Arterial pressure-based, automatic determination of a cardiovascular parameter

• US 7,452,333 B2
• Filed: 07/14/2004
• Issued: 11/18/2008
• Est. Priority Date: 12/05/2003
• Status: Active Grant

• Current Assignee: Edwards Lifesciences Corporation
• Original Assignee: Edwards Lifesciences Corporation
• Inventors: Roteliuk, Luchy
• Primary Examiner(s): Nasser, Jr.; Robert L.
• Assistant Examiner(s): Toth; Karen E
• Application Number:
  US10/890,887
• Publication Number:
  US 20050124904A1
• Time in Patent Office: 1,588 Days
• Field of Search: 600481-507
• US Class Current: 600/485
• CPC Class Codes: A61B 5/02 Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence

Abstract

One or more cardiovascular parameters is estimated as a function of the arterial pressure waveform, in particular, using at least one statistical moment of pressure waveform having an order greater than one. Arterial compliance, the exponential pressure decay constant, vascular resistance, cardiac output, and stroke volume are examples of cardiovascular parameters that can be estimated using various aspects of the invention. In one embodiment of the invention, not only are the first four moments (mean, standard deviation, skewness, and kurtosis) of the pressure waveform used to estimate the cardiovascular parameter(s) of interest, but also heart rate, statistical moments of a set of pressure-weighted time values, and certain anthropometric patient measurements such as age, sex, body surface area, etc.

Claims

1. A method for determining a cardiovascular parameter of a subject comprising:

sensing an input signal that indicates arterial blood pressure;

calculating at least one statistical moment of a first function of the input signal having an order of two or higher; and

estimating the cardiovascular parameter as a second function of at least one statistical moment of a first function of the input signal having an order greater than one.

2. A method as in claim 1, in which the cardiovascular parameter is arterial compliance.

3. A method as in claim 1, in which the cardiovascular parameter is vascular resistance.

4. A method as in claim 1, in which the cardiovascular parameter is cardiac output.

5. A method as in claim 1, in which the cardiovascular parameter is stroke volume.

6. A method as in claim 1, in which the cardiovascular parameter is a pressure decay constant.

7. A method as in claim 1, in which the step of estimating the cardiovascular parameter comprises computing the statistical moment(s) of a sequence of measured arterial pressure values.

8. A method as in claim 7, further comprising estimating the cardiovascular parameter as a function of the kurtosis of the input signal.

9. A method as in claim 7, further comprising estimating the cardiovascular parameter as a function of the skewness of the input signal.

10. A method as in claim 7, further comprising:

measuring a predetermined set of anthropometric parameters of the subject; and

estimating the cardiovascular parameter as a function of the measured anthropometric parameters.

11. A method as in claim 7, in which the cardiovascular parameter is arterial compliance.

12. A method as in claim 7, in which the cardiovascular parameter is vascular resistance.

13. A method as in claim 7, further comprising:

computing both the standard deviation and at least one statistical moment, having an order greater than two, of the input signal;

estimating an arterial compliance value as a function of at least the statistical moment of the input signal having an order greater than two; and

computing an estimate of stroke volume as a function of the product of the standard deviation and the arterial compliance value.

14. A method as in claim 13, further comprising:

computing the kurtosis of the input signal;

computing an estimate of stroke volume as a function not only of the product of the standard deviation and the arterial compliance value, but also of an offset factor that is proportional to the kurtosis.

15. A method as in claim 7, further comprising:

measuring the subject'"'"'s heart rate;

computing both the mean and the standard deviation of the input signal;

computing, as the cardiovascular parameter, a pressure decay constant a function that is proportional to the mean and inversely proportion to both the standard deviation and the heart rate.

16. A method as in claim 15, further comprising:

computing an arterial compliance value; and

computing, as the cardiovascular parameter, a vascular resistance value as a function that is proportional to the pressure decay constant and inversely proportion to the arterial compliance value.

17. A method as in claim 7, in which the cardiovascular parameter is arterial compliance, further comprising:

determining an approximating function relating a set of clinically determined reference measurements to arterial compliance, in which the approximating function is a function of at least three different statistical moments of the input signal, as well as of a set of anthropometric values;

computing the three different statistical moments of the input signal, as well as measuring the set of anthropometric values of the subject;

estimating the arterial compliance of the subject by evaluating the approximating function with the computed three different statistical moments of the input signal, as well as the measured set of anthropometric values of the subject.

18. A method as in claim 17, further comprising:

sensing the input signal over a period corresponding to at least one cardiac cycle; and

computing a set of pressure-weighted time values, each corresponding to the product of a sensing time, relative to an initial time, and arterial pressure at the sensing time;

in which the approximating function is a function also of the statistical moment(s) of the set of pressure-weighted time values.

