative to the PG signal to determine one or more relative compliance indexes, wherein each of the one or more relative compliance indexes is associated with a particular region of the vasculature.