Method for ascertaining the pressure pulse and related parameters in the ascending aorta from the contour of the pressure pulse in the peripheral arteries

• US 5,265,011 A
• Filed: 11/08/1991
• Issued: 11/23/1993
• Est. Priority Date: 04/03/1989
• Status: Expired due to Term

• Current Assignee: Eastern Medical Testing Services Incorporated
• Original Assignee: Eastern Medical Testing Services Incorporated
• Inventors: O'Rourke, Michael F.
• Primary Examiner(s): Weinhardt, Robert A.
• Assistant Examiner(s): Huntley, David
• Application Number:
  US07/790,644
• Time in Patent Office: 746 Days
• Field of Search: 128/672, 128/680, 364/413.01, 364/413.02, 364/413.03, 364/413.05
• US Class Current: 600/485
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/02108 from analysis of pulse wave characteristics
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61B 5/7257 using Fourier transforms
• CPC Class Codes: Y10S 128/92 Computer assisted medical diagnostics

Abstract

The system measures the pressure pulses in an upper body peripheral artery and produces an electrical signal which represents the contours of these pulses. It then digitizes the signal and synthesizes the pressure pulses in the ascending aorta using either a frequency-domain or a time-domain calculation method. Next, the system separately averages the signals corresponding to the measured pulses and those corresponding to the synthesized pulses, and forms for each an "average pulse." The system identifies the wave foot in each of the average pulses, identifies the incisura in the average peripheral pulse, determines the amount of time associated with systole and, based on this time, segments the synthesized pulse into systolic and diastolic components. The system then identifies the two pressure peaks and determines their amplitudes using either the average peripheral pulse or the average synthesized pulse, by taking first and third derivatives of the pulses and determining the locations of the relevant minimum and maximum points. The system then determines the peak and mean pressures throughout the wave and at various critical points such as the primary pressure peak, the reflective wave peak, and throughout systole and diastole. Using these peaks and pressures, the system calculates maximum and mean systolic and diastolic pressures, an augmentation index, a measure of subendocardial viability, and the pressure at the end of systole.

Claims

1. A method of determining systolic and diastolic pressure in the ascending aorta from measurements of pressure in an upper body peripheral artery, said method comprising the steps of:

A. measuring pressure pulses in a peripheral artery and producing an electrical signal representing the pressure pulses;

B. deriving a Fourier transform for the measured peripheral pulses;

C. dividing the peripheral pulse Fourier transform by a transfer function H(w) relating a Fourier transform of pressure pulses in the peripheral artery and a Fourier transform of pressure pulses in the aorta, thereby producing a Fourier transform associated with the aortic pressure pulse;

D. deriving the inverse of the Fourier transform associated with the aortic pressure pulse, thereby producing an electrical signal representing a synthesized ascending aortic pressure pulse;

E. determining in the signal representing the measured peripheral pulse a point of systolic onset by taking a first derivative of the measured peripheral pulse and locating a zero crossing from negative-to-positive which precedes a maximum point on the first derivative curve;

F. determining the location of a point of incisura in the signal representing the measured peripheral pressure pulse by finding in a signal representing the third derivative of the measured peripheral pulse a zero crossing from positive-to-negative in proximity to the largest maximum point of the third derivative after the peak of a second systolic shoulder;

G. determining in the electrical signal representing the synthesized aortic pressure pulse, the systole and diastole components of the synthesized signal based on the location of the incisura and systolic onset in the signal representing the measured peripheral pulse;

H. determining from the electrical signal representing the synthesized aortic pressure pulse a maximum systolic pressure and a maximum diastolic pressure; and

I. displaying a graph of the electrical signal representing the measured peripheral pulse, the electrical signal representing the synthesized ascending aortic pressure pulse and the related maximum systolic and diastolic pressures.

