Method and apparatus for monitoring of diastolic hemodynamics
First Claim
1. A system adapted to be coupled to a patient, comprising:
- an acoustic sensor including an accelerometer adapted to sense an acoustic energy and produce an acoustic sensor signal indicative of heart sounds of the patient and physical activities of the patient;
a signal conditioning circuit coupled to the acoustic sensor, the signal conditioning circuit adapted to filter the acoustic sensor signal to reduce noise in the acoustic sensor signal;
a cardiac sensing circuit to sense a cardiac signal indicative of cardiac electrical events;
a heart sound detector coupled to the signal conditioning circuit and the cardiac sensing circuit, the heart sound detector adapted to detect selected heart sounds based on the acoustic sensor signal and the cardiac signal, the selected heart sounds indicative of ventricular diastolic hemodynamic performance;
a parameter generator coupled to the heart sound detector, the parameter generator adapted to make measurements on the acoustic sensor signal timed using the detected selected heart sounds and generate values of at least one predetermined parameter related to the selected heart sounds using the measurements and including;
a noise monitoring module adapted to produce a background noise level using the acoustic sensor signal, the background noise level indicative of the physical activities of the patient; and
a screening module coupled to the noise monitoring module and adapted to exclude the values of the at least one predetermined parameter generated using the measurements made when the background noise level exceeds a predetermined level;
a processor coupled to the parameter generator, the processor adapted to perform a statistical process analyzing the values of the at least one predetermined parameter generated for a predetermined duration and produce at least one trend quantitatively presenting one or more ventricular diastolic filling pattern changes during the predetermined duration using an outcome of the statistical process;
a data acquisition enabler adapted to time data acquisition by enabling one or more system components according to a predetermined schedule, the one or more system components including one or more of the acoustic sensor, the cardiac sensing circuit, the heart sound detector, and the parameter generator; and
a therapy circuit communicatively coupled to the processor, the therapy circuit adapted to deliver at least one cardiac therapy with at least one therapy parameter determined based on the at least one trend.
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Abstract
A cardiac rhythm management system provides for ambulatory monitoring of hemodynamic performance based on quantitative measurements of heart sound related parameters for diagnostic and therapeutic purposes. Monitoring of such heart sound related parameters allows the cardiac rhythm management system to determine a need for delivering a therapy and/or therapy parameter adjustments based on conditions of a heart. This monitoring also allows a physician to observe or assess the hemodynamic performance for diagnosing and making therapeutic decisions. Because the conditions of the heart may fluctuate and may deteriorate significantly between physician visits, the ambulatory monitoring, performed on a continuous or periodic basis, ensures a prompt response by the cardiac rhythm management system that may save a life, prevent hospitalization, or prevent further deterioration of the heart.
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Citations
43 Claims
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1. A system adapted to be coupled to a patient, comprising:
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an acoustic sensor including an accelerometer adapted to sense an acoustic energy and produce an acoustic sensor signal indicative of heart sounds of the patient and physical activities of the patient; a signal conditioning circuit coupled to the acoustic sensor, the signal conditioning circuit adapted to filter the acoustic sensor signal to reduce noise in the acoustic sensor signal; a cardiac sensing circuit to sense a cardiac signal indicative of cardiac electrical events; a heart sound detector coupled to the signal conditioning circuit and the cardiac sensing circuit, the heart sound detector adapted to detect selected heart sounds based on the acoustic sensor signal and the cardiac signal, the selected heart sounds indicative of ventricular diastolic hemodynamic performance; a parameter generator coupled to the heart sound detector, the parameter generator adapted to make measurements on the acoustic sensor signal timed using the detected selected heart sounds and generate values of at least one predetermined parameter related to the selected heart sounds using the measurements and including; a noise monitoring module adapted to produce a background noise level using the acoustic sensor signal, the background noise level indicative of the physical activities of the patient; and a screening module coupled to the noise monitoring module and adapted to exclude the values of the at least one predetermined parameter generated using the measurements made when the background noise level exceeds a predetermined level; a processor coupled to the parameter generator, the processor adapted to perform a statistical process analyzing the values of the at least one predetermined parameter generated for a predetermined duration and produce at least one trend quantitatively presenting one or more ventricular diastolic filling pattern changes during the predetermined duration using an outcome of the statistical process; a data acquisition enabler adapted to time data acquisition by enabling one or more system components according to a predetermined schedule, the one or more system components including one or more of the acoustic sensor, the cardiac sensing circuit, the heart sound detector, and the parameter generator; and a therapy circuit communicatively coupled to the processor, the therapy circuit adapted to deliver at least one cardiac therapy with at least one therapy parameter determined based on the at least one trend. