Estimating cardiovascular pressure and volume using impedance measurements

• US 8,938,292 B2
• Filed: 10/31/2008
• Issued: 01/20/2015
• Est. Priority Date: 07/31/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Hettrick, Douglas A., Cho, Yong K., Rouw, Mattias, Sarkar, Shantanu, Zielinski, Todd M.
• Primary Examiner(s): Brown, Melanie Y
• Assistant Examiner(s): Crawford, Erik B
• Application Number:
  US12/263,065
• Publication Number:
  US 20100030087A1
• Time in Patent Office: 2,272 Days
• Field of Search: 600/300, 600/301, 600/481, 600/485, 600/486, 600/504, 600/506, 600/507, 600/547, 600/561, 128/898
• US Class Current: 600/547
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/02158 provided with two or more sensor elements
• 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 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36564 controlled by blood pressure

Abstract

Techniques for estimating a cardiac chamber or vascular pressure based upon impedance are described. A device or system may measure an impedance between at least two electrodes implanted within or proximate to a cardiovascular system. The device or system may estimate a pressure of an element of the cardiovascular system based on a relationship between impedance and volume of the element, and based on a empirical relationship between the volume and the pressure. The device or system may also estimate the dimension of the element based on the impedance-volume relationship, or other characteristics based on the impedance. Because the impedance measurements may be obtained, in some examples, by using electrodes and leads implanted within the cardiovascular system and coupled to an implantable medical device, a practical estimation of a cardiovascular pressure can be obtained on a chronic basis without requiring the use other invasive sensors, such as micronanometer transducers.

Claims

1. A method comprising:

storing in a memory of an implantable medical device a plurality of relationships between volume and pressure, the plurality of relatioships comprising a relationship between volume and pressure in avascular lumen;

storing in the memory a plurality of relationships between impedence and volume;

measuring an impedance between at least two electrodes implanted within or proximate to a cardiovascular system of a patient;

enabling a control unit to select one of the stored plurality of relationships between volume and pressure and one of the stored plurality of relationships between impedence and volume based on at least one selection criterion; and

estimating by the control unit, a pressure of an element of the cardiovascular system based on the selected relationship between impedence and volume and the selected relationship between the volume and the pressure, wherein the relationship between the volume and the pressure comprises an elastance function derived from empirical data comprising historical data of the patient.

2. The method of claim 1, wherein the element of the cardiovascular system comprises one of a cardiac chamber or a vascular lumen.

3. The method of claim 1, wherein relationship between the measured impedance and the volume comprises an inversely proportional relationship.

4. The method of claim 1,

wherein the relationship between the volume and the pressure comprises a linear approximation of the elastance function for a given volume interval.

5. The method of claim 1, further comprising:

selecting the relationship between the volume and the pressure from the plurality of relationships based upon a particular characteristic of the patient.

6. The method of claim 1,

wherein measuring the impedance comprises measuring a change in impedance,

wherein estimating the pressure comprises estimating a change in pressure based on a relationship between the measured change in impedance and a change in volume of the element of the cardiovascular system and based on a relationship between the change in volume and the change in pressure.

7. The method of claim 1, further comprising:

selecting a combination of electrodes as the at least two electrodes based upon the element of the cardiovascular system to be measured.

8. The method of claim 1, wherein measuring the impedance comprises:

generating a plurality of electric fields between the at least two electrodes;

applying the plurality of electric fields to the element of the cardiovascular system such that the combined electric field is substantially homogeneous over the element; and

measuring an impedance of a resultant current flow between the at least two electrodes.

9. The method of claim 1, wherein measuring the impedance comprises:

measuring a first impedance for a first region;

measuring a second impedance for a second region; and

subtracting the second impedance from the first impedance to determine an impedance for the element.

10. The method of claim 1, wherein the measured impedance comprises a real component and a reactive component, and estimating a pressure comprises estimating the pressure based on the real component.

11. The method of claim 1, further comprising estimating a volume of the element based on the relationship between impedance and volume.

12. The method of claim 1, wherein measuring the impedance comprises measuring a complex impedance between the at least two electrodes, wherein the method further comprises determining a real component of the complex impedance, and wherein estimating the pressure comprises estimating the pressure of the element of the cardiovascular system based on a relationship between the real component of the complex impedance and volume and the relationship between the volume and the pressure.