19. A method as in claim 17, further comprising computing at least two statistical moments not only of the input signal, but also of the set of pressure-weighted time values;

in which the approximating function is a function of the computed statistical moments of both the input signal and of the set of pressure-weighted time values.

20. A method as in claim 17, further comprising:

measuring the subject'"'"'s heart rate;

estimating stroke volume as a function of the product of the estimated arterial compliance and the standard deviation of the input signal; and

computing cardiac output value as a function of the product of the estimated stroke volume and the measured heart rate.

21. A method as in claim 1, further including the step of sensing the input signal over a period corresponding to at least one cardiac cycle, and in which the step of estimating the cardiovascular parameter comprises

computing a set of pressure-weighted time values, each corresponding to the product of a sensing time, relative to an initial time, and arterial pressure at the sensing time;

and

computing the statistical moment(s) of the pressure-weighted time values.

22. A method as in claim 21, in which the cardiovascular parameter is arterial compliance.

23. A method as in claim 21, in which the cardiovascular parameter is vascular resistance.

24. A method as in claim 21, in which the cardiovascular parameter is cardiac output.

25. A method as in claim 21, in which the cardiovascular parameter is stroke volume.

26. A method as in claim 21, in which the cardiovascular parameter is a pressure decay constant.

27. A method as in claim 21, further comprising estimating the cardiovascular parameter as a function of the kurtosis of the pressure-weighted time values.

28. A method as in claim 21, further comprising estimating the cardiovascular parameter as a function of the standard deviation of the pressure-weighted time values.

29. A method as in claim 21, further comprising estimating the cardiovascular parameter as a function of the skewness of the pressure-weighted time values.

30. A method as in claim 21, further comprising:

measuring a predetermined set of anthropometric parameters of the subject; and

estimating the cardiovascular parameter as a function of the measured anthropometric parameters.

31. A method as in claim 21, in which the cardiovascular parameter is arterial compliance, further comprising:

determining an approximating function relating a set of clinically determined reference measurements to arterial compliance, in which the approximating function is a function of the statistical moment(s) of the pressure-weighted time values and of a set of anthropometric values;

computing the statistical moment(s) of the pressure-weighted time values, as well as measuring the set of anthropometric values of the subject;

estimating the arterial compliance of the subject by evaluating the approximating function with the computed statistical moment(s) of the pressure-weighted time values, as well as with the measured set of anthropometric values of the subject.

32. A method as in claim 1, further comprising:

sensing the input signal over a period corresponding to at least one cardiac cycle, and in which the step of estimating the cardiovascular parameter comprises;

computing at least one statistical moment of a sequence of measured arterial pressure values;

computing a set of pressure-weighted time values, each corresponding to the product of a sensing time, relative to an initial time, and arterial pressure at the sensing time; and

computing at least one statistical moment of the set of pressure-weighted time values;

estimating the cardiovascular parameter as function of both the statistical moment(s) of the sequence of measured arterial pressure values and the statistical moment(s) of the set of pressure-weighted time values.

33. A method as in claim 32, further comprising:

measuring a predetermined set of anthropometric parameters of the subject; and

estimating the cardiovascular parameter as a function also of the measured anthropometric parameters.

34. A method as in claim 32, in which the cardiovascular parameter is arterial compliance.

35. A method as in claim 34, further comprising:

measuring a predetermined set of anthropometric parameters of the subject; and

determining an approximating function relating a set of clinically determined reference measurements to arterial compliance, in which the approximating function is a function of at least the statistical moment(s) of the sequence of measured arterial pressure values, of the statistical moment(s) of the set of pressure-weighted time values, and of the set of anthropometric values;

estimating the arterial compliance of the subject by evaluating the approximating function with the statistical moment(s) of the sequence of measured arterial pressure values, of the statistical moment(s) of the set of pressure-weighted time values, and of the set of anthropometric values, all of the subject.

36. A method as in claim 32, in which the cardiovascular parameter is vascular resistance.

52. A system as in claim 1, further comprising:

the moment-calculating module comprises further computer-executable code for computing the kurtosis of the input signal;

the estimation module comprises further computer-executable code computing an estimate of stroke volume as a function not only of the product of the standard deviation and the arterial compliance value, but also of an offset factor that is proportional to the kurtosis.

37. A method for determining cardiac stroke volume comprising:

sensing an input signal that indicates arterial blood pressure of a subject;

calculating the standard deviation and kurtosis of the input signal;

determining an arterial compliance value of the subject;

computing an estimate of stroke volume as a function of the product of the standard deviation and the arterial compliance value, as well as of an offset factor that is proportional to the kurtosis.