2. The method of claim 1, wherein the method further includes the steps of:

J. determining, from the electrical signal representing the synthesized ascending aortic pressure pulse, mean aortic systolic pressure;

K. measuring heart rate; and

L. calculating a systole pressure-time index based on the mean systolic pressure determined from the maximum systolic pressure determined in step H, the length of time in systole calculated from systolic onset to the point of incisura as determined in step G and the measured heart rate determined in step K; and

M. displaying the systole pressure-time index.

3. The method of claim 2, wherein the method further includes the steps of:

N. determining from the electrical signal representing the synthesized aortic pressure pulse, mean aortic pressure during diastole;

O. calculating a diastole pressure-time index based on the mean aortic diastolic pressure during diastole determined from the maximum systolic pressure determined in step H, the length of time in diastole determined in step G and the measured heart rate determined in step K; and

P. displaying the diastole pressure-time index.

4. The method of claim 3, wherein the method further includes the step of determining subendocardial viability ratio by dividing the diastolic pressure-time index by the systolic pressure-time index.

5. The method of claim 1, wherein the step of separating the electrical signal representing the synthesized aortic pressure pulse into systole and diastole components further includes:

i. determining the duration of systole by calculating the time difference between the occurrence of systolic onset and the occurrence of the incisura in the peripheral pressure pulse; and

ii. identifying the incisura in the electrical signal representing the synthesized aortic pressure pulse as a point separated by the time interval determined in step i from a point on the synthesized aortic pressure pulse corresponding to systolic onset.

6. A method of claim 1, wherein the step of locating the incisura in the signal representing the measured peripheral pressure pulse further includes locating a zero crossing from positive-to-negative associated with the largest maximum in the third derivative after a point corresponding to a first systolic shoulder, if the second systolic shoulder cannot be identified.

7. The method of claim 1, wherein the step of locating the incisura further includes:

i. locating in the signal representing the measured peripheral pressure pulse a maximum pressure point, SMAX, and determining its time of occurrence, T_SMAX ;

ii. locating in a first derivative of the signal representing the measured peripheral pressure pulse a maximum point, MAXdpdt;

iii. locating in a third derivative of the signal representing the measured peripheral pressure pulse a maximum point, Max3rd, which immediately follows a point on the third derivative which corresponds to MAXdpdt and determining its time of occurrence, T_max3rd ;

iv. if T_smax is not greater than or equal to T_max3rd +60 msec, identifying SMAX as the peak of a first systolic shoulder and identifying a next negative-to-positive zero crossing point Zc3rd-+ of the third derivative as the point which corresponds to the peak of a second systolic shoulder of the signal representing the measured peripheral pressure pulse providing that T_zc3rd-+ is less than T_SMAX +60 msec or and is greater than 300 msec after systolic onset; and

v. if T_smax follows T_max3rd by 60 msec or more, identifying the Max3rd point as corresponding to the peak of the first systolic shoulder of the signal representing the measured peripheral pressure pulse and identifying SMAX as the peak of the second systolic shoulder.

8. The method of claim 1, wherein the step of locating the incisura further includes:

i. locating in the measured peripheral pressure pulse a maximum pressure point, SMAX, and determining its time of occurrence, T_SMAX ;

ii. locating in a first derivative of the signal representing the measured peripheral pressure pulse a maximum point, MAXdpdt and determining its time of occurrence, T_MAXdpdt.

iii. locating in a third derivative of the signal representing the measured peripheral pressure pulse a first positive-to-negative zero crossing point, Zc3rd+-, which immediately follows T_maxdpdt and determining its time of occurrence T_zc3rd+- ;

iv. If T_smax is not greater than or equal to T_zc3rd+- +60 msec, identifying SMAX as corresponding to the peak of a first systolic shoulder and identifying a point on the signal representing the measured peripheral pressure pulse corresponding to a next negative-to-positive zero crossing point, Zc3rd-+, as the peak of a second systolic shoulder providing that T_zc3rd-+ is less than 60 msec+T_smax or greater than 300 msec from systolic onset; and

v. T_smax follows T_zc3rd+- by 60 msec or more, identifying a point on the signal representing the measured peripheral pressure pulse which corresponds to the Zc3rd+- point as the peak of the first systolic shoulder and identifying SMAX as the peak of the second systolic shoulder.

