System and method for systolic interval analysis

• US 8,972,008 B2
• Filed: 01/25/2013
• Issued: 03/03/2015
• Est. Priority Date: 10/26/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Patangay, Abhilash, Siejko, Krzysztof Z., Carlson, Gerrard M., Moon, Loell Boyce
• Primary Examiner(s): GETZOW, SCOTT M
• Application Number:
  US13/750,458
• Publication Number:
  US 20130138008A1
• Time in Patent Office: 767 Days
• Field of Search: 600/528, 600/514, 607 4- 28
• US Class Current: 607/18
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/0265 using electromagnetic means, e.g. electromagnetic flowmeter
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61B 5/7282 Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/349, A61B5/0823 take precedence
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36571 controlled by blood flow rate, e.g. blood velocity or cardiac output
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters

Abstract

A system and method provide for systolic interval analysis. In an example, an implantable device measures a cardiac impedance signal. A transformation of the cardiac impedance interval is generated. The device also measures a heart sound signal. A time interval between a point on the transformed signal of the cardiac impedance signal and a point on the heart sound signal is calculated.

Claims

1. A processor-readable medium, comprising instructions that, when performed by the processor, cause the processor to:

obtain information indicative of an acoustic signal from an implantable acoustic sensor;

identify a first heart sound feature in the information indicative of the acoustic signal;

obtain information indicative of a cardiac impedance from an implantable cardiac impedance sensor;

transform the information indicative of the cardiac impedance to obtain transformed cardiac impedance information;

identify a first cardiac impedance feature in the transformed cardiac impedance information;

determine a first interval between the identified first heart sound feature in the information indicative of the acoustic signal and the identified first cardiac impedance feature in the transformed cardiac impedance information; and

determine a heart failure decompensation status using information about the determined first interval.

2. The processor-readable medium of claim 1, wherein the first interval corresponds to a left ventricular ejection time (LVET), and wherein the instructions include instructions that, when performed by the processor, cause the processor to:

determine a second interval corresponding to a pre-ejection period (PEP);

determine a relative indication of information between the PEP and the LVET; and

determine the heart failure decompensation status using the relative indication of information.

3. The processor-readable medium of claim 2, wherein the instructions to determine the relative indication of information include instructions to determine a ratio of the PEP to the LVET.

4. The processor-readable medium of claim 3, comprising instructions that, when performed by the processor, cause the processor to:

determine respective instances of the ratio of the PEP to the LVET corresponding to respective cardiac cycles;

identify a trend in the determined respective instances of the ratio of the PEP to the LVET; and

determine a heart failure decompensation status using information about the identified trend.

5. The processor-readable medium of claim 4, wherein the identified trend includes identified information indicative of an increasing ratio of the PEP to the LVET.

6. The processor-readable medium of claim 2, comprising instructions that, when performed by the processor, cause the processor to:

obtain information indicative of cardiac electrical activity from an implantable cardiac electrical activity sensing circuit;

identify a cardiac electrical activity feature in the information indicative of the cardiac electrical activity; and

identify a second feature heart sound feature in the information indicative of the acoustic signal;

wherein the instructions that, when performed by the processor, cause the processor to determine the second interval between the identified cardiac electrical activity feature and the second heart sound feature.

7. The processor-readable medium of claim 1, comprising instructions that, when performed by the processor, cause the processor to:

determine respective instances of the first interval corresponding to respective cardiac cycles; and

identify a trend in the determined respective instances of the first interval;

wherein the instructions to determine the heart failure decompensation status using information about the determined first interval include instructions to determine the heart failure decompensation status using information about the identified trend.

8. The process-readable medium of claim 7, wherein the first interval corresponds to a left ventricular ejection time (LVET);

and

wherein the identified trend includes identified information indicative of a decreasing LVET over multiple cardiac cycles.

9. The processor-readable medium of claim 1, wherein the instructions to transform the cardiac impedance information include instructions to obtain information indicative of respective slopes between respective points in the information indicative of the cardiac impedance.

