Assessment of pulmonary vascular resistance via pulmonary artery pressure

• US 8,632,470 B2
• Filed: 09/24/2009
• Issued: 01/21/2014
• Est. Priority Date: 11/19/2008
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E., Siejko, Krzysztof Z.
• Primary Examiner(s): Mallari, Patricia
• Assistant Examiner(s): JANG, CHRISTIAN YONGKYUN
• Application Number:
  US12/566,432
• Publication Number:
  US 20100125211A1
• Time in Patent Office: 1,580 Days
• Field of Search: 600/481, 600/483, 600/485, 600/486
• US Class Current: 600/486
• CPC Class Codes: A61B 5/02007 Evaluating blood vessel condition, e.g. elasticity, compliance
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00

Abstract

Methods and systems for assessing pulmonary or systemic vascular resistance in a patient using pressure measurements are disclosed. An illustrative method of measuring pulmonary vascular resistance includes electrically inducing a retrograde pressure pulse within the heart, sensing at least one arterial pressure parameter in response to the retrograde pressure pulse using a pressure sensor located within a pulmonary artery, and computing a value of the pulmonary vascular resistance using the at least one sensed arterial pressure parameter. Data from multiple pulmonary vascular resistance assessments can be taken over an extended period of time within the patient to aid in detecting an underlying cardiac or pulmonary condition such as cardiogenic pulmonary edema.

Claims

1. A method of measuring pulmonary vascular resistance within a patient, the method comprising:

electrically inducing a retrograde pressure pulse from the left atrium of the heart by using a pulse generator to electrically stimulate the heart to cause the mitral valve to be closed during atrial systole;

sensing at least one arterial pressure parameter in response to the retrograde pressure pulse using a pressure sensor located within a pulmonary artery of the patient; and

computing a value of the change in pulmonary vascular resistance using the at least one sensed arterial pressure parameter.

2. The method of claim 1, wherein electrically inducing a retrograde pressure pulse from the left atrium of the patient'"'"'s heart includes:

providing an electrical stimulus to a ventricle of the heart at a first time period prior to an intrinsic atrial contraction; and

providing an electrical stimulus to an atrium of the heart at a second time period subsequent to the first time period.

3. The method of claim 1, wherein sensing at least one arterial pressure parameter includes sensing a first arterial pressure parameter and a second arterial pressure parameter.

4. The method of claim 3, wherein computing a value of the change in pulmonary vascular resistance includes comparing the first arterial pressure parameter against the second arterial pressure parameter.

5. The method of claim 4, wherein computing a value of the change in pulmonary vascular resistance in response to the retrograde pressure pulse includes comparing an amplitude of the first arterial pressure parameter against an amplitude of the second arterial pressure parameter.

6. The method of claim 4, wherein computing a value of the change in pulmonary vascular resistance in response to the retrograde pressure pulse includes computing a measure of the change in pulmonary capillary resistance in response to the retrograde pressure pulse.

7. The method of claim 1, wherein computing a value of the change in pulmonary vascular resistance in response to the retrograde pressure pulse includes analyzing the morphology of the at least one sensed arterial pressure parameter.

8. The method of claim 1, wherein computing a value of the change in pulmonary vascular resistance in response to the retrograde pressure pulse is performed by an external monitor in wireless communication with the pressure sensor.

9. The method of claim 1, wherein computing a value of the change in pulmonary vascular resistance in response to retrograde pressure pulse is performed by a processor of the pulse generator.

10. The method of claim 1, wherein computing a value of the change in pulmonary vascular resistance in response to the retrograde pressure pulse is performed by a processor of the pressure sensor.

11. The method of claim 1, further including computing one or more additional values of the pulmonary vascular resistance, and comparing the one or more additional values against a previously computed value to determine a change in pulmonary vascular resistance.

12. The method of claim 1, further including trending data from multiple pulmonary vascular resistance values taken over a period of time.

13. The method of claim 12, wherein trending data from multiple pulmonary vascular resistance values over a period of time includes:

taking a first pulmonary vascular resistance assessment at a first time period within the patient;

taking a second pulmonary vascular resistance assessment at a second time period subsequent to the first time period;

comparing the second pulmonary vascular resistance assessment against the first pulmonary vascular resistance assessment and determining a trend in the pulmonary vascular resistance; and

detecting a cardiac or pulmonary condition within the patient based on the first and second pulmonary vascular resistance assessments.

14. A method of measuring pulmonary or systemic vascular resistance within a patient, the method comprising:

electrically inducing a retrograde pressure pulse from an atrium of the heart by using a pulse generator to electrically stimulate the heart to cause the mitral valve to be closed during atrial systole;

sensing at least one pressure parameter in response to the retrograde pressure pulse using a pressure sensor located within a body lumen of the patient; and

computing a value of pulmonary or systemic vascular resistance using the at least one sensed pressure parameter.

15. A system for measuring pulmonary vascular resistance within a patient, the system comprising:

a pulse generator including at least one lead adapted to induce a retrograde pressure pulse from the left atrium of the heart by electrically stimulating the heart to cause the mitral valve to be closed during atrial systole;

a pressure sensor adapted to sense an arterial pressure waveform within a pulmonary artery; and

a processor adapted to compute a value of pulmonary vascular resistance in response to the retrograde pressure pulse based the sensed arterial pressure waveform.

16. The system of claim 15, wherein the at least one lead includes:

a first lead adapted to provide an electrical pacing stimulus to a ventricle of the patient'"'"'s heart; and

a second lead adapted to provide an electrical pacing stimulus to an atrium of the patient'"'"'s heart.

17. The system of claim 15, wherein the processor is a component of the pulse generator.

18. The system of claim 15, wherein the processor is a component of an external monitoring device in wireless communication with the pressure sensor.

19. The system of claim 15, wherein the pulse generator is operable between a normal mode of operation for providing atrioventricular pacing to the patient'"'"'s heart and an assessment mode of operation for inducing the retrograde pressure pulse within the pulmonary artery.

20. The system of claim 15, wherein the processor is configured to compute a value of a change in pulmonary vascular resistance in response to the retrograde pressure pulse from at least two arterial pressure parameters sensed by the pressure sensor.

21. The system of claim 15, wherein the processor is configured to compute a value of a change in pulmonary vascular resistance in response to the retrograde pressure pulse by computing a change in pulmonary capillary resistance.

22. The system of claim 15, wherein the processor is configured to compute a value of a change in pulmonary vascular resistance in response to the retrograde pressure pulse by analyzing the morphology of the arterial pressure waveform.