Monitoring the hemodynamic state of a patient from measurements of myocardial contractility using doppler ultrasound techniques
First Claim
1. An apparatus for monitoring performance of a patient'"'"'s heart, comprising:
- an ultrasound transducer means adapted to be implanted within the patient'"'"'s heart for transmitting ultrasonic energy pulses into cardiac muscle tissue and for detecting returning ultrasonic energy echoes reflected from a plurality of individual cardiac myofibrils within the tissue,means for analyzing an average frequency response of said transmitted pulses and said returning echoes,means for detecting an average cardiac myofibril motion parameter corresponding to the results generated by said analyzing means,means for deriving at least one parameter characterizing performance of the heart as a function of said average cardiac myofibril motion parameter, andmeans for storing said at least one heart performance parameter.
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Abstract
A hemodynamic control apparatus and method for regulating blood flow within the cardiovascular system in a closed-loop control system using ultrasound measurement techniques to determine a hemodynamic sttus of the patient and to derive a control parameter for modulating the hemodynamics of the system using electrical or pharmaceutical therapy. This apparatus and method provides for the monitoring of cardiac myofibril motion to assess heart contractility and hemodynamic performance, and to control an implantable cardiac assist or therapy device. In this manner, the invention maintains the patient'"'"'s hemodynamic status without invading the left heart or the arterial system of the patient.
202 Citations
30 Claims
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1. An apparatus for monitoring performance of a patient'"'"'s heart, comprising:
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an ultrasound transducer means adapted to be implanted within the patient'"'"'s heart for transmitting ultrasonic energy pulses into cardiac muscle tissue and for detecting returning ultrasonic energy echoes reflected from a plurality of individual cardiac myofibrils within the tissue, means for analyzing an average frequency response of said transmitted pulses and said returning echoes, means for detecting an average cardiac myofibril motion parameter corresponding to the results generated by said analyzing means, means for deriving at least one parameter characterizing performance of the heart as a function of said average cardiac myofibril motion parameter, and means for storing said at least one heart performance parameter. - View Dependent Claims (2, 3)
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4. A hemodynamic control apparatus for determining a patient'"'"'s hemodynamic status and adjusting the hemodynamic output of the patient'"'"'s heart to correspond to the patient'"'"'s metabolic needs, comprising:
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means for generating electrical stimulation pulse events, ultrasonic means adapted to be implanted within the patient'"'"'s heart for monitoring movement of a plurality of individual cardiac myofibrils, means for determining a cardiac performance parameter based on said monitored movement of a plurality of individual cardiac myofibrils, and means for adjusting said pulse generating means as a function of said cardiac performance parameter. - View Dependent Claims (5, 6, 7, 8, 9, 10)
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11. A method of operating an apparatus for monitoring performance of a patient'"'"'s heart, said apparatus including an ultrasound transducer adapted to be implanted within the heart, comprising the steps of:
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transmitting ultrasonic energy pulses into cardiac muscle tissue, detecting returning ultrasonic energy echoes reflected from a plurality of individual cardiac myofibrils within the tissue, analyzing an average frequency response of said transmitted pulses and said returning echoes, detecting an average cardiac myofibril motion parameter corresponding to the results generated by said analysis, deriving at least one parameter characterizing performance of the heart as a function of said average cardiac myofibril motion parameter, and storing said at least one heart performance parameter. - View Dependent Claims (12, 13)
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14. A method of operating a hemodynamic control apparatus for determining a patient'"'"'s hemodynamic status using an ultrasonic transducer adapted to be implanted within the patient'"'"'s heart and adjusting the hemodynamic output of the patient'"'"'s heart to correspond to the patient'"'"'s metabolic needs, comprising the steps of:
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generating electrical stimulation pulses, ultrasonically monitoring movement of a plurality of individual cardiac myofibrils, determining a cardiac performance parameter based on said monitored movement of a plurality of individual cardiac myofibrils, and adjusting at least one parameter operative for varying characteristics of pulses generated in said pulse generating step as a function of said cardiac performance parameter. - View Dependent Claims (15, 16, 17, 18, 19, 20)
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21. A hemodynamic control apparatus for determining a patient'"'"'s hemodynamic status and adjusting the hemodynamic output of the patient'"'"'s heart to correspond to the patient'"'"'s metabolic needs, comprising:
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means for generating electrical stimulation pulse events, ultrasonical means adapted to be implanted within the patient'"'"'s heart for monitoring cardiac myofibril motion, wherein said ultrasonic means is adapted to be implanted within the patient'"'"'s right heart and adjacent to the septum separating the right from the left ventricle for ensonifying the patient'"'"'s septum with ultrasonic energy and detecting returning ultrasonic energy from cardiac myofibrils within the septum, means for determining cardiac performance based on said monitored cardiac myofibril motion, and means for adjusting said pulse generating means as a function of said cardiac performance.
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22. A hemodynamic control apparatus for determining a patient'"'"'s hemodynamic status and adjusting the hemodynamic output of the patient'"'"'s heart to correspond to the patient'"'"'s metabolic needs, comprising:
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means for generating electrical stimulation pulse events, ultrasonical means adapted to be implanted within the patient'"'"'s heart for monitoring cardiac myofibril motion, wherein said ultrasonic means is adapted to be implanted within the patient'"'"'s right heart and adjacent to the septum separating the right from the left ventricle for ensonifying the patient'"'"'s septum with ultrasonic energy and detecting returning ultrasonic energy from cardiac myofibrils within the septum, means for determining cardiac performance based on said monitored cardiac myofibril motion, and means for adjusting said pulse generating means as a function of said cardiac performance, wherein said pulse generating means includes means for generating ventricular pacing pulses, wherein said means for determining cardiac performance comprises a means for deriving a cardiac performance index, and wherein said apparatus further comprises; means for sensing atrial heartbeats, means for determining a metabolic indicator rate as a function of said cardiac performance index and independent of the rate of sensed natural atrial heart beats, means for classifying whether the sensed natural atrial heart rate is physiological or pathological based on the sensed natural atrial heart rate, the metabolic indicator rate and the cardiac performance index, and control means operative when the sensed natural atrial heart rate is physiological for keying the operation of said ventricular pacing pulse generating means to the operation of said atrial heart beat sensing means, and operative otherwise for keying the operation of said ventricular pacing pulse generating means to said metabolic indicator rate. - View Dependent Claims (23, 24, 25)
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26. A method of operating a hemodynamic control apparatus for determining a patient'"'"'s hemodynamic status using an ultrasonic transducer adapted to be implanted within the patient'"'"'s heart and adjusting the hemodynamic output of the patient'"'"'s heart to correspond to the patient'"'"'s metabolic needs, comprising the steps of:
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generating electrical stimulation pulses, ultrasonically monitoring cardiac myofibril motion, wherein said step of ultrasonically monitoring cardiac myofibril motion includes the steps of ensonifying cardiac myofibrils within the septum separating the right from the left ventricle with ultrasonic energy and detecting returning ultrasonic energy from the cardiac myofibrils, determining cardiac performance based on said monitored cardiac myofibril motion, and adjusting parameters operative for varying characteristics of pulses generated in said pulse generating step as a function of said cardiac performance. - View Dependent Claims (27, 28, 29, 30)
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Specification