10. The processor-readable medium of claim 1, wherein the instructions to transform the cardiac impedance information include instructions to obtain information indicative of a derivative of the information indicative of the cardiac impedance.

11. An implantable medical device comprising:

an acoustic sensor configured to provide information indicative of an acoustic signal obtained using the acoustic sensor;

a cardiac impedance sensing circuit configured to provide information indicative of a cardiac impedance obtained using the cardiac impedance sensing circuit;

a transform circuit coupled to the cardiac impedance circuit and configured to receive the information indicative of the cardiac impedance and configured to provide transformed cardiac impedance information; and

a processor circuit communicatively coupled to the to the acoustic sensor and to the transform circuit, the processor circuit configured to;

receive the information indicative of the acoustic signal;

identify a first heart sound feature in the information indicative of the acoustic signal;

receive the transformed cardiac impedance information;

identify a first cardiac impedance feature in the transformed cardiac impedance information;

determine a first interval between the identified first heart sound feature in the information indicative of the acoustic signal and the identified first cardiac impedance feature in the transformed cardiac impedance information, the first interval corresponding to a left ventricular ejection time (LVET);

determine a second interval corresponding to a pre-ejection period (PEP);

determine a relative indication of information between the PEP and the LVET; and

determine a heart failure decompensation status using information about the relative indication of information.

12. A system, comprising:

an implantable medical device comprising;

an acoustic sensor configured to provide information indicative of an acoustic signal obtained using the acoustic sensor;

a cardiac impedance sensing circuit configured to provide information indicative of a cardiac impedance obtained using the cardiac impedance sensing circuit; and

a transform circuit coupled to the cardiac impedance circuit and configured to receive the information indicative of the cardiac impedance and configured to provide transformed cardiac impedance information; and

a processor circuit communicatively coupled to the to acoustic sensor and to the transform circuit, the processor circuit configured to;

receive the information indicative of the acoustic signal;

identify a first heart sound feature in the information indicative of the acoustic signal;

receive the transformed cardiac impedance information;

identify a first cardiac impedance feature in the transformed cardiac impedance information;

determine a first interval between the identified first heart sound feature in the information indicative of the acoustic signal and the identified first cardiac impedance feature in the transferred cardiac impedance information; and

determine a heart failure decompensation status using information about the determined first interval.

13. The system of claim 12, wherein the first interval corresponds to a left ventricular ejection time (LVET), and wherein the processor circuit is configured to:

determine a second interval corresponding to a pre-ejection period (PEP); and

determine a relative indication of information between the PEP and the LVET; and

determine the heart failure decompensation status using the relative indication of information.

14. The system of claim 13, wherein the processor circuit is configured to determine the relative indication of information including determining a ratio of the PEP to the LVET.

15. The system of claim 14, wherein the processor circuit is configured to:

determine respective instances of the ratio of the PEP to the LVET corresponding to respective cardiac cycles;

identify a trend in the determined respective instances of the ratio of the PEP to the LVET; and

determine a heart failure decompensation status using information about the identified trend.

16. The system of claim 15, wherein the identified trend includes identified information indicative of an increasing ratio of the PEP to the LVET.

17. The system of claim 13, wherein the processor circuit is configured:

obtain information indicative of cardiac electrical activity from an implantable cardiac electrical activity sensing circuit;

identify a cardiac electrical activity feature in the information indicative of the cardiac electrical activity;

identify a second feature heart sound feature in the information indicative of the acoustic signal; and

determine the second interval between the identified cardiac electrical activity feature and the second heart sound feature.

18. The system of claim 12, wherein the processor circuit is configured to:

determine respective instances of the first interval corresponding to respective cardiac cycles;

identify a trend in the determined respective instances of the first interval corresponding to respective cardiac cycles; and

determine the heart failure decompensation status using information about the identified trend.

19. The system of claim 18, wherein the first interval corresponds to a left ventricular ejection time (LVET);

and

wherein the identified trend includes identified information indicative of a decreasing LVET over multiple cardiac cycles.

20. The system of claim 12, further comprising an adjunct device;

and

wherein the processor circuit is included as a portion of the adjunct device.