Measurement of cardiac cycle length and pressure metrics from pulmonary arterial pressure

• US 9,241,640 B2
• Filed: 04/25/2011
• Issued: 01/26/2016
• Est. Priority Date: 07/28/2010
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Greenhut, Saul E., Taepke, Robert T., Bloem, David R., Cho, Yong K., Salmi, Donna M.
• Primary Examiner(s): Natnithithadha, Navin
• Assistant Examiner(s): MESSERSMITH, ERIC J
• Application Number:
  US13/093,146
• Publication Number:
  US 20120029364A1
• Time in Patent Office: 1,737 Days
• Field of Search: 600/481, 600483-486, 600/488, 600500-503, 600/513
• US Class Current: 1/1
• 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 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/6847 mounted on an invasive device
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/6869 Heart
• CPC Class Codes: A61B 5/6876 Blood vessel
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61M 2205/054 with electrotherapy
• CPC Class Codes: A61M 2210/125 Heart
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

Various techniques for measuring cardiac cycle length and pressure metrics based on pulmonary artery pressures are described. One example method described includes identifying a point within a derivative signal of a cardiovascular pressure signal without reference to electrical activity of a heart, initiating a time window from the identified point in the derivative signal, identifying a point within the cardiovascular signal within the time window, and determining at least one of a systolic pressure or diastolic pressure based on the identified point.

Claims

1. A method of monitoring a cardiovascular pressure signal in a medical device, comprising:

identifying, by the medical device, a point within a derivative signal of the cardiovascular pressure signal without reference to electrical activity of a heart;

initiating, by the medical device, a time window that begins at the identified point in the derivative signal, wherein the time window comprises one of a fixed temporal length or a variable temporal length, and wherein the variable temporal length is determined based on a plurality of cardiac cycle lengths;

identifying, with the medical device, a point within the cardiovascular pressure signal within the time window; and

determining, with the medical device, at least one of a systolic pressure or a diastolic pressure based on the identified point within the cardiovascular pressure signal.

2. The method of claim 1, wherein the derivative signal is a first derivative signal, wherein identifying, by the medical device, the point within the first derivative signal of the cardiovascular pressure signal without reference to electrical activity of the heart comprises identifying a maximum value of the first derivative signal as the point within the first derivative signal.

3. The method of claim 2,

wherein the time window begins at and extends forward in time from the identified maximum value of the first derivative signal,

wherein identifying, with the medical device, the point within the cardiovascular pressure signal within the time window comprises identifying a point of maximum value within the cardiovascular pressure signal within the time window, and

wherein determining, with the medical device, at least one of the systolic pressure or the diastolic pressure based on the identified point comprises determining the systolic pressure based on the identified point of maximum value within the cardiovascular pressure signal within the time window.

4. The method of claim 2, wherein the time window begins at and extends backward in time from the identified maximum value of the first derivative signal, the method further comprising:

identifying, with the medical device, a point within a second derivative signal of the cardiovascular pressure signal within the time window without reference to electrical activity of the heart.

5. The method of claim 4,

wherein the point within the second derivative signal of the cardiovascular pressure signal is a point of maximum second derivative within the time window,

wherein identifying, with the medical device, the point within the cardiovascular pressure signal within the time window comprises identifying the point within the cardiovascular pressure signal within the time window that corresponds in time to the identified point of maximum second derivative, and

wherein determining, with the medical device, at least one of the systolic pressure or the diastolic pressure based on the identified point comprises determining the diastolic pressure based on the identified point within the cardiovascular pressure signal within the time window that corresponds in time to the identified point of maximum second derivative.

6. The method of claim 1, wherein the time window comprises the variable temporal length.

7. The method of claim 1, wherein the time window comprises the fixed temporal length.

8. The method of claim 1, further comprising:

controlling delivery of at least one of electrical stimulation and a therapeutic agent based on the determination.

25. The method of claim 1, wherein the fixed temporal length and the variable temporal length are less than a cardiac cycle length of a cardiac cycle for at least one of the systolic pressure or the diastolic pressure.

9. A medical device system for monitoring a cardiovascular pressure signal, comprising:

at least one pressure sensor to generate the cardiovascular pressure signal; and

at least one pressure analysis module configured to;

identify a point within a derivative signal of the cardiovascular pressure signal without reference to electrical activity of a heart;

initiate a time window that begins at the identified point in the derivative signal, wherein the time window comprises one of a fixed temporal length or a variable temporal length, and wherein the variable temporal length is determined based on a plurality of cardiac cycle lengths;

identify a point within the cardiovascular pressure signal within the time window; and

determine at least one of a systolic pressure or a diastolic pressure based on the identified point within the cardiovascular pressure signal.

10. The system of claim 9, wherein the derivative signal is a first derivative signal, wherein the at least one pressure analysis module configured to identify the point within the first derivative signal of the cardiovascular pressure signal without reference to electrical activity of the heart is configured to identify a maximum value of the first derivative signal as the point within the first derivative signal.