38. A method as in claim 37, in which the offset factor is γ

(μ

₄3), where γ

is a predetermined constant and μ

₄ is the kurtosis.

39. A system for determining a cardiovascular parameter of a subject comprising:

a monitoring system sensing an input signal that indicates arterial blood pressure and including a processing system including;

a moment-calculating module comprising computer-executable code for calculating at least one statistical moment of a first function of the input signal having an order of two or higher; and

an estimation module comprising computer-executable code for estimating the cardiovascular parameter as a second function of at least one statistical moment of a first function of the input signal having an order greater than one.

40. A system as in claim 39, in which the cardiovascular parameter is arterial compliance.

41. A system as in claim 39, in which the cardiovascular parameter is vascular resistance.

42. A system as in claim 39, in which the cardiovascular parameter is cardiac output.

43. A system as in claim 39, in which the cardiovascular parameter is stroke volume.

44. A system as in claim 39, in which the cardiovascular parameter is pressure decay constant.

45. A system as in claim 39, in which the estimation module further comprises computer-executable code for estimating the cardiovascular parameter by computing the statistical moment(s) of a sequence of measured arterial pressure values.

46. A system as in claim 39, in which the estimation module further comprises computer-executable code for estimating the cardiovascular parameter as a function of the kurtosis of the input signal.

47. A system as in claim 39, in which the estimation module further comprises computer-executable code for estimating the cardiovascular parameter as a function of the skewness of the input signal.

48. A system as in claim 45, further comprising:

an input arrangement for inputting to the processing system a predetermined set of anthropometric parameters of the subject;

the estimation module including additional computer-executable code for estimating the cardiovascular parameter as a function also of the measured anthropometric parameters.

49. A system as in claim 45, in which the cardiovascular parameter is arterial compliance.

50. A system as in claim 45, in which the cardiovascular parameter is vascular resistance.

51. A system as in claim 45, in which

the moment-calculating module comprises further computer-executable code for computing both the standard deviation and at least one statistical moment, having an order greater than two, of the input signal;

and

the estimation module comprises further computer-executable code for estimating an arterial compliance value as a function of at least the statistical moment of the input signal having an order greater than two; and

for computing an estimate of stroke volume as a function of the product of the standard deviation and the arterial compliance value.

53. A system as in claim 45, further comprising:

a heart rate monitor measuring the subject'"'"'s heart rate;

in which

the moment-calculating module comprises further computer-executable code for computing both the mean and the standard deviation of the input signal;

the estimation module comprises further computer-executable code for computing, as the cardiovascular parameter, a pressure decay constant a function that is proportional to the mean and inversely proportion to both the standard deviation and the heart rate.

54. A system as in claim 53, in which

the moment-calculating module comprises further computer-executable code for computing an arterial compliance value;

and for computing, as the cardiovascular parameter, a vascular resistance value as a function that is proportional to the pressure decay constant and inversely proportion to the arterial compliance value.

55. A system as in claim 45, in which the cardiovascular parameter is arterial compliance, in which:

the moment-calculating module comprises further computer-executable code for computing at least three different statistical moments of the input signal;

the estimation module comprises further computer-executable code for estimating the arterial compliance of the subject by evaluating an approximating function with the computed three different statistical moments of the input signal, as well with a measured set of anthropometric values of the subject;

the approximating function relating a set of clinically determined reference measurements to arterial compliance, the reference measurements including the at least three different statistical moments and the set of anthropometric values.

56. A system as in claim 55, in which:

the processing system is provided for sensing the input signal over a period corresponding to at least one cardiac cycle and includes computer-executable code for computing a set of pressure-weighted time values, each corresponding to the product of a sensing time, relative to an initial time, and arterial pressure at the sensing time;

the moment-calculating module comprises further computer-executable code for computing at least one statistical moment of the set of pressure-weighted time values;

the approximating function is a function also of the statistical moment(s) of the set of pressure-weighted time values.

57. A system as in claim 55, further comprising computing at least two statistical moments not only of the input signal, but also of the set of pressure-weighted time values;

in which the approximating function is a function of the computed statistical moments of both the input signal and of the set of pressure-weighted time values.

58. A method as in claim 55, further comprising:

a heart rate measuring arrangement providing a signal indicating the subject'"'"'s heart rate;

in which;

the estimation module comprises further computer-executable code for estimating stroke volume as a function of the product of the estimated arterial compliance and the standard deviation of the input signal; and

for computing cardiac output value as a function of the product of the estimated stroke volume and the measured heart rate.

