Systems and methods for measuring electromechanical delay of the heart

• US 9,451,887 B2
• Filed: 03/31/2010
• Issued: 09/27/2016
• Est. Priority Date: 03/31/2010
• Status: Active Grant

• Current Assignee: Nellcor Puritan Bennett Ireland
• Original Assignee: Nellcor Puritan Bennett Ireland
• Inventors: Watson, James N., Addison, Paul Stanley, Stoughton, Robert
• Primary Examiner(s): Mallari, Patricia
• Assistant Examiner(s): Ramachandran, Vasuda
• Application Number:
  US12/751,814
• Publication Number:
  US 20110245690A1
• Time in Patent Office: 2,372 Days
• Field of Search: 600/500
• US Class Current: 1/1
• CPC Class Codes: A61B 5/022 by applying pressure to close blood vessels, e.g. against the skin; Ophthalmodynamometers
• CPC Class Codes: A61B 5/02416 using photoplethysmograph signals, e.g. generated by infrared radiation A61B5/14552 takes precedence
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/6814 Head
• CPC Class Codes: A61B 5/6816 Ear lobe
• CPC Class Codes: A61B 5/6823 Trunk, e.g., chest, back, abdomen, hip
• CPC Class Codes: A61B 5/6824 Arm or wrist
• CPC Class Codes: A61B 5/6826 Finger

Abstract

Systems and methods are disclosed herein for measuring the electromechanical delay of the heart of a patient. An electrocardiogram (EKG) signal may be used to detect heart electrical activity. Photoplethysmograph (PPG) signals may be used to detect heart mechanical activity. The electromechanical delay may be calculated based at least in part on the timing of an EKG signal and at least two PPG signals.

Claims

1. A system for measuring electromechanical delay of the heart of a patient, the system comprising:

a first PPG sensor configured for attaching to the patient at a first location and for generating a first PPG signal from the first location;

a second PPG sensor configured for attaching to the patient at a second location and for generating a second PPG signal from the second location, wherein the first and second locations are distal to the heart;

an EKG sensor configured for attaching to the patient and for generating an EKG signal;

a processor coupled to the first and second PPG sensors and the EKG sensor, wherein the processor is capable of;

determining a plurality of differential pulse transit time (DPTT) values, wherein each of the plurality of DPTT values is based on both the first and second PPG signals, wherein the first and second PPG signals indicate a pulse wave at the respective first and second locations distal to the heart,

determining at least one EKG to PPG transit time value based at least in part on the EKG signal and the first PPG signal,

determining a calibration coefficient using at least one DPTT value of the plurality of DPTT values and the at least one EKG to PPG transit time value, and

calculating an electromechanical delay value based at least in part on another DPTT value of the plurality of DPTT values and the determined calibration coefficient; and

an output device coupled to the processor.

2. The system of claim 1, wherein the at least one EKG to PPG transit time value comprises a substantially constant electromechanical delay component and a variable pulse transit time component, wherein the variable pulse transit time component scales substantially linearly with DPTT.

3. The system of claim 2, wherein the relationship between the at least one EKG to PPG transit time value and the at least one DPTT value is

E=A·

T+D

or a mathematical equivalent thereof, wherein E is an EKG to PPG transit time value, T is a DPTT value, D is the electromechanical delay value, and A is the calibration coefficient.

4. The system of claim 1, wherein the processor is further capable of:

determining a further EKG to PPG transit time value based at least in part on the EKG signal and the second PPG signal; and

determining a calibration second coefficient based at least in part on the at least one DPTT value of the plurality of DPTT values and the further EKG to PPG transit time value.

5. The system of claim 4, wherein the processor is further capable of determining a third calibration coefficient based at least in part on the at least one DPTT value of the plurality of DPTT values and the EKG to PPG transit time values determined from the first and the second PPG signals.

6. The system of claim 1, wherein the processor is further capable of assessing a condition of the patient'"'"'s heart based at least in part on the electromechanical delay value.

7. The system of claim 6, wherein the processor is further capable of:

monitoring the electromechanical delay value over time;

determining a change in the electromechanical delay value; and

triggering the output device to generate an alert.

8. The system of claim 1, wherein the processor is further capable of calculating a blood pressure value of the patient based on at least one of:

(a) the plurality of DPTT values and (b) the electromechanical delay value and the at least one EKG to PPG transit time value.

9. The system of claim 8, wherein the processor is further capable of:

detecting a signal degradation of at least one of the first and second PPG signals; and

calculating a blood pressure value of the patient based on the electromechanical delay value and EKG to PPG transit time values based on at least one other PPG signal in response to detecting the signal degradation.