9. The method of claim 1, wherein the step of separating the signal representing the synthesized aortic pressure pulse into systole and diastole components includes:

i. locating in the signal representing the synthesized aortic pressure pulse a maximum pressure point, SMAX and determining its time of occurrence, T_SMAX ;

ii. locating in a first derivative of the signal representing the synthesized aortic pressure pulse a maximum point, MAXdpdt;

iii. locating in a third derivative of the signal representing the synthesized aortic pressure pulse a maximum point, Max3rd, which immediately follows a point on the third derivative which corresponds to MAXdpdt and determining its time of occurrence, T_max3rd ;

iv. if T_smax is not greater than or equal to T_max3rd +60 msec, identifying SMAX as the peak of a first systolic shoulder and identifying a next negative-to-positive zero crossing point Zc3rd-+ of the third derivative as the point which corresponds to the peak of a second systolic shoulder of the signal representing the synthesized aortic pressure pulse providing that T_zc3rd-+ is less than 60 msec+T_smax or greater than 300 msec from systolic onset; and

v. if T_smax follows T_max3rd by 60 msec or msec, identifying the Max3rd point as corresponding to the peak of the first systolic shoulder of the synthesized pulse and identifying SMAX as the peak of the second systolic shoulder.

10. The method of claim 9, wherein the method further includes the steps of:

A. determining if the signal representing the synthesized aortic pressure pulse corresponds to an augmented ascending aorta pressure pulse by determining if the pressure peak at the second

ii. locating in a first derivative of the signal representing the measured peripheral pressure pulse a maximum point, MAXdpdt;

iii. locating in a third derivative of the signal representing the measured peripheral pressure pulse a maximum point, Max3rd, which immediately follows a point on the third derivative which corresponds to MAXdpdt and determining its time of occurrence, T_MAX3rd ;

iv. If T_SMAX is not greater than or equal to T_max3rd +60 msec, identifying SMAX as the peak of a first systolic shoulder and identifying a next negative-to-positive zero crossing point Zc3rd-+ of the third derivative as the point which corresponds to the peak of a second systolic shoulder of the signal representing the measured peripheral pressure pulse providing that T_zc3rd-+ follows is less than T_SMAX +60 msec or greater than 300 msec from systolic onset; and

v. if T_SMAX follows T_MAX3rd by60 msec or more, identifying the Max3rd point as corresponding to the peak of the first systolic shoulder of the signal representing the synthesized aortic pressure pulse and identifying SMAX as the peak of the second systolic shoulder.

11. The method of claim 10, wherein the method further includes step of determining a reference age corresponding to the augmentation index, wherein the reference age categorizes the functional age of the arterial tree.

12. The method of claim 1, wherein the step of separating the signal representing the synthesized aortic pressure pulse into systole and diastole components includes:

i. locating in the signal representing the aortic pressure pulse a maximum pressure point, SMAX and determining its time of occurrence, T_SMAX ;

ii. locating in a first derivative of the signal representing the synthesized aortic pressure pulse a maximum point, MAXdpdt and determining its time of occurrence, T_MAXdpdt ;

iii. locating in a third derivative of the signal representing the synthesized aortic pressure pulse a positive-to-negative zero crossing point, Zc3rd+-, which immediately follows T_maxdpdt and determining its time of occurrence T_zc3rd+- ;

iv. if T_SMAX is not greater than or equal to T_zc3rd+- +60 msec identifying SMAX as corresponding to the peak of a first systolic shoulder and identifying a point on the signal representing the synthesized aortic pressure pulse corresponding to a next negative-to-positive zero crossing point, Zc3rd-+, as the peak of a second systolic shoulder providing that T_zc3rd-+ is less than 60 msec from T_smax or greater than 300 msec+systolic onset; and

v. if T_smax follows T_zc3rd+- by 60 msec or more, identifying a point of the signal representing the synthesized aortic pressure pulse which corresponds to the Zc3rd+- point as the peak of the first systolic shoulder and identifying SMAX as the peak of the second systolic shoulder.