59. A system as in claim 39, in which:

the processing system is provided for sensing the input signal over a period corresponding to at least one cardiac cycle;

the moment-calculating module comprises further computer-executable code for computing a set of pressure-weighted time values, each corresponding to the product of a sensing time, relative to an initial time, and arterial pressure at the sensing time; and

for computing the statistical moment(s) of the pressure-weighted time values.

60. A system as in claim 59, in which the cardiovascular parameter is arterial compliance.

61. A system as in claim 59, in which the cardiovascular parameter is vascular resistance.

62. A system as in claim 59, in which the cardiovascular parameter is cardiac output.

63. A system as in claim 59, in which the cardiovascular parameter is stroke volume.

64. A system as in claim 59, in which the cardiovascular parameter is a pressure decay constant.

65. A system as in claim 59, in which

the moment-calculating module comprises further computer-executable code for computing the kurtosis of the set of pressure-weighted time values;

and

the estimation module comprises further computer-executable code for estimating the cardiovascular parameter as a function of the kurtosis of the pressure-weighted time values.

66. A system as in claim 59, in which

the moment-calculating module comprises further computer-executable code for computing the standard deviation of the set of pressure-weighted time values;

and

the estimation module comprises further computer-executable code for estimating the cardiovascular parameter as a function of the standard deviation of the pressure-weighted time values.

67. A system as in claim 59, in which:

the moment-calculating module comprises further computer-executable code for computing the skewness of the set of pressure-weighted time values; and

the estimation module comprises further computer-executable code for estimating the cardiovascular parameter as a function of the skewness of the pressure-weighted time values.

68. A system as in claim 59, further comprising:

an input arrangement for inputting to the processing system a predetermined set of anthropometric parameters of the subject;

the estimation module including additional computer-executable code for estimating the cardiovascular parameter as a function also of the measured anthropometric parameters.

69. A system as in claim 59, in which the cardiovascular parameter is arterial compliance, in which:

the moment-calculating module comprises further computer-executable code for computing at least three different statistical moments of the pressure-weighted time values;

the estimation module comprises further computer-executable code for estimating the arterial compliance of the subject by evaluating an approximating function with the computed three different statistical moments of the pressure-weighted time values, as well with a measured set of anthropometric values of the subject;

the approximating function relating a set of clinically determined reference measurements to arterial compliance, the reference measurements including the at least three different statistical moments and the set of anthropometric values.

70. A system as in claim 39, in which the moment-calculating module and the estimation module are implemented as a single body of computer-executable code.

71. A system as in claim 39, in which:

the processing system is provided for sensing the input signal over a period corresponding to at least one cardiac cycle;

the moment-calculating module comprises further computer-executable code

for computing at least one statistical moment of a sequence of measured arterial pressure values;

for computing a set of pressure-weighted time values, each corresponding to the product of a sensing time, relative to an initial time, and arterial pressure at the sensing time; and

for computing at least one statistical moment of the pressure-weighted time values;

the estimation module comprises further computer-executable code for estimating the cardiovascular parameter as function of both the statistical moment(s) of the sequence of measured arterial pressure values and the statistical moment(s) of the set of pressure-weighted time values.

72. A system as in claim 71, further comprising an input arrangement for inputting to the processing system a predetermined set of anthropometric parameters of the subject;

the estimation module including additional computer-executable code for estimating the cardiovascular parameter as a function also of the measured anthropometric parameters.

73. A system as in claim 71, in which the cardiovascular parameter is arterial compliance.

74. A system as in claim 73, further comprising:

an input arrangement for inputting to the processing system a predetermined set of anthropometric parameters of the subject;

in which;

the estimation module comprises further computer-executable code for estimating the arterial compliance of the subject by evaluating an approximating function of the statistical moment(s) of the sequence of measured arterial pressure values, of the statistical moment(s) of the set of pressure-weighted time values, and of the set of anthropometric values, the approximating function relating a set of clinically determined reference measurements to arterial compliance, the reference measurements including the at least three different statistical moments and the set of anthropometric values.

75. A system as in claim 71, in which the cardiovascular parameter is vascular resistance.

76. A system for determining cardiac stroke volume comprising:

a processing system sensing an input signal that indicates arterial blood pressure of a subject;

a moment-calculating module comprising computer-executable code for calculating the standard deviation and kurtosis of the input signal;

an estimation module for comprising computer-executable code for determining an arterial compliance value of the subject; and

for computing an estimate of stroke volume as a function of the product of the standard deviation and the arterial compliance value, as well as of an offset factor that is proportional to the Kurtosis.