20. The system of claim 1, wherein the processor is further capable of:

determining a plurality of EKG to PPG transit time values based at least in part on the EKG signal and the first PPG signal, wherein determining the calibration coefficient comprises performing data regression analysis of a data set based on at least some DPTT values of the plurality of DPTT values and the plurality of EKG to PPG transit time values.

21. The system of claim 1, wherein one or more DPPT values of the plurality of DPTT values are determined over time when the patient is undertaking at least one activity for increasing or decreasing blood pressure of the patient.

22. The system of claim 1, wherein each DPTT value of the plurality of DPTT values is determined at a different time.

10. A method for measuring electromechanical delay of the heart of a patient, the method comprising:

obtaining a first PPG signal using a first PPG sensor that is attached to the patient at a first location;

obtaining a second PPG signal using a second PPG sensor that is attached to the patient at a second location, wherein the first and second locations are distal to the heart;

obtaining an EKG signal using an EKG sensor that is attached to the patient;

determining, using a processor, a plurality of differential pulse transit time (DPTT) values, wherein each of the plurality of DPTT values is based on both the first and second PPG signals, wherein the first and second PPG signals indicate a pulse wave at the respective first and second locations distal to the heart;

determining, using the processor, at least one EKG to PPG transit time value based at least in part on the EKG signal and the first PPG signal;

determining, using the processor, a calibration coefficient using at least one DPTT value of the plurality of DPTT values and the at least one EKG to PPG transit time value; and

calculating, using the processor, an electromechanical delay value based at least in part on another DPTT′

value of the plurality of DPTT values and the determined calibration coefficient.

11. The method of claim 10, wherein the at least one EKG to PPG transit time value comprises a substantially constant electromechanical delay component and a variable pulse transit time component, wherein the variable pulse transit time component scales substantially linearly with DPTT.

12. The method of claim 11, wherein the relationship between the at least one EKG to PPG transit time and the at least one DPTT value is

E=A·

T+D

or a mathematical equivalent thereof, wherein E is an EKG to PPG transit time value, T is a DPTT value, D is the electromechanical delay value, and A the calibration coefficient.

13. The method of claim 10, further comprising:

determining a further EKG to PPG transit time value based at least in pan on the EKG signal and the second PPG signal; and

determining a second calibration coefficient based at least in part on the plurality of DPTT values and the further EKG to PPG transit time value.

14. The method of claim 13, further comprising determining a third calibration coefficient based at least in part on the at least one DPTT value of the plurality of DPTT values and the EKG to PPG transit time values determined from the first and the second PPG signals.

15. The method of claim 10, further comprising assessing a condition of the patient'"'"'s heart based at least in part on the electromechanical delay value.

16. The method of claim 15, further comprising:

monitoring the electromechanical delay value over time;

determining a change in the electromechanical delay value; and

triggering the output device to generate an alert.

17. The method of claim 10, further comprising calculating a blood pressure value of the patient based on at least one of:

(a) the plurality of DPTT values and (b) the electromechanical delay value and the at least one EKG to PPG transit time value.

18. The method of claim 17, further comprising:

detecting a signal degradation of at least one of the first and second PPG signals; and

calculating a blood pressure value of the patient based on the electromechanical delay value and EKG to PPG transit time values based on at least one other PPG signal in response to detecting the signal degradation.

23. The method of claim 10, wherein each DPTT value of the plurality of DPTT values is determined at a different time.

19. A non-transitory computer-readable medium for use in measuring electromechanical delay of the heart of a patient, the non-transitory computer-readable medium comprising:

computer program instructions recorded thereon for causing a pulse oximeter to;

obtain a first PPG signal from a first PPG sensor configured for attaching to the patient at a first location;

obtain a second PPG signal from a second PPG sensor configured for attaching to the patient at a second location, wherein the first and second locations are distal to the heart;

obtain an EKG signal from an EKG sensor configured for attaching to the patient;

determine a plurality of differential pulse transit time (DPTT) values, wherein each of the plurality of DPTT values is based on both the first and second PPG signals, wherein the first and second PPG signals indicate a pulse wave at the respective first and second locations distal to the heart;

determine at least one EKG to PPG transit time value based at least in part on the EKG signal and the first PPG signal;

determine a calibration coefficient using at least one DPTT value of the plurality of DPTT values and the at least one EKG to PPG transit time value; and

calculate an electromechanical delay value based at least in part on another DPTT value of the plurality of DPTT values and the calibration coefficient.