Apparatus and methods for the noninvasive measurment of cardiovascular system parameters

• US 5,647,369 A
• Filed: 04/19/1996
• Issued: 07/15/1997
• Est. Priority Date: 10/04/1994
• Status: Expired due to Term

• Current Assignee: Edwards Lifesciences Corporation
• Original Assignee: Rutgers University
• Inventors: Smith, Alan M., Welkowitz, Walter, Liss, Lisa K., Orbine, Stephen A. III, Petrucelli, Steven P.
• Primary Examiner(s): Nasser, Robert L.
• Application Number:
  US08/634,974
• Time in Patent Office: 452 Days
• Field of Search: 128/668, 128/670-2, 128/687, 128/690-4, 128/702, 128/661.08
• US Class Current: 600/526
• 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. A method of noninvasively measuring cardiac output of a living subject, comprising the steps of:

measuring systolic minus diastolic pulse pressure of the subject;

measuring the heart rate of the subject;

computing the cardiac output of the patient from the following equation;

space="preserve" listing-type="equation">CO=HR*PP*C*0.133

where CO is cardiac output in liters/minute;

HR is the measured heart rate in beats/minutes;

PP is the measured systolic minus diastolic pulse pressure in mmHg;

0.133 is a conversion factor; and

C is a capacitance value representative of arterial compliance, wherein C has a magnitude of about

space="preserve" listing-type="equation">C=X*10.sup.-6 Farads,

and X is a function of one or more of pulse pressure, age in years, height in centimeters, and weight in kilograms.

2. The method according to claim 1, wherein X is calculated using one of the following equations:

space="preserve" listing-type="equation">X=11,359-70*PP;

space="preserve" listing-type="equation">X=12,373-97*PP+0.2*PP*PP;

space="preserve" listing-type="equation">X=-2,439-75*PP+82*h;

space="preserve" listing-type="equation">X=-1,887-75*PP+75*h+7.5*w;

and

space="preserve" listing-type="equation">X=-2,071-73*PP+80*h+5.6*w-8.9*a;

where, h is the patient'"'"'s height in centimeters, a is the patient'"'"'s age in years, and w is the patient'"'"'s w in kilograms.

3. The method according to claim 1, wherein said step of performing a numerical analysis comprises performing a numerical analysis on the cardiac output data to derive a general equation for C as a function of X, PP and height of a patient.

4. The method according to claim 1, wherein said step of performing a numerical analysis comprises performing a numerical analysis on the cardiac output data to derive a general equation for C as a function of X, PP, height, age, and weight of a patient.

5. A method of noninvasively measuring cardiac output of a living subject, comprising the steps of:

measuring systolic minus diastolic pulse pressure of the subject;

measuring the heart rate of the subject; and

computing the cardiac output of the patient as a function of heart rate, the measured systolic minus diastolic pulse pressure, a constant, and a capacitance value indicative of arterial compliance, wherein said capacitance has a non-constant value and is derived from a Windkessel circuit model analog.

6. The method of claim 5, wherein computing the cardiac output of the patient further comprises deriving the capacitance value from the application of at least one regression equation, wherein the at least one regression equation is derived by taking measurements of pulse pressure, heart rate, and cardiac output from a predetermined number of living subjects.

7. The method of claim 6, further including obtaining the measurements of pulse pressure, heart rate, and cardiac output from said predetermined number of living subjects utilizing a thermodilution standard.

8. The method of claim 6, further including obtaining the measurements of pulse pressure, heart rate, and cardiac output from said predetermined number of living subjects utilizing a Doppler ultrasound standard.

9. The method of claim 6, wherein the at least one regression equation contains variables dependent upon the height of the living subject.

10. The method of claim 6, wherein the at least one regression equation contains variables dependent upon the height and weight of the living subject.

11. The method according to claim 6, wherein the at least one regression equation contains variables dependent upon the height, weight, and age of the living subject.

12. The method according to claim 5, further including obtaining the heart rate in beats/minute;

the pulse pressure is measured in mmHg;

the constant is a conversion factor of 0.133; and

the capacitance is measured in Farads electrically or hydraulically.

13. An apparatus for measuring cardiac output using system parameters of a living subject, comprising:

means for modeling the parameters of the living subject with a lumped element electric circuit model analogous to the living subject'"'"'s cardiovascular system, wherein the circuit model includes 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 measuring the heart rate of the subject

means for computing the value of said systolic capacitor from measurements of the living subject'"'"'s heart rate and pulse pressure; and

means for computing the cardiac output from said capacitor value.

14. The apparatus according to claim 13, wherein the means for computing the value of said systolic capacitance calculates said value using at least one regression equation derived from measurements of cardiac output and heart rate and pulse pressure data taken from a predetermined number of living subjects.

15. The apparatus according to claim 14, wherein the cardiac out measurements used to derived the at least one regression equation are obtained utilizing thermodilution.

16. The apparatus according to claim 14, wherein the cardiac out measurements used to derived the at least one regression equation are obtained utilizing Doppler ultrasound.

17. The apparatus according to claim 13, wherein the means for computing the value of said systolic capacitance further comprises at least one regression equation selected from the group consisting of:

space="preserve" listing-type="equation">C=(11,359-70*PP)*10.sup.-6 Farads;

space="preserve" listing-type="equation">C=(12,373-97*PP+0.2*PP*PP)*10.sup.-6 Farads;

space="preserve" listing-type="equation">C=(-2,439-75*PP+82*h)*10.sup.-6 Farads;

space="preserve" listing-type="equation">C=(-1,887-75*PP+75*h+7.5*w)*10.sup.-6 Farads;

and

space="preserve" listing-type="equation">C=(-2,071-73*PP+80*h+5.6*w-8.9*a)*10.sup.-6 Farads;

where C is the systolic capacitance, a is the age of the living subject in years, w is the weight of the living subject in kilograms, and h is the height of the living subject in centimeters.

18. The apparatus according to claim 13, wherein said means for computing the cardiac output computes said cardiac output as a function of the measured heart rate of the patient in beats/minute, the measured systolic minus diastolic pulse pressure in mmHg, a conversion factor, and the capacitance value representative of arterial compliance.

19. The apparatus according to claim 13, wherein said means for computing the cardiovascular system parameters computes said parameters from the following equation,