Physiological status indicator apparatus and method

• US 8,750,982 B2
• Filed: 12/21/2012
• Issued: 06/10/2014
• Est. Priority Date: 12/23/2011
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Thakur, Pramodsingh Hirasingh, Hatlestad, John D., Wariar, Ramesh, Averina, Viktoria A., Swanson, Lynne E.
• Primary Examiner(s): KAHELIN, MICHAEL WILLIAM
• Application Number:
  US13/725,675
• Publication Number:
  US 20130165755A1
• Time in Patent Office: 536 Days
• Field of Search: 600/506, 600/547
• US Class Current: 600/547
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/72 Signal processing specially adapted for physiological signals or for diagnostic purposes character recognition, recognising digital ink, document-oriented image-based pattern recognition G06V30/00; recognition or understanding of postal images G06V30/424

Abstract

A processor circuit can be configured to obtain a first multidimensional vector. The first multidimensional vector can include dimensions corresponding to respective first conductivity characteristics obtained from different implantable electrode configurations associated with a subject. The processor circuit can also be configured to obtain a second multidimensional vector or vector space. The second multidimensional vector or vector space can include dimensions corresponding to respective second conductivity characteristics obtained from such different electrode configurations associated with the same or a different subject. The processor circuit can also provide a physiological status indicator that can be obtained at least in part by performing a vector comparison of the first multidimensional vector to the second multidimensional vector space or vector.

Claims

1. An apparatus comprising:

a processor circuit, configured to

obtain a first multidimensional vector, comprising dimensions corresponding to respective first conductivity characteristics obtained from different implantable electrode configurations associated with a subject;

obtain a second multidimensional vector space or vector, comprising dimensions corresponding to respective second conductivity characteristics obtained from the different electrode configurations associated with the same or a different subject, wherein the first conductivity characteristics are of the same type as the second conductivity characteristics, and wherein the different electrode configurations corresponding to the respective dimensions of the first multidimensional vector are of the same type as the different electrode configurations corresponding to the respective dimensions of the second multidimensional vector space or vector; and

providing a physiological status indicator obtained at least in part by performing a vector comparison that determines proximity of the first multidimensional vector to the second multidimensional vector space or vector.

2. The apparatus of claim 1, wherein the processor circuit is configured such that:

the first conductivity characteristics and the second conductivity characteristics comprise physiological impedances, or changes in respective physiological impedances, in which at least one of circadian or other biological rhythm variations, cardiac cycle variations, respiration cycle variations, physical activity variations, or posture variations are attenuated, de-emphasized, or compensated for performing the vector comparison;

the second multidimensional vector space or vector is obtained earlier from the same subject or obtained from a patient population that is representative of the same subject; and

the physiological status indicator is configured to detect a first physiological condition as distinguishable from at least one second physiological condition, wherein the first and second physiological conditions are both capable of affecting the physiological impedances.

3. The apparatus of claim 2, wherein the first and second physiological conditions include any two of the following:

(1) vascular volume status;

(2) vascular engorgement status;

(3) hematocrit status;

(4) blood conductivity status (5) extravascular lung water status; and

(6) implantable medical device (IMD) pocket fluid status.

4. The apparatus of claim 1, wherein the physiological status indicator obtained at least in part by performing a static or dynamic vector comparison of the first multidimensional vector to the second multidimensional vector space or vector indicates congestive heart failure (CHF) compensation or decompensation status, and wherein the processor circuit is configured to provide the physiological status indicator to a user or to an automated process.

5. The apparatus of claim 1, wherein the processor circuit is configured to provide a therapy titration control signal, and wherein the processor circuit is configured to determine the therapy titration control signal at least in part using the physiological status indicator obtained at least in part by performing the vector comparison of the first multidimensional vector to the second multidimensional vector space or vector.

6. The apparatus of claim 1, wherein the processor circuit is configured to

obtain a first posture or time-of-day indicator providing a posture or time-of-day indicator associated with the first multidimensional vector;

use the first posture or time-of-day indicator to select the second multidimensional vector space or vector, from a plurality of second multidimensional vector spaces or vectors associated with different postures or times-of-day, to provide information associated with a like posture or time-of-day to the posture or time-of-day indicator associated with the first multidimensional vector; and

wherein the physiological status indicator is obtained at least in part by performing a like-posture or like time-of-day vector comparison of the first multidimensional vector to the second multidimensional vector space or vector.

7. The apparatus of claim 1, wherein the processor circuit is configured to provide a multidimensional physiological status indicator obtained at least in part by performing a static or dynamic vector comparison of information about the first multidimensional vector to information about the second multidimensional vector space or vector, wherein the multidimensional physiological status indicator includes dimensions corresponding to factors representing contributions associated with different physiological conditions.

8. The apparatus of claim 7, wherein the processor circuit is configured to adjust the multidimensional physiological status indicator to account for relative risks associated with the different physiological conditions.

9. The apparatus of claim 1, wherein the processor circuit is configured to provide a trend, over a period of time that is longer than at least one hour, of at least one of:

(1) the first multidimensional vector or (2) the physiological status indicator obtained at least in part by performing the vector comparison of the first multidimensional vector to the second multidimensional vector space or vector.

10. The apparatus of claim 1, wherein the second multidimensional vector space or vector is obtained from an initial template obtained from a patient population that is representative of the same subject, wherein the initial template is adjusted using physiological information about the same subject.