13. The method of claim 1, wherein measuring the impedance comprises measuring a complex impedance between the at least two electrodes, and wherein the method further comprises:

determining a reactive component of the complex impedance; and

providing at least one of an indicator of hypertrophying of the element of the cardiovascular system and an indicator of myocardial tissue degradation of the element of the cardiovascular system due to ischemia based upon the reactive component of the complex impedance.

14. An implantable medical device comprising:

an impedance measurement module configured to measure an impedance between at least two electrodes implanted within a cardiovascular system of a patient;

a memory configured to store data representing a relationship between impedance and volume, and a relationship between the volume and pressure, wherein the relationship between the volume and the pressure comprises an elastance function derived from empirical data comprising historical data of the patient, the memory storing a plurality of relationships between volume and pressure, the plurality of relationships comprising a relationship between volume and pressure in a vascular lumen, the memory storing a plurality of relationships between impedance and volume; and

a processor configured to select one of the stored plurality of relationships between volume and pressure from the memory and, based upon at least one selection criterion, select one of the stored plurality of relationships between impedance and volume, and estimate a pressure of an element of the cardiovascular system based on the stored data and the selected relationships.

15. The device of claim 14, wherein the relationship between the measured impedance and the volume comprises an inversely proportional relationship.

16. The device of claim 14,

wherein the relationship between the volume and the pressure comprises

a linear approximation of the elastance function for a given volume interval.

17. The device of claim 14, wherein the processor further comprises:

a control unit configured to select the relationship between the volume and the pressure from the plurality of relationships based upon a particular patient type.

18. The device of claim 14,

wherein the impedance measuring measurement is further configured to measure a change in impedance,

wherein the processor is further configured to estimate a change in pressure based on a relationship between the measured change in impedance and a change in volume of the element of the cardiovascular system and based on a relationship between the change in volume and the change in pressure.

19. The device of claim 14, wherein the processor further comprises a control unit configured to select a combination of electrodes as the at least two electrodes based upon the element of the cardiovascular system to be measured.

20. The device of claim 14, wherein the impedance measurement module is further configured to measure the impedance the at least in part by:

generating a plurality of electric fields between the at least two electrodes;

applying the plurality of electric fields to the element of the cardiovascular system such that the combined electric field is substantially homogeneous over the element; and

measuring an impedence of a resultant current flow between the at least two electrodes.

21. The device of claim 14, wherein the impedance measurement module is further configured to measure a complex impedance between the at least two electrodes, and wherein the processor is further configured to determine a real component of the complex impedance, and estimate the pressure of the element of the cardiovascular system based on a relationship between the real component of the complex impedance and volume and the relationship between the volume and the pressure.

22. The device of claim 14, wherein the impedance measurement module is further configured to measure a complex impedance between the at least two electrodes, and wherein the processor is further configured to determine a reactive component of the complex impedance, and provide at least one of an indicator of hypertrophying of the element of the cardiovascular system and an indicator of myocardial tissue degradation of the element of the cardiovascular system due to ischemia based upon the reactive component of the complex impedance.

23. A system comprising:

means for storing a plurality of relationships between volume and pressure, the plurality of relationships comprising a relationship between volume and pressure in a vascular lumen;

means for storing a plurality of relationships between impedance and volume;

means for measuring an impedance between at least two electrodes implanted within a cardiovascular system of a patient;

means for selecting one of the stored plurality of relationships between volume and pressure;

means for selecting one of the stored plurality of relationships between impedance and volume based upon at least one selection criterion; and

means for estimating a pressure of an element of the cardiovascular system based on the selected relationship between impedance and volume and based on the selected relationship between volume and pressure, wherein the relationship between the volume and the pressure comprises an elastance function derived from empirical data comprising historical data of the patient.

24. The system of claim 23, wherein the element of the cardiovascular system comprises one of a cardiac chamber or a vascular lumen.

25. The system of claim 23, wherein the relationship between the measured impedance and the volume comprises an inversely proportional relationship.

26. The system of claim 23,

wherein the relationship between the volume and the pressure comprises a linear approximation of the elastance function for a given volume interval.

27. The system of claim 23, further comprising:

means for selecting the relationship between the volume and the pressure from the plurality of relationships based upon a particular patient type.

28. The system of claim 23,

wherein the means for measuring the impedance comprises means for measuring a change in impedance,

wherein the means for estimating the pressure comprises means for estimating a change in pressure based on a relationship between the measured change in impedance and a change in volume of the element of the cardiovascular system and based on a relationship between the change in volume and the change in pressure.

