Monitoring heart disease using implantable sensors and slopes determined therefrom

• US 8,170,664 B1
• Filed: 10/31/2007
• Issued: 05/01/2012
• Est. Priority Date: 10/31/2007
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Nabutovsky, Yelena, Ryu, Kyungmoo, Farazi, Taraneh Ghaffari, Bornzin, Gene A.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Behringer, Luther
• Application Number:
  US11/931,165
• Time in Patent Office: 1,644 Days
• Field of Search: 600/483, 607/9
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36557 controlled by chemical substances in blood
• 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 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

Specific embodiments of the present invention use an implanted sensor, during a period of time, to measure a physiologic property when the patient'"'"'s heart is not stressed, and when the patient'"'"'s heart is stressed. A slope is determined, where the slope is indicative of a change in the physiologic property during the period of time. Heart disease is monitored based on a magnitude of the slope. In further embodiments of the present invention, a slope indicative of a change in a physiologic property during a period of time is determined, for each of a plurality of periods of time. Changes in the patient'"'"'s heart disease are monitored based on changes in the slope.

Claims

1. A method for monitoring a patient'"'"'s heart disease, comprising:

(a) during a period of time, using an implanted sensor to measure a physiologic property when the patient'"'"'s heart is not stressed, and to measure the physiologic property when the patient'"'"'s heart is stressed by pacing the patient'"'"'s heart to exceed a specified threshold for a specified length of time;

(b) determining a slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from not being stressed to being stressed, or vice versa, during the period of time; and

(c) monitoring an extent of the heart disease based on a magnitude of the slope;

wherein the physiologic property is selected from the group consisting of venous oxygen saturation (SVO2), left atrial pressure (LAP), cardiomechanics (CMES), cardiogenic impedance (Zc) and transthoracic impedance (Z).

2. The method of claim 1, wherein the patient'"'"'s heart is not stressed when a level of activity determined using an activity sensor and/or a measure of heart rate do not exceed a corresponding specified threshold for a corresponding specified period of time.

3. The method of claim 1, wherein:

step (b) includes determining a slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from not being stressed to being stressed.

4. The method of claim 1, wherein:

step (b) includes determining a slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from being stressed to not being stressed.

5. The method of claim 1, wherein:

step (b) includes

(b.1) determining a first slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from not being stressed to being stressed; and

(b.2) determining a second slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from being stressed to not being stressed; and

step (c) includes monitoring an extent of the heart disease based on the magnitude of the first slope and the magnitude of the second slope.

6. The method of claim 1, wherein:

steps (a) and (b) are repeated during one or more further period of time, to thereby determine a slope indicative of a change in the physiologic property during each of the one or more further period of time; and

step (c) includes monitoring changes in the heart disease, based on changes in the magnitude of the slope.

7. The method of claim 6, wherein step (c) includes determining whether the heart disease progressed, regressed or stayed relatively the same, based on how the magnitude of the slope changes over time.

8. A system for monitoring a patient'"'"'s heart disease, comprising:

an implantable sensor to measure a physiologic property when the patient'"'"'s heart is not stressed, and to measure the physiologic property when the patient'"'"'s heart is stressed by pacing the patient'"'"'s heart to exceed a specified threshold for a specified length of time; and

a heart disease monitor to determine a slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from not being stressed to being stressed, or vice versa, during the period of time; and

wherein the monitor monitors the heart disease based on a magnitude of the slope;

wherein the physiologic property is selected from the group consisting of venous oxygen saturation (SVO2), left atrial pressure (LAP), cardiomechanics (CMES), cardiogenic impedance (Zc) and transthoracic impedance (Z).

9. The system of claim 8, further comprising:

an implantable activity sensor;

wherein the patient'"'"'s heart is not stressed when a level of activity determined using the activity sensor and/or a measure of heart rate do not exceed a corresponding specified threshold for a corresponding specified period of time.

10. The system of claim 8, wherein:

the monitor determines a slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from not being stressed to being stressed.

11. The system of claim 10, wherein:

the monitor determines a second slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from being stressed to not being stressed.

12. The system of claim 8, wherein:

the monitor determines a slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from being stressed to not being stressed; and

the monitor monitors the heart disease based on the magnitude of the slope.

13. The system of claim 8, wherein the monitor determines changes in the patient'"'"'s heart disease based on how the slope changes over time.

