Apparatus and methods for the noninvasive measurement of cardiovascular system parameters

• US 5,535,753 A
• Filed: 10/04/1994
• Issued: 07/16/1996
• Est. Priority Date: 10/04/1994
• Status: Expired due to Term

• Current Assignee: Edwards Lifesciences Corporation
• Original Assignee: Rutgers University
• Inventors: Smith, Alan M., Petrucelli, Steven P., Welkowitz, Walter, Liss, Lisa K., Orbine, Stephen A. III
• Primary Examiner(s): Sykes, Angela D.
• Assistant Examiner(s): NASSER, ROBERT L
• Application Number:
  US08/317,927
• Time in Patent Office: 651 Days
• Field of Search: 128/668, 128/670, 128/672, 128/687, 128/690-694, 128/702, 128/661.08
• US Class Current: 600/485
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence

Abstract

Apparatus and methods for noninvasively measuring cardiovascular system parameters. According to a first preferred embodiment, the apparatus generates a time varying electrical voltage waveform having voltages corresponding to systolic and diastolic arterial pressures of the subject, the parameters being modelled by a lumped element electric circuit model analogous to the living subject'"'"'s cardiovascular system, said circuit model including a systolic capacitor analogous to arterial compliance during systole, said apparatus comprising means for computing the value of said systolic capacitor from a measurement of an elapsed time between two voltage levels within a portion of said voltage waveform corresponding to systole, according to a predetermined criteria; and means for computing at least one said cardiovascular system parameter from said capacitor value. According to a second embodiment, a time-varying systolic arterial compliance is measured by measuring an arterial pulse pressure waveform. A third embodiment discloses a method of measuring cardiac output noninvasively from a cuff measurement of a patient'"'"'s systolic minus diastolic blood pressure and a heart rate measurement. Cardiac output equations are derived from an unmodified Windkessel circuit model which models arterial compliance as a single lumped capacitance. General formulas for the value of the lumped capacitance are provided which are used to more accurately compute cardiac output from this circuit model.

Claims

1. An apparatus for measuring cardiovascular system parameters of a living subject, comprising:

means for modelling the parameters of the living subject with a lumped element electric circuit model analogous to the living subject'"'"'s cardiovascular system, said circuit model including a systolic capacitor analogous to arterial compliance during systole;

first transducer means for sensing a time varying arterial pressure pulse waveform from the living subject and converting said pressure pulse waveform to an electrical voltage waveform having voltages corresponding to systolic and diastolic arterial pressures of the subject;

means for computing the value of said systolic capacitor from a measurement of an elapsed time between two voltage levels within a portion of said voltage waveform corresponding to systole, according to a predetermined criteria; and

means for computing the cardiovascular system parameters from said capacitor value.

2. The apparatus according to claim 1 wherein said means for computing the value of said systolic capacitor computes said systolic capacitor value from the following equation:

space="preserve" listing-type="equation">C.sub.s =t.sub.s.sup.2 /π

.sup.2 L

where C_s is the systolic capacitance;

one of said two voltage levels is a low voltage level, the other of said two voltage levels is a high voltage level, t_s is said elapsed time between said low and high voltage levels; and

L is a predetermined inductance value representative of inertance of blood; and

wherein said means for computing the cardiovascular system parameters computes said arterial compliance during systole from said systolic capacitance.

3. The apparatus according to claim 2 wherein the cardiovascular system parameters include average blood flow from the living subject'"'"'s heart, and further including:

means for computing a loop current representative of blood flow from the living subject'"'"'s heart to the living subject'"'"'s aorta during systole, said loop current defined by the following equation;

space="preserve" listing-type="equation">i(t)=(Vp/[(LC.sub.s).sup.0.5 ])* sin [(LC.sub.s).sup.-0.5 t]

where i(t) is the loop current, t is time;

Vp is one half of said high voltage level of said portion of said electrical voltage waveform corresponding to systole; and

further including;

means for converting said loop current to a corresponding average blood flow value in the living subject by averaging said loop current over a single cardiac cycle.

4. The apparatus according to claim 3 wherein the cardiovascular system parameters also include mean blood flow in diastole from the living subject'"'"'s heart, and further including:

means for determining a mean diastolic pressure Pd from said portion of said electrical voltage waveform corresponding to diastole;

means for computing said mean blood flow in diastole Qd, from said loop current averaged over said portion of said electrical voltage waveform corresponding to diastole; and

means for computing arterial diastolic resistance Rd defined by the equation;

space="preserve" listing-type="equation">Rd=Pd/Qd.