29. The system of claim 23, further comprising:

means for selecting a combination of electrodes as the at least two electrodes based upon the element of the cardiovascular system to be measured.

30. The system of claim 23, wherein the means for measuring the impedance comprises:

means for generating a plurality of electric fields between the at least two electrodes;

means for applying the plurality of electric fields to the element of the cardiovascular system such that the combined electric field is substantially homogeneous over the element; and

means for measuring an impedance of a resultant current flow between the at least two electrodes.

31. The system of claim 23, wherein the means for measuring the impedance comprises means for measuring a complex impedance between the at least two electrodes, wherein the system further comprises means for determining a real component of the complex impedance, and wherein the means for estimating the pressure comprises means for estimating the pressure of the element of the cardiovascular system based on a relationship between the real component of the complex impedance and volume and the relationship between the volume and the pressure.

32. The system of claim 23, wherein the means for measuring the impedance comprises means for measuring a complex impedance between the at least two electrodes, and wherein the system further comprises:

means for determining a reactive component of the complex impedance; and

means for providing at least one of an indicator of hypertrophying of the element of the cardiovascular system and an indicator of myocardial tissue degradation of the element of the cardiovascular system due to ischemia based upon the reactive component of the complex impedance.

33. A non-transitory computer-readable storage medium comprising instructions that cause a processor to:

measure an impedance between at least two electrodes implanted within a cardiovascular system of a patient;

select one of a plurality of stored relationships between volume and pressure, the plurality of stored relationships comprising a relationship between volume and pressure in a vascular lumen;

select one of a plurality of stored relationships between impedance and volume based upon at least one selection criterion; and

estimate a pressure of an element of the cardiovascular system based on the relationship between the measured impedance and a volume of the element of the cardiovascular system and based on the selected relationship between the volume and the pressure, wherein the relationship between the volume and the pressure comprises an elastance function derived from empirical data comprising historical data of the patient.

34. A method comprising:

storing in a memory of an implantable medical device a plurality of relationships between volume and pressure, the plurality of relationships comprising a relationship between volume and pressure in a vascular lumen;

storing in the memory a plurality of relationships between impedance and volume;

measuring a complex impedance between at least two electrodes implanted within or proximate to a cardiovascular system of a patient;

determining a reactive component of the measured complex impedance;

enabling a control unit to select one of the stored plurality of relationships between volume and pressure and one of the stored plurality of relationships between impedance and volume based on at least one selection criterion; and

providing, by the control unit, an indication of change in size of an element of the cardiovascular system based on the reactive component of the measured complex impedance and an indication of a change in pressure in the element of the cardiovascular system based on the selected relationship between volume and pressure.

35. The method of claim 34, wherein providing the indication of change in size of the element of the cardiovascular system comprises:

providing an indication of hypertrophying of the element of the cardiovascular system based on the reactive component of the measured complex impedance.

36. The method of claim 34, wherein providing the indication of change in size of the element of the cardiovascular system comprises:

providing an indication of myocardial tissue degradation of the element of the cardiovascular system due to ischemia based on the reactive component of the measured complex impedance.

37. The method of claim 34, further comprising:

determining a real component of the measured complex impedance; and

estimating a pressure of the element of the cardiovascular system based on the real component of the measured complex impedance.

38. An implantable medical device comprising:

a memory storing a plurality of relationships between volume and pressure, the plurality of relationships comprising a relationship between volume and pressure in a vascular lumen;

the memory storing a plurality of relationships between impedance and volume;

an impedance measurement module configured to measure a complex impedance between at least two electrodes implanted within or proximate to a cardiovascular system of a patient; and

a processor configured to determine a reactive component of the measured complex impedance, and provide an indication of change in size of an element of the cardiovascular system based on the reactive component of the measured complex impedance, select one of the stored plurality of relationships between volume and pressure, select one of the stored plurality of relationships between impedance and volume based upon at least one selection criterion, and provide an indication of a change in pressure based on the change in size and the selected relationships.

39. The device of claim 38, wherein the processor is further configured to provide an indication of hypertrophying of the element of the cardiovascular system based on the reactive component of the measured complex impedance.

40. The device of claim 38, wherein the processor is further configured to provide an indication of myocardial tissue degradation of the element of the cardiovascular system due to ischemia based on the reactive component of the measured complex impedance.

41. The device of claim 38, wherein the processor is further configured to determine a real component of the measured complex impedance, and estimate a pressure of the element of the cardiovascular system based on the real component of the measured complex impedance.