13. The method of claim 1, wherein the method further includes the step of determining the pressure at the end of systole based on the pressure at the point on the synthesized aortic pressure pulse at which systole ends.

14. The method of claim 1, wherein the step of locating the incisura further includes:

i. locating in the signal representing the synthesized aortic pressure pulse a maximum pressure point, SMAX, and determining its time of occurrence, T_SMAX ;

ii. locating in a first derivative of the signal representing the measured peripheral pressure pulse a maximum point, MAXdpdt;

iii. locating in a third derivative of the signal representing the measured peripheral pressure pulse a maximum point, Max3rd, which immediately follows a point on the third derivative which corresponds to MAXdpdt and determining its time of occurrence, T_MAX3rd ;

iv. if T_SMAX is not greater than or equal to T_max3rd +60 msec, identifying SMAX as the peak of a first systolic shoulder and identifying a next negative-to-positive zero crossing point Zc3rd-+ of the third derivative as the point which corresponds to the peak of a second systolic shoulder of the signal representing the measured peripheral pressure pulse providing that T_zc3rd-+ follows is less than T_SMAX +60 msec or greater than 300 msec from systolic onset; and

v. if T_SMAX follows T_MAX3rd by 60 msec or more, identifying the Max3rd point as corresponding to the peak of the first systolic shoulder of the signal representing the synthesized aortic pressure pulse and identifying SMAX as the peak of the second systolic shoulder.

15. A method of determining pressure in the ascending aorta from measurements of pressure in an upper body peripheral artery, said method comprising the steps of:

A. non-invasively measuring pressure pulses in a peripheral artery and producing an electrical signal representing the pressure;

B. deriving a Fourier transform for the measured peripheral pulses;

C. dividing the peripheral pulse Fourier transform by a transform function H(w) relating a Fourier transform of pressure pulses in the peripheral artery and a Fourier transform of pressure pulses in the aorta, thereby producing a Fourier transform associated with the aortic pressure pulse;

D. deriving the inverse of the Fourier transform associated with the aortic pressure pulse, thereby producing an electrical signal representing a synthesized ascending aortic pressure pulse;

E. determining in the signal representing the measured peripheral pulse a point of systolic onset by taking a first derivative of the measured peripheral pulse and locating a zero crossing from negative-to-positive which precedes a maximum point on the first derivative curve;

F. determining the location of a point of incisura in the signal representing the measured peripheral pressure pulse by finding in a signal representing the third derivative of the measured peripheral pulse a zero crossing from positive-to-negative in proximity to the largest maximum point of the third derivative after the peak of a second systolic shoulder;

G. separating in the electrical signal representing the synthesized aortic pressure pulse, the systole and diastole components of the synthesized signal based on the location of the incisura and systolic onset in the signal representing the measured peripheral pulse;

H. determining from the electrical signal representing the synthesized aortic pressure pulse a maximum systolic pressure and a maximum diastolic pressure; and

I. displaying a graph of the electrical signal representing the measured peripheral pulse, the electrical signal representing the synthesized ascending aortic pressure pulse and the related maximum systolic and diastolic pressures.

