System for non-invasive detection of changes of cardiac volumes and aortic pulses

• US 5,178,151 A
• Filed: 09/16/1991
• Issued: 01/12/1993
• Est. Priority Date: 04/20/1988
• Status: Expired due to Term

• Current Assignee: VivoMetrics, Inc.
• Original Assignee: Marvin A. Sackner
• Inventors: Sackner, Marvin A.
• Primary Examiner(s): Howell, Kyle L.
• Assistant Examiner(s): JASTRZAB, JEFFREY R
• Application Number:
  US07/759,862
• Time in Patent Office: 484 Days
• Field of Search: 128/671-672, 128/694, 128/695, 128/721, 128/687, 128/713-719, 128/774
• US Class Current: 600/485
• CPC Class Codes: A61B 5/1135 by monitoring thoracic expansion
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives

Abstract

A method and an apparatus therefor for monitoring cardiac function in an animal or human subject including the steps of: placing a first movement detecting transducer on the torso, said transducer overlying at least part of two diametrically opposed borders of the heart or great vessels; generating a signal indicative of the movement of the torso portion subtended by the transducer, said signal including a cardiac component comprising at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform; and assessing cardiac function by monitoring changes in said venticular volume waveform or said aortic pressure pulse waveform.

Claims

1. A method for monitoring cardiac function in an animal or human subject comprising:

placing a first movement detecting transducer on the torso, said transducer overlying at least part of two diametrically opposed borders of the heart or great vessels;

generating a signal indicative of the movement of the torso portion subtended by the transducer, said signal including a cardiac component comprising at least a sequential ventricular volume waveform or a segmental aortic pressure pulse waveform; and

assessing cardiac function by monitoring changes in said ventricular volume waveform or said aortic pressure pulse waveform.

2. The method of claim 1, wherein said movement detecting transducer comprises a conductor disposed on said torso portion for movement therewith, movement of said torso portion resulting in corresponding changes in the self-inductance of said conductor.

3. The method of claim 2, wherein said conductor extends about said torso portion and subtends a finite height.

4. The method of claim 3, wherein said height is about 2.5 cm.

5. The method of claims 1 or 3, wherein said transducer is disposed at or near the xiphoid process and wherein said at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform is a segmental ventricular volume waveform.

6. The method of claims 1 or 3, wherein said transducer is disposed at or near the uppermost portion of the sternum or the abdomen, and wherein said at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform is a segmental aortic pressure pulse waveform.

7. The method of claims 1 or 3, wherein said at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform is a segmental ventricular volume waveform, and wherein said assessing step further comprises monitoring the amplitude of said ventricular volume waveform for monitoring stroke volume.

8. The method of claims 1 or 3, wherein said assessing step further comprises monitoring changes in the slope, derivative of slope, or duration of said at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform.

9. The method of claim 7, and further comprising monitoring the heart rate of said subject;

and monitoring changes in cardiac output by monitoring changes in the product of said heart rate and said stroke volume.

10. The method of claim 9, further comprising monitoring arterial oxygen saturation;

and monitoring systemic oxygen delivery (DO₂) trends by monitoring trends in the product of cardiac output and arterial oxygen saturation.

11. The method of claim 7, and further comprising measuring the absolute value of stroke volume by an independent method, and adjusting the level of said signal to indicate said absolute value, whereby said signal indicates absolute stroke volume.

12. The method of claim 1, wherein the step of generating a signal further comprising generating a signal having a respiration component and wherein the method for monitoring further comprises the step of removing the respiration component from said signal.

13. The method of claim 12, wherein said respiration component removing step comprises ensemble averaging said signal for removing the respiration component.

14. The method of claim 12, wherein said respiration component removing step comprises subtracting a curve fit from said signal for removing the respiration component.

15. The method of claim 12, wherein said respiration component removing step comprises adaptive digital filtering of said signal for removing the respiration component.

16. The method of claim 12, further comprising high pass filtering said signal for removing noise.

17. The method of claim 12, further comprising monitoring said respiration component.

18. The method of claim 1, further comprising performing said assessing step during breathholding for avoiding changes in said signal due to respiration.

