Statistical method for assessing autonomic balance
First Claim
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1. A method performed by an implantable medical device, comprising:
- measuring time intervals between successive heart beats, referred to as RR intervals, over a predetermined long-term period, where N is the total number of RR interval measurements during the predetermined long-term period and the measured RR intervals RR1 through RRN are referred to as an RR time series;
computing mean values Mx1 through MxL of successive x-second segments of the RR time series, where x is a predetermined number and L is the total number of such x-second segments in the RR time series, and computing a variance of the mean values Mx1 through MxL, referred to as [SDx]2;
computing mean values My1 through MyK of successive y-second segments of the RR time series, where y is a predetermined number greater than x and K is the total number of such y-second segments in the RR time series, and computing a variance of the mean values My1 through MyK, referred to as [SDy]2;
computing a mean value of squared successive differences between the RR intervals in the RR time series, referred to as [rMSSD]2; and
,estimating a ratio of the low frequency content in the RR time series between approximately 1/x Hz and 1/y Hz and higher frequency content in the P.R time series, referred to as LF/HF, as;
LF/HF=K([SDx]2−
[SDy]2)/[rMSSD]2wherein K is a defined constant.
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Abstract
A computationally efficient method for assessing a subject'"'"'s autonomic balance by measurement of heart rate variability is disclosed which is particularly suitable for implementation by an implantable medical device. Statistical surrogates are used to represent frequency components of an RR time series. A ratio of the low frequency component to the high frequency component may then be estimated to assess the subject'"'"'s autonomic balance.
193 Citations
20 Claims
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1. A method performed by an implantable medical device, comprising:
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measuring time intervals between successive heart beats, referred to as RR intervals, over a predetermined long-term period, where N is the total number of RR interval measurements during the predetermined long-term period and the measured RR intervals RR1 through RRN are referred to as an RR time series; computing mean values Mx1 through MxL of successive x-second segments of the RR time series, where x is a predetermined number and L is the total number of such x-second segments in the RR time series, and computing a variance of the mean values Mx1 through MxL, referred to as [SDx]2; computing mean values My1 through MyK of successive y-second segments of the RR time series, where y is a predetermined number greater than x and K is the total number of such y-second segments in the RR time series, and computing a variance of the mean values My1 through MyK, referred to as [SDy]2; computing a mean value of squared successive differences between the RR intervals in the RR time series, referred to as [rMSSD]2; and
,estimating a ratio of the low frequency content in the RR time series between approximately 1/x Hz and 1/y Hz and higher frequency content in the P.R time series, referred to as LF/HF, as;
LF/HF=K([SDx]2−
[SDy]2)/[rMSSD]2wherein K is a defined constant. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
where the summations are carried out from i=1 to T.
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3. The method of claim 1 further comprising:
- defining an integral number S of RR interval bins B1 through BS representing RR interval values I1 through IS;
assigning each computed mean value My1 through MyK of the successive y-second segments of the RR time series to a corresponding one of the RR interval bins B1 through BS; counting the number of computed mean values assigned to each RR interval bin B1 through BS and dividing each such number by K to derive a relative frequency FYi for each interval value Ii; and
,computing [SDy]2 as
[SDy]2=Σ
(Ii)2FYi−
(Σ
(Ii)FYi)2where the summations are carried out from i=1 to S.
- defining an integral number S of RR interval bins B1 through BS representing RR interval values I1 through IS;
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4. The method of claim 1 further comprising:
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defining an integral number W of RR interval difference bins C1 through CW representing RR interval difference values D1 through DW; computing an interval difference between each pair of RR intervals in the RR time series as (RR2−
RR1) through (RRN−
RRN−
1);assigning each of the computed interval differences between RR intervals in the RR time series to a corresponding one of the RR interval difference bins C1 through CW; counting the number of computed interval differences assigned to each RR interval difference bin C1 through CW and dividing each such number by N−
1 to derive a relative frequency FDi for each interval difference Di; and
,computing [rMSSD]2 as
[rMSSD]2=Σ
(Di)2FDiwhere the summation is carried out from i=1 to W.
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5. The method of claim 1 further comprising:
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cumulatively summing each computed mean value Mxi; cumulatively summing each computed mean value Mxi squared; computing [SDx]2 as;
[SDx]2=(1/L)Σ
(Mxi)2−
((1/L)Σ
Mxi)2where the summations are carried out from i=1 to L by the cumulative summing operations.
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6. The method of claim 1 further comprising:
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cumulatively summing each computed mean value Myi; cumulatively summing each computed mean value Myi squared; computing [SDy]2 as;
[SDy]2=(1/L)Σ
(Myi)2−
((1/L)Σ
Myi)2where the summations are carried out from i=1 to K by the cumulative summing operations.
