Histogram-based thoracic impedance monitoring

• US 8,831,716 B2
• Filed: 09/11/2007
• Issued: 09/09/2014
• Est. Priority Date: 09/11/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Hatlestad, John D., Roeske, Cal, Moon, Loell Boyce, Cook, Jeffrey P.
• Primary Examiner(s): SZMAL, BRIAN SCOTT
• Application Number:
  US11/853,590
• Publication Number:
  US 20090069708A1
• Time in Patent Office: 2,555 Days
• Field of Search: 600/547, 600/529, 600/538, 600/484, 607/17, 607/28, 607/4, 607/5, 607/7, 607/9, 607/11, 607/27
• 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 5/0535 Impedance plethysmography for measuring blood flow A61B5/0295
• CPC Class Codes: A61B 5/0537 Measuring body composition by impedance, e.g. tissue hydration or fat content
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0809 by impedance pneumography
• CPC Class Codes: A61B 5/416 the spleen
• CPC Class Codes: A61B 5/6846 specially adapted to be brought in contact with an internal body part, i.e. invasive
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance

Abstract

Systems and methods for monitoring pulmonary edema or other thoracic fluid status in a subject use thoracic impedance histogram information. An internal or external processor circuit receives the thoracic impedance histogram information and uses it to compute and provide a lung fluid status indication. The thoracic impedance histogram information can include a count, mean or median of a histogram bin or subrange of bins within the histogram range.

Claims

1. A system comprising:

an implantable medical device including,

an electrical impedance measurement circuit configured to measure one or more thoracic impedance-indicating signal characteristics, including at least a liquid status component, using information about electrical energy injected between two or more electrodes and a potential difference created thereby between the same or different two or more electrodes; and

a memory circuit including a number of histogram bins, each bin representing a subrange of thoracic impedance-indicating signal characteristic values, including values indicative of a liquid status, the memory circuit configured for storing a count representative of the one or more thoracic impedance-indicating signal characteristics, including at least the liquid status component, into a histogram bin having a numerically inclusive subrange; and

a processor circuit including an input to receive and use information about the count representative of the one or more thoracic impedance-indicating signal characteristics, including at least the liquid status component, stored in the histogram to provide a lung edema status indication.

2. The system of claim 1, comprising a trigger circuit to trigger a thoracic impedance-indicating measurement synchronized with a refractory portion of a subject'"'"'s cardiac cycle, wherein the trigger circuit comprises at least one of a timing circuit or a cardiac sensor circuit.

3. The system of claim 1, comprising a posture sensor configured to produce a posture signal indicative of a posture of a subject, the posture sensor configured to trigger a thoracic impedance-indicating measurement when the posture signal is indicative of a upright orientation.

4. The system of claim 1, wherein the memory circuit includes a counter circuit configured to increment the count of a histogram bin.

5. The system of claim 4, wherein the processor circuit is configured to use information about the count of the histogram bin to compute and provide the lung edema status indication.

6. The system of claim 1, comprising a histogram-selective circuit configured to select one or more histogram bins representative of a reduced subrange of the histogram.

7. The system of claim 6, wherein the processor circuit is configured to use information about a count or a value representative of the reduced subrange to compute and provide the lung edema status indication, wherein the reduced subrange represents an upper-percentile of the histogram or an intra-percentile range of the histogram.

8. The system of claim 7, wherein the information about the count or the value representative of the reduced subrange includes information about a central tendency of one or more values stored in the selected one or more histogram bins, which are representative of the reduced subrange.

9. The system of claim 1, comprising a comparator circuit configured to compute a deviation between one or more histogram bins previously received from the memory circuit and one or more corresponding baseline histogram bins having the same numerical subrange;

and

wherein the processor circuit is configured to use information about the deviation to compute and provide the lung edema status indication.

10. The system of claim 9, wherein the deviation is indicative of a difference in the number of counts from the corresponding baseline histogram bin.

11. The system of claim 9, wherein the deviation is between an average of thoracic impedance signal characteristic data of the one or more histogram bins previously received and thoracic impedance signal characteristic data of the one or more baseline histogram bins.

12. The system of claim 1, comprising an external user-interface device communicatively coupled to the implantable medical device and including a user-detectable indication,

the user-detectable indication configured to provide a display of at least one of received information about thoracic impedance signal characteristic data of one or more histogram bins, a deviation trend between such received information and corresponding information of one or more baseline histogram bins, or the computed lung edema status indication.

13. The system of claim 1, wherein the one or more thoracic impedance-indicating signal characteristics include a respiration status component.

14. A method comprising:

measuring a thoracic impedance-indicating signal characteristic including a liquid status component;

storing a count representative of the thoracic impedance-indicating signal characteristic, including the liquid status component, in a histogram that includes a plurality of histogram bins representing corresponding subranges of thoracic impedance-indicating signal characteristic values, including values indicative of a liquid status; and

computing and providing a lung edema status indication using histogram information about the count representative of the thoracic impedance-indicating signal characteristic, including the liquid status component.

15. The method of claim 14, comprising attenuating a cardiac stroke component of the thoracic impedance-indicating signal, including synchronizing the thoracic impedance-indicating signal measurement to a specified portion of a subject'"'"'s cardiac cycle.

16. The method of claim 14, comprising selecting one or more histogram bins representative of a subrange of the histogram;

and

using information about a count or a value representative of the one or more bins representative of the subrange to provide the lung edema status indication.

17. The method of claim 14, comprising overwriting a first histogram comprising first histogram bins with a second histogram comprising second histogram bins, the second histogram comprising data acquired later in time than for the first histogram array.

18. The method of claim 14, comprising initiating or adjusting a regimen in response to the lung edema status indication.

19. The method of claim 14, comprising triggering the thoracic impedance-indicating signal characteristic measurement when a posture signal indicative of a upright orientation is measured.

20. The method of claim 14, wherein storing the count-representative of the thoracic impedance-indicating signal characteristic includes incrementing a count associated with a histogram bin;

and

wherein computing the lung edema status indication includes using count information from the histogram.

21. The method of claim 20, comprising aggregating count information from each of the histogram bins;

and

using the aggregated count information to compute the lung edema status indication.

22. The method of claim 14, wherein storing the count representative of the thoracic impedance-indicating signal characteristic includes storing the count representative of the thoracic impedance-indicating signal characteristic into a bin of an intraday histogram.

23. The method of claim 22, comprising aggregating thoracic impedance-indicating signal characteristic information from a plurality of intraday histograms;

and

using the aggregated thoracic impedance signal characteristic information to compute the lung edema status indication.

24. The method of claim 14, wherein computing the lung edema status indication includes computing a deviation between at least one histogram bin of a short-term histogram and at least one corresponding histogram bin of a baseline histogram.

25. The method of claim 24, comprising updating the short-term histogram using a count representative of a first thoracic impedance-indicating signal characteristic measured over a first time period;

and

updating the baseline histogram using a count representative of a second thoracic impedance-indicating signal characteristic, which is the same or different than the first thoracic impedance-indicating signal, measured over a second time period that is longer than the first time period.

26. The method of claim 14, wherein computing the lung edema status indication includes recognizing whether a thoracic liquid accumulation event is present.