14. A method for monitoring a patient'"'"'s heart disease, comprising:

(a) during a period of time, using an implanted sensor to measure a physiologic property when the patient'"'"'s heart is not stressed, and to measure the physiologic property when the patient'"'"'s heart is stressed by pacing the patient'"'"'s heart to exceed a specified threshold for a specified length of time, to thereby determine a slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from not being stressed to being stressed, or vice versa, during the period of time; and

(b) repeating step (a) during one or more further period of time, to thereby determine a slope indicative of a change in the physiologic property during each of the one or more further period of time; and

(c) monitoring changes in the patient'"'"'s heart disease based on how the slope changes over time;

wherein the physiologic property is selected from the group consisting of venous oxygen saturation (SVO2), left atrial pressure (LAP), cardiomechanics (CMES), cardiogenic impedance (Zc) and transthoracic impedance (Z).

15. The method of claim 14, wherein:

step (a) includes determining a slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from not being stressed to being stressed; and

step (c) includes monitoring changes in the patient'"'"'s heart disease based on how the magnitude of the slope changes over time.

16. The method of claim 14, wherein:

step (a) includes determining a slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from being stressed to not being stressed; and

step (c) includes monitoring changes in the patient'"'"'s heart disease based on how the magnitude of the slope changes over time.

17. The method of claim 14, wherein:

step (a) includes

determining a first slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from not being stressed to being stressed; and

determining a second slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from being stressed to not being stressed; and

step (c) includes monitoring changes in the patient'"'"'s heart disease based on how the magnitude of the first slope and the magnitude of the second slope changes over time.

18. The method of claim 14, wherein:

the implantable sensor comprises an implanted venous oxygen saturation sensor;

the physiologic property comprises venous oxygen saturation (SVO2);

for each period of time step (a) includes determining a slope indicative of a change in SVO2 that occurs in response to the patient'"'"'s heart changing from not being stressed to being stressed; and

step (c) includes

interpreting an increase in the magnitude of the slope over time as being indicative of worsening of the heart disease;

interpreting a decrease in the magnitude of the slope over time as being indicative of improvement of the heart disease; and

interpreting no substantial change in the magnitude of the slope over time as being indicative of the heart disease staying relative the same.

19. The method of claim 14, wherein:

the implanted sensor comprises an implanted venous oxygen saturation sensor;

the physiologic property comprises venous oxygen saturation (SVO2);

for each period of time step (a) includes determining a slope indicative of a change in SVO2 that occurs in response to the patient'"'"'s heart changing from being stressed to not being stressed; and

step (c) includes

interpreting an decrease in the magnitude of the slope over time as being indicative of worsening of the heart disease;

interpreting an increase in the magnitude of the slope over time as being indicative of improvement of the heart disease; and

interpreting no substantial change in the magnitude of the slope over time as being indicative of the heart disease staying relative the same.

20. A system for monitoring a patient'"'"'s heart disease, comprising:

at least one pulse generator to generate pacing pulses for pacing the patient'"'"'s heart;

an implanted sensor to measure of physiologic property; and

a heart disease monitor to monitor the physiologic property when the patient'"'"'s heart is not stressed, and to monitor the physiologic property when the patient'"'"'s heart is stressed by pacing the patient'"'"'s heart to exceed a specified threshold for a specified length of time, to thereby determine a slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from not being stressed to being stressed, or vice versa, for each of a plurality of periods of time;

wherein the monitor monitors changes in the patient'"'"'s heart disease based on how a magnitude of the slope changes over time;

wherein the physiologic property is selected from the group consisting of venous oxygen saturation (SVO2), left atrial pressure (LAP), cardiomechanics (CMES), cardiogenic impedance (Zc) and transthoracic impedance (Z).

21. The system of claim 20, wherein the slope is indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from not being stressed to being stressed.

22. The system of claim 21, wherein the slope is indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from being stressed to not being stressed.

23. The system of claim 21, wherein the monitor:

determines a first slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from not being stressed to being stressed;

determines a second slope indicative of a change in the physiologic property that occurs in response to the patient'"'"'s heart changing from being stressed to not being stressed; and

monitors changes in the patient'"'"'s heart disease based on the first and second slopes.

24. The system of claim 21, further comprising:

an implantable activity sensor;

wherein the patient'"'"'s heart is not stressed when a level of activity determined using the activity sensor and/or a measure of heart rate do not exceed a corresponding specified threshold for a corresponding specified period of time.