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7. The method of claim 1 further comprising:
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cumulatively summing each computed interval difference value (RRi+1−
RRi) squared;computing [rMSSD]2 as;
[rMSSD]2=(1/(N−
1))Σ
(RRi+1−
RRi)2where the summation is carried out from i=1 to N−
1 by the cumulative summing operation.
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8. The method of claim 1 wherein the predetermined long-term period is 24 hours.
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9. The method of claim 1 wherein the predetermined numbers x and y are 7 and 25, respectively, such that the estimated LF/HF represents a ratio of the low frequency content in the RR time series between approximately 0.04 Hz and 0.15 Hz and the high frequency content in the RR time series between approximately 0.15 Hz and 0.4 Hz.
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10. The method of claim 1 further comprising computing a moving average of estimated LF/HF ratios over successive long-term time periods.
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11. A system, comprising:
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means for measuring time intervals between successive heart beats, referred to as RR intervals, over a predetermined long-term period, where N is the total number of RR interval measurements during the predetermined long-term period and the measured RR intervals RR1 through RRN are referred to as an RR time series; means for computing mean values Mx1 through MxL of successive x-second segments of the RR time series, where x is a predetermined number and L is the total number of such x-second segments in the RR time series, and computing a variance of the mean values Mx1 through MxL, referred to as [SDy]2; means for computing mean values My1 through MyK of successive y-second segments of the RR time series, where y is a predetermined number greater than x and K is the total number of such y-second segments in the RR time series, and computing a variance of the mean values My1 through MyK, referred to as [SDy]2; means for computing a mean value of squared successive differences between the RR intervals in the RR time series, referred to as [rMSSD]2; and
,means for estimating a ratio of the low frequency content in the RR time series between approximately 1/x Hz and 1/y Hz and higher frequency content in the RR time series, referred to as LF/HF, as;
LF/HF=K([SDx]2−
[SDy]2)/[rMSSD]2wherein K is a defined constant. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18, 19, 20)
where the summations are carried out from i=1 to T.
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13. The system of claim 11 further comprising:
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means for defining an integral number S of RR interval bins B1 through BS representing RR interval values I1 through IS; means for assigning each computed mean value My1 through MyK of the successive y-second segments of the RR time series to a corresponding one of the RR interval bins B1 through BS; means for counting the number of computed mean values assigned to each RR interval bin B1 through BS and dividing each such number by K to derive a relative frequency FYi for each interval value Ii; and
,means for computing [SDy]2 as
[SDy]2=Σ
(Ii)2FYi−
(Σ
(Ii)FYi)2where the summations are carried out from i=1 to S.
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14. The system of claim 11 further comprising:
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means for defining an integral number W of RR interval difference bins C1 through CW representing RR interval difference values D1 through DW; means for computing an interval difference between each pair of RR intervals in the RR time series as (RR2−
RR1) through (RRN−
RRN−
1);means for assigning each of the computed interval differences between RR intervals in the RR time series to a corresponding one of the RR interval difference bins C1 through CW; means for counting the number of computed interval differences assigned to each RR interval difference bin C1 through CW and dividing each such number by N−
1 to derive a relative frequency FDi for each interval difference Di; and
,means for computing [rMSSD]2 as
[rMSSD]2=Σ
(Di)2FDiwhere the summation is carried out from i=1 to W.
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15. The system of claim 11 further comprising:
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means for cumulatively summing each computed mean value Mxi; means for cumulatively summing each computed mean value Mxi squared; means for computing [SDx]2 as;
[SDx]2=(1/L)Σ
(Mxi)2−
((1/L)Σ
Mxi)2where the summations are carried out from i=1 to L by the cumulative summing operations.
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16. The system of claim 11 further comprising:
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means for cumulatively summing each computed mean value Myi; means for cumulatively summing each computed mean value Myi squared; means for computing [SDy]2 as;
[SDy]232 (1/L)Σ
(Myi)2−
((1/L)Σ
Myi)2where the summations are carried out from i=1 to K by the cumulative summing operations.
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17. The system of claim 11 further comprising:
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means for cumulatively summing each computed interval difference value (RRi+1−
RRi) squared;means for computing [rMSSD]2 as;
[rMSSD]2=(1/(N−
1))Σ
(RRi+1−
RRi)2where the summation is carried out from i=1 to N−
1 by the cumulative summing operation.
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18. The system of claim 11 wherein the predetermined long-term period is 24 hours.
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19. The system of claim 11 wherein the predetermined numbers x and y are 7 and 25, respectively, such that the estimated LF/HF represents a ratio of the low frequency content in the RR time series between approximately 0.04 Hz and 0.15 Hz and the high frequency content in the RR time series between approximately 0.15 Hz and 0.4 Hz.
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20. The system of claim 11 further comprising means for computing a moving average of estimated LF/HF ratios over successive long-term time periods.
Specification