5. The apparatus according to claim 4, further including:

means for determining another elapsed time between another low voltage level and another high voltage level of said portion of said electrical waveform corresponding to diastole, said another low voltage level corresponding to pressure at the end of diastole, said another high voltage value corresponding to pressure at the end of systole;

means for computing a diastolic capacitance value of said lumped element circuit model according to the equation;

space="preserve" listing-type="equation">Cd=τ

/Rd

where Cd is said diastolic capacitance value;

τ

is said another elapsed time; and

Rd is said diastolic resistance; and

wherein said means for computing the cardiovascular system parameters further includes means for computing a value of arterial diastolic compliance from said diastolic capacitance value.

6. The apparatus according to claim 1 further including:

means for identifying systolic and diastolic portions of said electrical waveform;

second transducer means for providing an ECG signal from the subject;

A/D conversion means coupled to said first and second transducer means for digitizing said electrical voltage waveform and said ECG signal;

processing means coupled to said A/D conversion means, for separating continuous data streams of said electrical voltage waveform and said ECG signal into a plurality of individual data files each representative of said pressure waveform and said ECG signal during one cardiac cycle, said data files being used to compute the cardiovascular system parameters of the living subject by said means for computing the cardiovascular system parameters, said processing means including means for searching for each QRS complex of said ECG signal to define start and stop points of each cardiac cycle; and

display means coupled to said processing means for displaying said voltage waveform and said ECG signal one said individual data file at a time.

7. The apparatus according to claim 6 further including means for discriminating among voltage waveforms of said individual data files to selectively enable subsequent computation of cardiovascular system parameters on said voltage waveforms of said individual data files.

8. A method for noninvasively measuring cardiovascular system parameters of a living subject, comprising the steps of:

providing a lumped element electric circuit model analogous to the living subject'"'"'s cardiovascular system for modelling the parameters of the living subject, said circuit model including a systolic capacitor analogous to arterial compliance during systole;

sensing a time varying arterial pressure pulse waveform from the living subject;

converting said pressure pulse waveform to an electrical voltage waveform having voltages corresponding to systolic and diastolic arterial pressures of the subject;

computing the value of said systolic capacitor from a measurement of an elapsed time between two voltage levels within a portion of said voltage waveform corresponding to systole, according to a predetermined criteria; and

computing the cardiovascular system parameters from said capacitor value.

9. The method according to claim 8 wherein said step of sensing includes sensing said arterial pressure pulse waveform from the carotid artery of the living subject.

10. The method according to claim 8 wherein said step of sensing includes sensing an arterial A-line pressure pulse waveform from the carotid artery of the living subject.

11. The method according to claim 8 wherein said step of computing the value of said systolic capacitor includes:

providing a first equation;

space="preserve" listing-type="equation">C.sub.s =t.sub.s.sup.2 /π

.sup.2 L

where C_s is the systolic capacitance;

one of said two voltage levels is a low voltage level, the other of said two voltage levels is a high voltage level, t_s is said elapsed time between said low and high voltage levels; and

L is a predetermined inductance value representative of inertance of blood;

computing the value of said systolic capacitor using said first equation.

12. The method according to claim 11 wherein said step of computing the cardiovascular system parameters from said capacitor value includes computing the arterial compliance during systole from said systolic capacitance.

13. The method according to claim 12 wherein the cardiovascular system parameters include average blood flow from the living subject'"'"'s heart, and further including:

providing a second equation;

space="preserve" listing-type="equation">i(t)=(Vp/[(LC.sub.s).sup.0.5 ])* sin [(LC.sub.s).sup.0.5 t],

where i(t) is the loop current which is representative of blood flow from the living subject'"'"'s heart to the living subject'"'"'s aorta during systole, t is time;

Vp is one half of said high voltage level of said portion of said electrical voltage waveform corresponding to systole;

computing said loop current using said second equation; and

converting said loop current to an average blood flow value in the living subject by averaging said loop current over a single cardiac cycle.

14. The method according to claim 13 wherein the cardiovascular system parameters also include mean blood flow in diastole from the living subject'"'"'s heart, and further including:

determining a mean diastolic pressure Pd from said portion of said electrical voltage waveform corresponding to diastole;

computing said mean blood flow in diastole Qd, from said loop current averaged over said portion of said electrical voltage waveform corresponding to diastole;

providing a third equation;

space="preserve" listing-type="equation">Rd=Pd/Qd; and

computing arterial diastolic resistance Rd using said third equation.

15. The method according to claim 14 further including the steps of:

determining a second elapsed time z between a second low voltage level and a second high voltage level of said portion said electrical waveform corresponding to diastole, said second high voltage level corresponding to pressure at the end of systole, said second low voltage value corresponding to pressure at the end of diastole;

providing a fourth equation;

space="preserve" listing-type="equation">Cd=τ

/Rd,

where Cd is said diastolic capacitance value;

τ

is said second elapsed time; and

Rd is said diastolic resistance;

computing a diastolic capacitance value of said lumped element circuit model using said fourth equation;

computing a value of arterial diastolic compliance from said diastolic capacitance value.