Tracking progression of congestive heart failure via a force-frequency relationship

• US 8,755,883 B2
• Filed: 12/09/2009
• Issued: 06/17/2014
• Est. Priority Date: 08/19/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Wariar, Ramesh, Carlson, Gerrard M.
• Primary Examiner(s): Heller, Tammie K
• Application Number:
  US12/634,277
• Publication Number:
  US 20100087890A1
• Time in Patent Office: 1,651 Days
• Field of Search: 600/485, 600/486, 600/513, 600/514, 600/528, 600/492, 607/6, 607/17, 607/23
• US Class Current: 607/17
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 5/11 Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb for measuring pulse A61B5/02 ;A61B5/1038 takes precedence; motion detection to correct for motion artifacts in physiological signals A61B5/721
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• CPC Class Codes: A61B 7/023 for introduction into the body, e.g. into the oesophagus oesophageal ECG probes A61B5/285
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Abstract

A system, method, or device monitor a force-frequency relationship exhibited by a patient'"'"'s heart. A contractility characteristic, such as a heart sound characteristic of an S1 heart sound, is measured. The contractility characteristic indicates the forcefulness of a contraction of the heart. The frequency at which the heart is contracting is determined. A group of (contractility characteristic, heart rate) pairs is stored in a memory device. The group of pairs defines a force-frequency relationship for the heart. The method may be implemented by an implantable device, or by a system including a implantable device.

Claims

1. A system comprising:

a transducer configured to measure a heart sound characteristic of a heart;

a control circuit configured to;

receive the heart sound characteristic;

determine a contractility characteristic of the heart using the measured heart sound characteristic;

determine a corresponding heart rate indicating how frequently the heart is contracting;

alter a pacing rate to determine and store in a memory device a group of (contractility characteristic, heart rate) pairs over a range of heart rates, the group of pairs over the range of heart rates defining a force-frequency relationship for the heart; and

determine a slope for at least some of the group of (contractility characteristic, heart rate) pairs based, at least in part, on at least one of a linear regression and a curve fit performed on the at least some of the group of (contractility characteristic, heart rate) pairs;

a stimulating circuit coupled to the control circuit, the stimulating circuit configured to deliver, in response to a control signal from the control circuit upon the control circuit determining the slope, stimulating signals based, at least in part, on the previously determined slope for the at least some of the group of (contractility characteristic, heart rate) pairs.

2. The system of claim 1, wherein the control circuit is configured to alter the pacing rate from a first pacing rate to a second pacing rate.

3. The system of claim 1, wherein the force-frequency relationship includes a trend of contractility characteristics and heart rates corresponding to the respective contractility characteristics.

4. The system of claim 1, wherein the control circuit is configured to provide an indication of a cardiac status of the heart using the force-frequency relationship.

5. The system of claim 4, wherein the control circuit is configured to provide an indication of congestive heart failure status of the heart using the force-frequency relationship.

6. The system of claim 1, including an implantable medical device, and wherein the implantable medical device includes the transducer and the control circuit.

7. The system of claim 1, wherein the stimulating circuit is configured to deliver the stimulating signals at a heart rate corresponding to the slope being negative.

8. An implantable medical device comprising:

a control circuit configured to;

receive a heart sound characteristic of a heart;

determine a heart rate corresponding to the heart sound characteristic, the heart rate indicating how frequently the heart is contracting;

determine a first (contractility characteristic, heart rate) pair at a first pacing rate;

determine a second (contractility characteristic, heart rate) pair at a second pacing rate, the second pacing rate different than the first pacing rate;

store the first and second pairs in a memory device, the first and second pairs each defining a force-frequency relationship of the heart; and

determine a slope for the first and second (contractility characteristic, heart rate) pairs based, at least in part, on at least one of a linear regression and a curve fit performed on the first and second (contractility characteristic, heart rate) pairs;

a stimulating circuit coupled to the control circuit, the stimulating circuit configured to deliver, in response to a control signal from the control circuit upon the control circuit determining the slope, stimulating signals based, at least in part, on the previously determined slope for at least some of the first and second (contractility characteristic, heart rate) pairs.

9. The implantable medical device of claim 8, including a transducer configured to measure the heart sound characteristic.