19. The method of claim 1, further comprising placing at least one additional movement detecting transducer on the torso, said additional transducer also overlying at least part of two diametrically opposed borders of the heart or great vessels;

generating a signal indicative of the movement of the torso portion subtended by said at least one additional transducer, said signal generated by said at least one additional transducer including a cardiac component comprising at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform; and

wherein said cardiac function assessing step comprises monitoring changes in said waveforms generated by said first transducer and said at least one additional transducer.

20. The method of claim 19, wherein said assessing step further comprises comparing the waveforms of said signals generated by said transducers.

21. The method of claim 19, wherein one of said movement detection transducers is selected as a reference, and further comprising the steps of determining the respiration component of the signals generated by said transducers;

adjusting the amplitude of the signals generated by each additional transducer such that the respiration component of each additional movement detection transducer signal is equal to the amplitude of the respiration component of said reference transducer; and

assessing cardiac function by comparing the amplitude of the cardiac component of the reference transducer signal to the amplitude of said cardiac component of at least one additional transducer signal that has been adjusted.

22. The method of claim 21, further comprising obtaining the relative amplitudes of said cardiac component of said signals generated by said transducers;

repeating the steps of claim 20 on a known normal;

obtaining the relative amplitudes of said cardiac component of said signals generated by said transducers when on said known normal; and

comparing said relative amplitudes for said subject to said relative amplitudes for said known normal for assessing cardiac function of said subject relative to said normal.

23. The method of claims 19, 20, 21 or 22, wherein said transducers subtend an entire dimension of the heart.

24. The method of claim 23, wherein said dimension is the height of said heart from the most apical segment to the most basilar segment.

25. The method of claim 1, wherein said movement detecting transducer is a bellows pneumograph, a mercury in silastic strain gauge, an inductive circumferential transducer, a differential linear transformer, or a surface inductive plethysmograph.

26. The method of claim 1, further comprising generating an EKG signal for said subject, and wherein said assessing step further comprises monitoring changes in the timing of said at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform relative to said EKG.

27. The method of claim 1, further comprising measuring ventriclar pressure;

generating a signal indicative of ventricular pressure, wherein said at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform is a segmental ventricular volume waveform; and

constructing ventricular volume-ventricular pressure curves from said signals.

28. The method of claim 1, wherein said step of placing a first movement detecting transducer on the subject'"'"'s torso comprises placing said movement detecting transducer for detecting a cardiac component of a fetus carried by said subject;

and removing a respiration component and the cardiac component of said subject from said signal whereby only the cardiac component of said fetus remains in said signal.

29. The method of claim 28, further comprising removing said respiration component of said subject by monitoring during breathholding.

30. The method of claim 1, wherein said two diametrically opposed borders are the left and right borders of the heart.

31. An apparatus for monitoring cardiac function in an animal or human subject comprising:

a first movement detecting transducer means for disposition on the torso of said subject, overlying at least part of two diametrically opposed borders of the heart or great vessels;

said transducer means including means for generating a first signal indicative of the movement of the torso portions subtended by the transducer means, said first signal including a cardiac component comprising at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform; and

means for assessing cardiac function by monitoring changes in said ventricular volume waveform or said aortic pressure pulse waveform.

32. The apparatus of claim 31, wherein said movement detecting transducer means includes a conductor for disposition on said torso portion for movement therewith, with movement of said torso portion resulting in corresponding changes in the self-inductance of said conductor.

33. The apparatus of claim 32, wherein said conductor is adapted to extend about said torso portion and subtend a finite height.

34. The apparatus of claim 33, wherein said height is about 2.5 cm.

35. The apparatus of claims 31 or 33, wherein said transducer means is adapted for disposition at or near the xiphoid process and wherein said at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform is a segmental ventricular volume waveform.

36. The apparatus of claims 31 or 33, wherein said transducer means is adapted for disposition at or near the uppermost portion of the sternum or the abdomen, and wherein said at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform is a segmental aortic pressure pulse waveform.

37. The apparatus of claim 31 or 33, wherein said at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform is a segmental ventricular volume waveform, and wherein said assessing means further comprises means for monitoring the amplitude of said ventricular volume waveform for monitoring stroke volume.

39. The apparatus of claim 37, and further comprising means for monitoring the heart rate of said subject;

and means for multiplying said heart rate by stroke volume for monitoring cardiac output.

