Systems and methods for estimating left atrial pressure (LAP) in patients with acute mitral valve regurgitation for use by an implantable medical device

• US 8,135,468 B2
• Filed: 08/09/2010
• Issued: 03/13/2012
• Est. Priority Date: 08/09/2010
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Gutfinger, Dan E., Qu, Fujian, Soriano, Alex, Rooke, Ryan, Nabutovsky, Yelena, Shah, Riddhi
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US12/853,157
• Publication Number:
  US 20120035681A1
• Time in Patent Office: 582 Days
• Field of Search: 607/28
• US Class Current: 607/28
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/02158 provided with two or more sensor elements
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/37235 Aspects of the external programmer
• CPC Class Codes: A61N 1/37258 Alerting the patient
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Various techniques are provided for use with an implantable medical device for estimating cardiac pressure within a patient based on admittance (or related electrical values such as impedance or conductance) that takes into account the presence of acute MR within the patient. Briefly, the device detects an indication of acute MR, if occurring within the patient. The device also applies electrical fields to tissues of the patient and measures electrical parameters influenced by the electrical field, such as admittance, impedance or conductance. The device then estimates cardiac pressure within the patient based on the measured electrical parameter and the indication of acute MR. In one example, different linear correlation functions are used to convert admittance values to left atrial pressure (LAP) values depending upon the presence or absence of acute MR within the patient.

Claims

1. A method for estimating cardiac pressure within a patient for use with an implantable medical device, the method comprising:

detecting an indication of acute mitral valve regurgitation (MR), if occurring within the patient;

applying an electrical field to tissues of the patient including cardiac tissues and measuring an electrical parameter influenced by the applied electrical field and affected by cardiac pressure; and

estimating cardiac pressure within the patient based on the electrical parameter and the indication of acute MR.

2. The method of claim 1 wherein applying an electrical field to tissues of the patient includes applying a detection pulse from which one or more of impedance (Z), admittance (Y) and conductance (G) can be measured.

3. The method of claim 1 wherein measuring the electrical parameter includes:

measuring one or more of impedance (Z), admittance (Y) and conductance (G) signal within the patient along one or more sensing vectors passing through cardiac tissue; and

deriving the electrical parameter from the detected signal.

4. The method of claim 1 wherein estimating cardiac pressure based on the electrical parameter is performed using one or more of a linear correlation, an exponential correlation and a polynomial correlation.

5. The method of claim 4 wherein estimating cardiac pressure includes calculating

Cardiac Pressure=Parameter* Slope+Baseline

if acute MR is not indicated, wherein Slope and Baseline are conversion factors representative of a linear correlation between the measured electrical parameter and the cardiac pressure;

and

calculating

Cardiac Pressure=Parameter* Slope+Baseline+MR Correction

if acute MR is indicated, wherein MR Correction is a correction factor for compensating for the affects of MR on the estimation.

6. The method of claim 5 wherein the MR Correction term is a constant.

7. The method of claim 5 wherein detecting the indication of MR includes detecting the degree of MR and wherein the MR correction term is adjusted based on the degree of MR.

8. The method of claim 5 further including detecting left ventricular (LV) volume and wherein the MR correction term is adjusted based on LV volume.

9. The method of claim 1 for use with a device equipped to measure heart sounds and wherein detecting the indication of acute MR within the patient includes:

detecting heart sounds within the patient; and

detecting the presence of acute MR based on the heart sounds.

10. The method of claim 9 further including assessing the severity of acute MR based on the heart sounds.

11. The method of claim 1 for use with a device equipped to measure admittance associated with electrodes mounted on a LV-sided and a RV-sided pacing leads and wherein the indication of acute MR is detected based on the admittance values associated with the LV-sided and RV-sided electrodes.

12. The method of claim 1 for use with a device equipped to measure cardiogenic impedance waveforms and wherein detecting the indication of acute MR within the patient includes:

detecting a cardiogenic impedance waveform along vectors affected by acute MR; and

detecting acute MR based on changes in the cardiogenic impedance waveform.

13. The method of claim 1 for use with a device equipped to measure systemic blood pressure and wherein detecting the indication of acute MR within the patient includes:

detecting systemic blood pressure associated with an increase in afterload within the patient; and

detecting the presence of acute MR based on systemic blood pressure.

14. The method of claim 1 for use with a device equipped with an activity sensor and wherein the method includes the additional steps of:

detecting patient activity within the patient using the sensor; and

detecting the indication of acute MR based on activity sensor signal associated with increased afterload.

15. The method of claim 1 for use with a device equipped to measure intracardiac electrograms (IEGM) and wherein the method includes the additional steps of:

detecting ST segments within IEGMs within the patient; and

detecting the indication of acute MR based on changes in ST segment elevation.

16. The method of claim 1 for use with a device equipped to measure the IEGM and wherein the method includes the additional steps of:

determining the relative timing of the atrial and ventricular contractions; and

detecting the indication of acute MR based on the relative time of the atrial and ventricular contractions.

17. The method of claim 1 further including generating warning signals based on the estimate of cardiac pressure.

18. The method of claim 1 further including controlling therapy based on the estimate of cardiac pressure.

19. A system for use with an implantable medical device for implant within a patient, the system comprising:

an acute mitral valve regurgitation (MR) detection system operative to detect an indication of acute MR, if occurring within the patient;

an electrical field generator operative to apply an electric field to tissues of the patient including cardiac tissues and further operative to measure an electrical parameter influenced by the applied electrical field and affected by cardiac pressure; and

a cardiac pressure estimation system operative to estimate cardiac pressure within the patient based on the electrical parameter and the indication of acute MR.

20. A system for use with an implantable medical device for implant within a patient, the system comprising:

means for detecting an indication of acute mitral valve regurgitation (MR), if occurring within the patient;

means for applying an electrical field to tissues of the patient including cardiac tissues and measuring an electrical parameter influenced by the applied electrical field and affected by cardiac pressure; and

means for estimating cardiac pressure within the patient based on the electrical parameter and the indication of acute MR.