11. A non-transitory device-readable medium including device-readable instructions that, when performed by a device, cause the device to perform the following acts:

obtaining a first multidimensional vector, comprising dimensions corresponding to respective first conductivity characteristics obtained from different electrode configurations associated with a subject;

obtaining a second multidimensional vector space or vector, comprising dimensions corresponding to respective second conductivity characteristics obtained from the different electrode configurations associated with the same or a different subject, wherein the first conductivity characteristics are of the same type as the second conductivity characteristics, and wherein the different electrode configurations corresponding to the respective dimensions of the first multidimensional vector are of the same type as the different electrode configurations corresponding to the respective dimensions of the second multidimensional vector space or vector; and

providing a physiological status indicator obtained at least in part by performing a vector comparison of the first multidimensional vector to the second multidimensional vector space or vector, wherein the performing the vector comparison includes determining proximity of the first multidimensional vector to the second multidimensional vector space or vector.

12. The device-readable medium of claim 11, including device-readable instructions that, when performed by the device, cause the device to perform the following acts:

obtaining the first multidimensional vector and obtaining the second multidimensional vector space or vector, such that the first conductivity characteristics and the second conductivity characteristics comprise physiological impedances, or changes in respective physiological impedances, in which at least one of circadian or other biological rhythm variations, cardiac cycle variations, respiration cycle variations, physical activity variations, or posture variations are attenuated, de-emphasized, or compensated for performing the vector comparison;

obtaining the second multidimensional vector space or vector earlier from the same subject or from a patient population that is representative of the same subject; and

providing the physiological status indicator to detect a first physiological condition as distinguishable from at least one second physiological condition, wherein the first and second physiological conditions are both capable of affecting the physiological impedances.

13. The device-readable medium of claim 11, including device-readable instructions that, when performed by the device, cause the device to perform the following acts:

obtaining a first posture or time-of-day indicator providing a posture or time-of-day indicator associated with the first multidimensional vector;

using the first posture or time-of-day indicator to select the second multidimensional vector space or vector, from a plurality of second multidimensional vector spaces or vectors associated with different postures or times-of-day, to provide information associated with a like posture or like-time-of-day to the posture or time-of-day indicator associated with the first multidimensional vector; and

wherein the physiological status indicator is obtained at least in part by performing a like-posture or like-time-of-day vector comparison of the first multidimensional vector to the second multidimensional vector space or vector.

14. The device-readable medium of claim 11, including device-readable instructions that, when performed by the device, cause the device to perform the following act:

providing a multidimensional physiological status indicator obtained at least in part by performing a regression or like vector comparison of the first multidimensional vector to the second multidimensional vector space or vector, wherein the multidimensional physiological status indicator includes dimensions corresponding to factors representing contributions associated with different physiological conditions.

15. The device-readable medium of claim 14, including device-readable instructions that, when performed by the device, cause the device to perform the following act:

adjusting the multidimensional physiological status indicator to account for relative risks associated with the different physiological conditions.

16. A method performed by an apparatus, the method comprising:

obtaining a first multidimensional vector, comprising dimensions corresponding to respective first conductivity characteristics obtained from different implantable electrode configurations associated with a subject;

obtaining a second multidimensional vector space or vector, comprising dimensions corresponding to respective second conductivity characteristics obtained from the different electrode configurations associated with the same or a different subject, wherein the first conductivity characteristics are of the same type as the second conductivity characteristics, and wherein the different electrode configurations corresponding to the respective dimensions of the first multidimensional vector are of the same type as the different electrode configurations corresponding to the respective dimensions of the second multidimensional vector space or vector; and

providing a physiological status indicator obtained at least in part by performing a static or dynamic vector comparison of the first multidimensional vector to the second multidimensional vector space or vector, wherein the performing the static or dynamic vector comparison includes determining proximity of the first multidimensional vector to the second multidimensional vector space or vector.

17. The method of claim 16, comprising:

obtaining the first multidimensional vector and obtaining the second multidimensional vector space or vector, such that the first conductivity characteristics and the second conductivity characteristics comprise physiological impedances, or changes in respective physiological impedances, in which at least one of circadian or other biological rhythm variations, cardiac cycle variations, respiration cycle variations, physical activity variations, or posture variations are attenuated, de-emphasized, or compensated for performing the vector comparison;

obtaining the second multidimensional vector space or vector earlier from the same subject or from a patient population that is representative of the same subject; and

providing the physiological status indicator to detect a first physiological condition as distinguishable from at least one second physiological condition, wherein the first and second physiological conditions are both capable of affecting the physiological impedances.

18. The method of claim 16, comprising:

obtaining a first posture or time-of-day indicator providing a posture or time-of-day indicator associated with the first multidimensional vector;

using the first posture or time-of-day indicator to select the second multidimensional vector space or vector, from a plurality of second multidimensional vector spaces or vectors associated with different postures or times-of-day, to provide information associated with a like posture or like-time-of-day to the posture or time-of-day indicator associated with the first multidimensional vector; and

wherein the physiological status indicator is obtained at least in part by performing a like-posture or like-time-of-day vector comparison of the first multidimensional vector to the second multidimensional vector space or vector.

19. The method of claim 16, comprising:

providing a multidimensional physiological status indicator obtained at least in part by performing the static or dynamic vector comparison of information about the first multidimensional vector to information about the second multidimensional vector space or vector, wherein the multidimensional physiological status indicator includes dimensions corresponding to factors representing contributions associated with different physiological conditions.

20. The method of claim 19, comprising:

adjusting the multidimensional physiological status indicator to account for relative risks associated with the different physiological conditions.