40. The apparatus of claim 39, further comprising means for monitoring arterial oxygen saturation;

and means for monitoring systemic oxygen delivery (DO₂) trends by monitoring trends in he product of cardiac output and arterial oxygen saturation.

41. The apparatus of claim 37, and further comprising independent means for measuring the absolute value of stroke volume;

and means for adjusting the level of said first signal to indicate said absolute value, whereby said first signal indicates absolute stroke volume.

42. The apparatus of claim 31, wherein the means for generating a first signal further comprises means for generating a first signal having a respiration component, and wherein the means for assessing further comprises means for removing the respiration component from said first signal.

43. The apparatus of claim 42, wherein said means for removing the respiration component from said first signal comprises means for ensemble averaging said first signal.

44. The apparatus of claim 42, wherein said means for removing the respiration component from said first signal comprises means for subtracting a curve fit from said first signal.

45. The apparatus of claim 42, wherein said means for removing the respiration component from said first signal comprises means for adaptive digital filtering said first signal.

46. The apparatus of claim 42, further comprising means for high pass filtering said first signal for removing noise.

47. The apparatus of claim 42, further comprising means for monitoring said respiration component.

48. The apparatus of claim 31, further comprising at least one additional movement detecting transducer means for disposition on said torso overlying at least part of two diametrically opposed borders of the heart or great vessels;

additional means for generating an additional signal indicative of the movement of the torso portion subtended by each said at least one additional transducer means, said additional signal including a cardiac component comprising at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform;

wherein said means for assessing cardiac function comprises means for monitoring changes in said waveforms of said first and additional signals.

49. The apparatus of claim 48, wherein said assessing means further comprises means for comparing the waveforms of said first and additional signals.

50. The apparatus of claim 48, further comprising means for determining the amplitude of the respiration component of the first signal;

means for adjusting each additional signal so that the amplitude of the respiration component of each additional signal is equal to the amplitude of the respiration component of said first signal, wherein said means for assessing cardiac function includes means for comparing the amplitude of the cardiac component of said first signal to the amplitude of the cardiac component of each additional signal adjusted by said means for adjusting.

51. The apparatus of claim 50, further comprising means for obtaining the relative amplitudes of said cardiac component of said first and additional signals, whereby cardiac function may be assessed by comparing said relative amplitudes for said subject to relative amplitudes obtained with a known normal.

52. The apparatus of claims 48, 49, 50 or 51, wherein said transducer means are adapted to subtend an entire dimension of the heart.

53. The apparatus of claim 52, wherein said dimension is the height of said heart from the most apical segment to the most basilar segment.

54. The apparatus of claim 48, further comprising means adapted to be worn by said subject for recording said first and additional signals for accommodating ambulatory monitoring.

55. The apparatus of claim 31, wherein said movement detecting transducer means is a bellows pneumograph, a mercury in silastic strain gauge, an inductive circumferential transducer, a differential linear transformer or a surface inductive plethysmograph.

56. The apparatus of claim 31, further comprising means for generating an EKG signal for said subject, and wherein said assessing means further comprises means for monitoring changes in the timing of said at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform relative to said EKG.

57. The apparatus of claim 31, further comprising means for measuring ventricular pressure;

means for generating a signal indicative of ventricular pressure, wherein said at least segmental ventricular volume waveform or a segmental aortic pressure pulse waveform is said at least segmental ventricular volume waveform; and

means for constructing ventricular volume-ventricular pressure curves from said signals.

58. The apparatus of claim 31, wherein said movement detecting transducer means is disposed for detecting a cardiac component of a fetus carried by said subject, and further comprising means for removing a respiration component and the cardiac component of said subject from said signal whereby only the cardiac component of said fetus remains.

59. The apparatus of claim 31, further comprising means adapted to be worn by said subject for recording the first signal for accommodating ambulatory monitoring.

60. The apparatus of claim 31, wherein said two diametrically opposed borders are the left and right borders of the heart.

38. The apparatus of claims or 31 or 33, wherein said assessing means further comprises means for monitoring changes in the slope, derivative of slope, or duration of said at least a segmental ventricular volume waveform or a segmental aortic pressure pulse waveform.