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)
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18. A method, comprising:
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sensing an acoustic energy to produce an acoustic sensor signal using an accelerometer, the acoustic signal indicative heart sounds of a patient and physical activities of the patient; amplifying and filtering the acoustic sensor signal to increase a signal-to-noise ratio of the acoustic sensor signal; sensing at least one cardiac signal indicative of cardiac electrical events; detecting selected heart sounds indicative of ventricular diastolic hemodynamic performance; measuring the acoustic sensor signal; timing the measuring the acoustic sensor signal using the detected selected heart sounds; generating values of at least one predetermined parameter related to the selected heart sounds and selected cardiac electrical events using a result of the measuring the acoustic sensor signal; producing a background noise level using the acoustic sensor signal, the background noise level indicative of the physical activities of the patient; excluding the values of the at least one predetermined parameter generated using the acoustic sensor signal measured when the background noise level exceeds a predetermined level; performing a statistical process analyzing selected values of the at least one predetermined parameter, the selected values associated with one or more types of the selected heart sounds detected during a first predetermined period of time, the one or more types of the selected heart sounds indicative of ventricular diastolic hemodynamic performance; producing at least one trend quantitatively presenting one or more ventricular diastolic filling pattern changes during the predetermined period of time using an outcome of the statistical process; and delivering at least one therapy with at least one parameter determined based on the at least one trend. - View Dependent Claims (19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32)
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33. A cardiac rhythm management system for treating a patient, comprising:
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an implantable device including; an acoustic sensor including an accelerometer adapted to sense an acoustic energy to produce an acoustic sensor signal indicative heart sounds of the patient and physical activities of the patient; a signal conditioning circuit coupled to the acoustic sensor, the signal conditioning circuit adapted to filter the acoustic sensor signal to reduce noise in the acoustic sensor signal; a cardiac sensing circuit to sense at least one cardiac signal indicative of cardiac electrical events; a gating module coupled to the signal conditioning circuit and the cardiac sensing circuit, the gating module adapted to generate heart sound detection windows each timed for detection of one of selected heart sounds based on a time of occurrence of one of selected cardiac electrical events; a heart sound detector, coupled to the gating module, to detect the selected heart sounds indicative of ventricular diastolic hemodynamic performance; a parameter generator coupled to the heart sound detector, the parameter generator adapted to generate values of at least one predetermined parameter related to the selected heart sounds using the acoustic sensor signal and including a noise monitoring module and a screening module, the noise monitoring module adapted to produce a background noise level indicative of the physical activities of the patient using the acoustic sensor signal, the screening module adapted to exclude the values of the at least one predetermined parameter generated using the acoustic sensor signal sensed when the background noise level exceeds a predetermined level; and a therapy circuit coupled to the measurement module, to deliver a therapy based on the values of the at least one predetermined parameter; and an external system communicatively coupled to the implantable device via telemetry, the external system including a processor communicatively coupled to the measurement module, the processor adapted to perform a statistical process analyzing the values of the at least one predetermined parameter generated for a predetermined duration and produce at least one trend quantitatively presenting one or more ventricular diastolic filling pattern changes during the predetermined duration using an outcome of the statistical process. - View Dependent Claims (34, 35, 36, 37, 38, 39, 40, 41, 42, 43)
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Specification