System and method for assessing cardiac performance through transcardiac impedance monitoring

• US 7,488,290 B1
• Filed: 02/19/2004
• Issued: 02/10/2009
• Est. Priority Date: 02/19/2004
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Kadhiresan, Veerichetty, Stahmann, Jeffrey E., Hatlestad, John D., Hopper, Donald L.
• Primary Examiner(s): Nasser; Robert L
• Application Number:
  US10/782,642
• Time in Patent Office: 1,818 Days
• Field of Search: None
• 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 7/00 Instruments for auscultation

Abstract

A system and method for assessing cardiac performance through transcardiac impedance monitoring is described. Intracardiac impedance measures are directly collected through an implantable medical device. The intracardiac impedance measures are correlated to cardiac dimensional measures relative to performance of an intrathoracic pressure maneuver. The cardiac dimensional measures are grouped into at least one measures set corresponding to a temporal phase of the intrathoracic pressure maneuver. The at least one cardiac dimensional measures set is evaluated against a cardiac dimensional trend for the corresponding intrathoracic pressure maneuver temporal phase to represent cardiac performance.

Claims

1. A system for assessing cardiac performance through transcardiac impedance monitoring, comprising:

an implantable medical device to directly collect intracardiac impedance measures;

a correlation component to correlate the intracardiac impedance measures to cardiac pressure measures relative to performance of an intrathoracic pressure maneuver and to group the cardiac pressure measures into at least one measures set corresponding to a temporal phase of the intrathoracic pressure maneuver; and

an analysis component to evaluate the at least one cardiac pressure measures set against a cardiac pressure trend for the corresponding intrathoracic pressure maneuver temporal phase to represent cardiac performance.

2. A system according to claim 1, wherein the cardiac pressure measures comprise at least one of cardiac stroke volume, left ventricular end diastolic pressure, and left ventricular end systolic pressure.

3. A system according to claim 1, further comprising:

a history subcomponent to evaluate a history of cardiac performance representations; and

a trending subcomponent to recognize a trend within the history indicating at least one of cardiovascular disease absence, onset, progression, regression, and status quo.

4. A system according to claim 1, further comprising:

a characteristic signature formed with the cardiac pressure trends over the performance of the intrathoracic pressure maneuver; and

a comparison subcomponent to compare an overall cardiac pressure profile comprising the at least one cardiac pressure measures set to the characteristic signature to form a cardiac performance assessment.

5. A system according to claim 4, further comprising:

a predefined threshold with the comparison module to analyze the cardiac performance assessment relative to the predefined threshold.

6. A system according to claim 5, further comprising:

a notification generated responsive to the cardiac performance assessment substantially non-complying to the predefined threshold.

7. A system according to claim 1, wherein the intrathoracic pressure maneuver comprises the Valsalva maneuver, further comprising:

a collection subcomponent to collect the intracardiac impedance measures relative to performance of the Valsalva maneuver.

8. A system according to claim 7, further comprising:

a phase subcomponent to specify four phases physiologically corresponding to the performance of the Valsalva maneuver, comprising defining Phase I corresponding to initial strain, defining Phase II corresponding to strain duration and cessation of breathing, defining Phase III corresponding to strain discontinuation and resumption of normal breathing, and defining Phase IV corresponding to recovery.

9. A system according to claim 8, further comprising:

a trending subcomponent to identify an overshoot of the cardiac pressure during the Phase IV.

10. A system according to claim 9, wherein the trending subcomponent further comprises identifying an increase of the cardiac pressure during the Phase I, identifying a transient decrease of the cardiac pressure during the Phase II, identifying a sharp decrease of the cardiac pressure during the Phase III, and identifying an increase preceding the overshoot and a decrease of the cardiac pressure during the Phase IV.

11. A system according to claim 1, further comprising:

a programming subcomponent to provide programming support to the implantable medical device.