10. The implantable medical device of claim 9, wherein the heart sound information is indicative of left ventricular pressure of the heart;

and

wherein the control circuit is configured to alter the pacing rate over a range of heart rates including the first pacing rate and the second pacing rate to determine a group of (contractility characteristic, heart rate) pairs, wherein the slope is based, at least in part, on the group of (contractility characteristic, heart rate) pairs.

11. The implantable medical device of claim 8, wherein the control circuit is configured to provide an indication of congestive heart failure status of the heart using the slope.

12. The implantable medical device of claim 8, wherein the stimulating circuit is configured to deliver the stimulating signals at a heart rate corresponding to the slope being negative.

13. A method comprising:

receiving a heart sound characteristic of a heart;

determining a corresponding heart rate indicating how frequently the heart is contracting based, at least in part, on the heart sound characteristic;

determining a first (contractility characteristic, heart rate) pair at a first pacing rate;

determining a second (contractility characteristic, heart rate) pair at a second pacing rate;

store the first and second pairs in a memory device, the first and second pairs each defining a force-frequency relationship of the heart;

determining a slope for the first and second (contractility characteristic, heart rate) pairs based, at least in part, on at least one of a linear regression and a curve fit performed on the first and second (contractility characteristic, heart rate) pairs; and

delivering stimulating signals to the heart based, at least in part, on the previously determined slope.

14. The method of claim 13, including altering the pacing rate from the first pacing rate to the second pacing rate.

15. The method of claim 13, wherein determining the slope includes providing a trend of contractility characteristics and heart rates corresponding to the respective contractility characteristics.

16. The method of claim 13, wherein determining the slope includes providing an indication of a cardiac status of the heart using the first and second contractility characteristics and the first and second pacing rates.

17. The method of claim 16, wherein the providing the indication of cardiac status of the heart includes providing an indication of congestive heart failure of the heart.

18. The method of claim 13, wherein the receiving the heart sound characteristic includes implantably receiving the heart sound characteristic.

19. The method of claim 13, wherein receiving the heart sound characteristic further includes receiving via an implantable device a left ventricular pressure information.

20. The method of claim 13, wherein the stimulating signals are delivered to the heart at a heart rate corresponding to the slope being negative.

21. A system comprising:

an accelerometer configured to receive heart contraction information of a heart and to produce a contractility signal;

a control circuit configured to;

receive the contractility signal;

determine a first contractility characteristic of the heart using the contractility signal;

determine a corresponding heart rate indicating how frequently the heart is contracting; and

alter a pacing rate to determine and store in a memory device a group of (contractility characteristic, heart rate) pairs over a range of heart rates, the group of pairs over the range of heart rates defining a force-frequency relationship for the heart; and

determine a slope for at least some of the group of (contractility characteristic, heart rate) pairs based, at least in part, on at least one of a linear regression and a curve fit performed on the at least some of the group of (contractility characteristic, heart rate) pairs;

a stimulating circuit coupled to the control circuit, the stimulating circuit configured to deliver, in response to a control signal from the control circuit upon the control circuit determining the slope, stimulating signals based, at least in part, on the previously determined slope for the at least some of the group of (contractility characteristic, heart rate) pairs.

22. The system of claim 21, wherein the stimulating circuit is configured to deliver simulating signals based on the pacing rate, and wherein the stimulating circuit is configured to alter delivery of the stimulating signals from a first pacing rate to a second pacing based, at least in part, on a control from the control circuit.

23. The system of claim 21, wherein the slope includes a trend of contractility characteristics and heart rates corresponding to the respective contractility characteristics.

24. The system of claim 21, wherein the control circuit is configured to provide an indication of a cardiac status of the heart using the slope.

25. The system of claim 24, wherein the control circuit is configured to provide an indication of congestive heart failure status of the heart using the slope.

26. The system of claim 21, including an implantable medical device, and wherein the implantable medical device includes the accelerometer and the control circuit.

27. The system of claim 21, wherein the heart contraction information includes at least one of left ventricular pressure information or heart sound information, and wherein the contractility signal includes at least one of a left ventricular pressure signal or a heart sound signal.

28. The system of claim 21, wherein the stimulating circuit is configured to deliver the stimulating signals at a heart rate corresponding to the slope being negative.

29. The system of claim 21, further comprising a lead, wherein the accelerometer is positioned on the lead.