11. The system of claim 10,

wherein the time window begins at and extends forward in time from the identified maximum value of the first derivative signal,

wherein the at least one pressure analysis module configured to identify the point within the cardiovascular pressure signal within the time window is configured to identify a point of maximum value within the cardiovascular pressure signal within the time window, and

wherein at least one pressure analysis module configured to determine at least one of the systolic pressure or the diastolic pressure based on the identified point is configured to determine the systolic pressure based on the identified point of maximum value within the cardiovascular pressure signal within the time window.

12. The system of claim 10, wherein the time window begins at and extends backward in time from the identified maximum value of the first derivative signal, and the at least one pressure analysis module is further configured to:

identify a point within a second derivative signal of the cardiovascular pressure signal within the time window without reference to electrical activity of the heart.

13. The system of claim 12,

wherein the point within the second derivative signal of the cardiovascular pressure signal is a point of maximum second derivative within the time window,

wherein the at least one pressure analysis module configured to identify the point within the cardiovascular pressure signal within the time window is configured to identify the point within the cardiovascular pressure signal within the time window that corresponds in time to the identified point of maximum second derivative, and

wherein the at least one pressure analysis module configured to determine at least one of the systolic pressure or the diastolic pressure based on the identified point is configured to determine the diastolic pressure based on the identified point within the cardiovascular pressure signal within the time window that corresponds in time to the identified point of maximum second derivative.

14. The system of claim 9, wherein the time window comprises the variable temporal length.

15. The system of claim 9, wherein the time window has a length that is fixed.

16. The system of claim 9, further comprising:

at least one medical device configured to deliver at least one of electrical stimulation and a therapeutic agent based on the determination.

17. A computer-readable storage medium comprising instructions that, when executed, cause a cardiovascular pressure analysis module of a medical device to:

identify a point within a derivative signal of a cardiovascular pressure signal without reference to electrical activity of a heart;

initiate a time window that begins at the identified point in the derivative signal;

identify a point within the cardiovascular pressure signal within the time window, wherein the time window comprises one of a fixed temporal length or a variable temporal length, and wherein the variable temporal length is determined based on a plurality of cardiac cycle lengths; and

determine at least one of a systolic pressure or a diastolic pressure based on the identified point within the cardiovascular pressure signal.

18. The computer-readable storage medium of claim 17, wherein the derivative signal is a first derivative signal, and

wherein the instructions that, when executed, cause the pressure analysis module to identify the point within the derivative signal of the cardiovascular pressure signal without reference to electrical activity of the heart comprise instructions that, when executed, cause the cardiovascular pressure analysis module to identify a maximum value of the first derivative signal, as the point within the first derivative signal.

19. The computer-readable storage medium of claim 18,

wherein the time window begins at and extends forward in time from the identified maximum value of the first derivative signal,

wherein the instructions that, when executed, cause the pressure analysis module to identify the point within the cardiovascular pressure signal within the time window comprise instructions that, when executed, cause the cardiovascular pressure analysis module to identify a point of maximum value within the cardiovascular pressure signal within the time window, and

wherein the instructions that, when executed, cause the cardiovascular pressure analysis module to determine at least one of the systolic pressure or the diastolic pressure based on the identified point comprise instructions that, when executed, cause the cardiovascular pressure analysis module to determine the systolic pressure based on the identified point of maximum value within the cardiovascular pressure signal within the time window.

20. The computer-readable storage medium of claim 18,

wherein the time window begins at and extends backward in time from the identified maximum value of the first derivative signal, the computer-readable storage medium further comprising instructions that, when executed, cause the cardiovascular pressure analysis module to:

identify a point within a second derivative signal of the cardiovascular pressure signal within the time window without reference to electrical activity of the heart.

21. The computer-readable storage medium of claim 20,

wherein the point within the second derivative signal of the cardiovascular pressure signal is a point of maximum second derivative within the time window,

wherein the instructions that, when executed, cause the cardiovascular pressure analysis module to identify the point within the cardiovascular pressure signal within the time window comprise instructions that, when executed, cause the cardiovascular pressure analysis module to identify the point within the cardiovascular pressure signal within the time window that corresponds in time to the identified point of maximum second derivative, and

wherein the instructions that, when executed, cause the cardiovascular pressure analysis module to determine at least one of the systolic pressure or the diastolic pressure based on the identified point comprise instructions that, when executed, cause the cardiovascular pressure analysis module to determine the diastolic pressure based on the identified point within the cardiovascular pressure signal within the time window that corresponds in time to the identified point of maximum second derivative.

22. The computer-readable storage medium of claim 17, wherein the time window comprises the variable temporal length.

23. The computer-readable storage medium of claim 17, wherein the time window comprises the fixed temporal length.

24. The computer-readable storage medium of claim 17, further comprising instructions that, when executed, cause the cardiovascular pressure analysis module of the medical device to:

control, based on the determination, delivery of at least one of electrical stimulation and a therapeutic agent.