12. A system according to claim 1, wherein the implantable medical device comprises at least one of an implantable cardiac pacemaker, implantable cardioverter defibrillator, implantable cardiac resynchronization device, implantable cardiovascular monitor, and therapeutic device monitoring and treating structural problems of the heart.

13. A system according to claim 1, further comprising:

a database to maintain the intracardiac impedance measures.

14. A system according to claim 1, wherein the intrathoracic pressure maneuver comprises at least one of the Valsalva maneuver and Mü

ller maneuver.

15. A method for assessing cardiac performance through transcardiac impedance monitoring, comprising:

directly collecting intracardiac impedance measures through an implantable medical device;

correlating the intracardiac impedance measures to cardiac pressure measures relative to performance of an intrathoracic pressure maneuver;

grouping the cardiac pressure measures into at least one measures set corresponding to a temporal phase of the intrathoracic pressure maneuver; and

evaluating the at least one cardiac pressure measures set against a cardiac pressure trend for the corresponding intrathoracic pressure maneuver temporal phase to represent cardiac performance.

16. A method according to claim 15, wherein the cardiac pressure measures comprise at least one of cardiac stroke volume, left ventricular end diastolic pressure, and left ventricular end systolic pressure.

17. A method according to claim 15, further comprising:

evaluating a history of cardiac performance representations; and

recognizing a trend within the history indicating at least one of cardiovascular disease absence, onset, progression, regression, and status quo.

18. A method according to claim 15, further comprising:

forming a characteristic signature with the cardiac pressure trends over the performance of the intrathoracic pressure maneuver; and

comparing an overall cardiac pressure profile comprising the at least one cardiac pressure measures set to the characteristic signature to form a cardiac performance assessment.

19. A method according to claim 18, further comprising:

analyzing the cardiac performance assessment relative to a predefined threshold.

20. A method according to claim 19, further comprising:

generating a notification responsive to the cardiac performance assessment substantially non-complying to the predefined threshold.

21. A method according to claim 15, wherein the intrathoracic pressure maneuver comprises the Valsalva maneuver, further comprising:

collecting the intracardiac impedance measures relative to performance of the Valsalva maneuver.

22. A method according to claim 21, further comprising:

specifying four phases physiologically corresponding to the performance of the Valsalva maneuver, comprising;

defining Phase I corresponding to initial strain;

defining Phase II corresponding to strain duration and cessation of breathing;

defining Phase III corresponding to strain discontinuation and resumption of normal breathing; and

defining Phase IV corresponding to recovery.

23. A method according to claim 22, further comprising:

identifying an overshoot of the cardiac pressure during the Phase IV.

24. A method according to claim 23, further comprising:

identifying an increase of the cardiac pressure during the Phase I;

identifying a transient decrease of the cardiac pressure during the Phase II;

identifying a sharp decrease of the cardiac pressure during the Phase III; and

identifying an increase preceding the overshoot and a decrease of the cardiac pressure during the Phase IV.

25. A method according to claim 15, further comprising:

providing programming support to the implantable medical device.

26. A method according to claim 15, wherein the implantable medical device comprises at least one of an implantable cardiac pacemaker, implantable cardioverter defibrillator, implantable cardiac resynchronization device, implantable cardiovascular monitor, and therapeutic device monitoring and treating structural problems of the heart.

27. A method according to claim 15, further comprising:

maintaining the intracardiac impedance measures in a database.

28. A method according to claim 15, wherein the intrathoracic pressure maneuver comprises at least one of the Valsalva maneuver and Mü

ller maneuver.

29. An apparatus for assessing cardiac performance through transcardiac impedance monitoring, comprising:

means for directly collecting intracardiac impedance measures through an implantable medical device;

means for correlating the intracardiac impedance measures to cardiac pressure measures relative to performance of an intrathoracic pressure maneuver;

means for grouping the cardiac pressure measures into at least one measures set corresponding to a temporal phase of the intrathoracic pressure maneuver; and

means for evaluating the at least one cardiac pressure measures set against a cardiac pressure trend for the corresponding intrathoracic pressure maneuver temporal phase to represent cardiac performance.