16. The method of claim 15, wherein the method further includes the steps of:

J. determining, from the electrical signal representing the synthesized ascending aortic pressure pulse, mean aortic systolic pressure;

K. measuring heart rate; and

L. calculating a systole pressure-time index based on the mean systolic pressure determined from the maximum systolic pressure determined in step H, the length of time in systole calculated from systolic onset to the point of incisura as determined in step G and the measured heart rate determined in step K; and

M. displaying the systole pressure-time index.

17. The method of claim 16, wherein the method further includes the steps of:

N. determining from the electrical signal representing the synthesized aortic pressure pulse, mean aortic pressure during diastole.;

O. calculating a diastole pressure-time index based on the mean aortic diastolic pressure during diastole determined from the maximum systolic pressure determined in step H, the length of time in diastole determined in step G and the measured heart rate determined in step J; and

P. displaying the diastole pressure-time index.

18. The method of claim 17, wherein the method further includes the step of determining subendocardial viability ratio by dividing the diastolic pressure-time index by the systolic pressure-time index.

19. The method of claim 15, wherein the step of separating the electrical signal representing the synthesized aortic pressure pulse into systole and diastole components further includes

i. determining the duration of systole by calculating the time difference between the occurrence of systolic onset and the occurrence of the incisura in the peripheral pressure pulse;

and

ii. identifying the incisura in the electrical signal representing the synthesized aortic pressure pulse as a point separated by the time interval determined in step from a point on the synthesized aortic pressure pulse which corresponds to systolic onset.

20. The method of claim 15, wherein the method further includes the step of determining the pressure at the end of systole based on the pressure at the point on the synthesized aortic pressure pulse at which systole ends.

21. The method of claim 15, wherein the step of non-invasively measuring the peripheral pressure includes use of a tonometer.

22. A method of determining pressure in the ascending aorta from measurements of pressure in an upper body peripheral artery, said method comprising the steps of:

A. non-invasively measuring pressure pulses in a peripheral artery and producing an electrical signal representing the pressure;

B. manipulating the signal to produce a signal representing a synthesized aortic pressure pulse;

C. determining in the signal representing the measured peripheral pulse a point of systolic onset by taking a first derivative of the measured peripheral pulse and locating a zero crossing from negative-to-positive which precedes a maximum point on the first derivative curve;

D. determining the location of a point of incisura in the signal representing the measured peripheral pressure pulse by finding in a signal representing the third derivative of the measured peripheral pulse a zero crossing from positive-to-negative in proximity to the largest maximum point of the third derivative after the peak of a second systolic shoulder;

E. separating in the electrical signal representing the synthesized aortic pressure pulse, the systole and diastole components of the synthesized signal based on the location of the incisura and systolic onset in the signal representing the measured peripheral pulse;

F. determining from the electrical signal representing the synthesized aortic pressure pulse a maximum systolic pressure and a maximum diastolic pressure; and

G. displaying a graph of the electrical signal representing the measured peripheral pulse, the electrical signal representing the synthesized ascending aortic pressure pulse and the related maximum systolic and diastolic pressures.

23. The method of claim 22, wherein the method further includes the steps of:

H. determining, from the electrical signal representing the synthesized ascending aortic pressure pulse, mean aortic systolic pressure;

I. measuring heart rate; and

J. calculating a systole pressure-time index based on the mean systolic pressure determined from the maximum systolic pressure determined in step F, the length of time in systole calculated from systolic onset to the point of incisura as determined in step G and the measured heart rate determined in step J; and

K. displaying the systole pressure-time index.

24. The method of claim 23, wherein the method further includes the steps of:

L. determining from the electrical signal representing the synthesized aortic pressure pulse, mean aortic pressure during diastole;

M. calculating a diastole pressure-time index based on the mean aortic diastolic pressure during diastole determined from the maximum systolic pressure determined in step F, the length of time in diastole determined in step G and the measured heart rate determined in step I; and

N. displaying the diastole pressure-time index.

25. The method of claim 22, wherein the step of separating the electrical signal representing the synthesized aortic pressure pulse into systole and diastole components further includes

i. determining the duration of systole by calculating the time difference between the occurrence of systolic onset and the occurrence of the incisura in the peripheral pressure pulse;

and

ii. identifying the incisura in the electrical signal representing the synthesized aortic pressure pulse as a point separated by the time interval determined in step i from a point on the pulse corresponding to systolic onset.