System and method of determining arterial blood pressure and ventricular fill parameters from ventricular blood pressure waveform data

• US 8,211,028 B2
• Filed: 04/30/2008
• Issued: 07/03/2012
• Est. Priority Date: 04/30/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Karamanoglu, Mustafa, Bennett, Tommy D.
• Primary Examiner(s): VIVLEMORE, TRACY ANN
• Application Number:
  US12/112,544
• Publication Number:
  US 20090275843A1
• Time in Patent Office: 1,525 Days
• Field of Search: None
• US Class Current: 600/485
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/02108 from analysis of pulse wave characteristics
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61N 1/36564 controlled by blood pressure

Abstract

A system and method of determining hemodynamic parameters uses sensed ventricular blood pressure during a portion of ventricular pressure waveform following peak pressure. An estimated arterial diastolic pressure is based upon an amplitude of the sensed ventricular pressure corresponding to a time at which a first derivative of ventricular pressure as a function of time is at a minimum (dP/dt_min). Fill parameters such as isovolumetric relaxation constant, ventricular suction pressure, atrial kick pressure, and transvalve pressure gradient are derived from measured pressures representing minimum ventricular pressure, ventricular diastolic pressure, and diastasis pressure.

Claims

1. An implantable medical device, comprising:

an input circuit that receives a pressure waveform signal representative of a pressure (P) sensed within a ventricle of a patient'"'"'s heart as a function of time (t); and

a processor that derives from the pressure waveform signal at least one hemodynamic parameter based upon at least one ventricular pressure value during a portion of the pressure waveform signal between a peak ventricular pressure and a beginning of a next ventricular pumping cycle; and

wherein the processor derives an estimated arterial diastolic pressure based upon pressure in the ventricle at a time corresponding to a maximum rate of pressure decline (dP/dt_min).

2. An implantable medical device according to claim 1 and further comprising a blood pressure sensor located in the ventricle for providing the pressure waveform signal to the input circuit.

3. An implantable medical device according to claim 2, wherein the blood pressure sensor is a right ventricular pressure sensor, and the estimated arterial diastolic pressure is an estimated pulmonary artery diastolic pressure.

4. An implantable medical device according to claim 2, wherein the blood pressure sensor is a left ventricular pressure sensor, and the estimated arterial diastolic pressure is an estimated aortic diastolic pressure.

5. An implantable medical device according to claim 1, wherein the input circuit also receives an electrical signal representative of electrical activity in the heart as a function of time.

6. An implantable medical device according to claim 1, wherein the processor derives from the pressure waveform signal at least one ventricular fill parameter based upon pressure values during a fill portion between occurrence of dP/dt_min and the beginning of a next ventricular pumping cycle.

7. An implantable medical device according to claim 6, wherein the processor derives at least one ventricular fill parameter by:

producing a dP/dt waveform from the pressure signal;

identifying a fill portion of the pressure waveform signal;

identifying a diastasis portion of the fill portion using the dP/dt waveform; and

deriving a diastasis pressure representing the ventricular pressure in the diastasis portion of the pressure waveform signal.

8. An implantable medical device according to claim 6, wherein the processor determines from the fill portion of the pressure waveform signal a ventricular diastolic pressure, a minimum ventricular pressure, and a diastasis pressure.

9. An implantable medical device, comprising:

an input circuit that receives a pressure waveform signal representative of a pressure (P) sensed within a ventricle of a patient'"'"'s heart as a function of time (t); and

a processor that derives from the pressure waveform signal at least one hemodynamic parameter based upon at least one ventricular pressure value during a portion of the pressure waveform signal between a peak ventricular pressure and a beginning of a next ventricular pumping cycle;

wherein the processor determines from the fill portion of the pressure waveform signal a ventricular diastolic pressure, a minimum ventricular pressure, and a diastasis pressure;

wherein the processor derives from the pressure waveform signal at least one ventricular fill parameter based upon pressure values during a fill portion between occurrence of dP/dt_min and the beginning of a next ventricular pumping cycle; and

wherein the processor derives an atrial kick parameter based upon a difference between the ventricular end diastolic pressure and the diastasis pressure.

10. An implantable medical device, comprising:

an input circuit that receives a pressure waveform signal representative of a pressure (P) sensed within a ventricle of a patient'"'"'s heart as a function of time (t); and

a processor that derives from the pressure waveform signal at least one hemodynamic parameter based upon at least one ventricular pressure value during a portion of the pressure waveform signal between a peak ventricular pressure and a beginning of a next ventricular pumping cycle;

wherein the processor determines from the fill portion of the pressure waveform signal a ventricular diastolic pressure, a minimum ventricular pressure, and a diastasis pressure;

wherein the processor derives from the pressure waveform signal at least one ventricular fill parameter based upon pressure values during a fill portion between occurrence of dP/dt_min and the beginning of a next ventricular pumping cycle; and

wherein the processor derives a ventricular suction parameter based upon a difference between the diastasis ventricular pressure and the minimum ventricular pressure.

11. An implantable medical device, comprising:

an input circuit that receives a pressure waveform signal representative of a pressure (P) sensed within a ventricle of a patient'"'"'s heart as a function of time (t); and

a processor that derives from the pressure waveform signal at least one hemodynamic parameter based upon at least one ventricular pressure value during a portion of the pressure waveform signal between a peak ventricular pressure and a beginning of a next ventricular pumping cycle;

wherein the processor determines from the fill portion of the pressure waveform signal a ventricular diastolic pressure, a minimum ventricular pressure, and a diastasis pressure;

wherein the processor derives from the pressure waveform signal at least one ventricular fill parameter based upon pressure values during a fill portion between occurrence of dP/dt_min and the beginning of a next ventricular pumping cycle; and

wherein the processor derives a transvalve pressure gradient parameter based upon a difference between the ventricular diastolic pressure and the minimum ventricular pressure.

12. An implantable medical device, comprising:

an input circuit that receives a pressure waveform signal representative of a pressure (P) sensed within a ventricle of a patient'"'"'s heart as a function of time (t); and

a processor that derives from the pressure waveform signal at least one hemodynamic parameter based upon at least one ventricular pressure value during a portion of the pressure waveform signal between a peak ventricular pressure and a beginning of a next ventricular pumping cycle; and

wherein the process derives an isovolumetric relaxation constant based upon dP/dt_min, a ventricular pressure at dP/dt (P_STI) and a ventricular pressure at occurrence of an R-wave (VDP).

13. An implantable medical device, comprising:

an input circuit that receives a pressure waveform signal representative of a pressure (P) sensed within a ventricle of a patient'"'"'s heart as a function of time (t); and

a processor that derives from the pressure waveform signal at least one hemodynamic parameter based upon at least one ventricular pressure value during a portion of the pressure waveform signal between a peak ventricular pressure and a beginning of a next ventricular pumping cycle, wherein the processor derives an atrial kick parameter based upon a difference between ventricular end diastolic pressure and diastasis pressure.

14. An implantable medical device, comprising:

an input circuit that receives a pressure waveform signal representative of a pressure (P) sensed within a ventricle of a patient'"'"'s heart as a function of time (t); and

a processor that derives from the pressure waveform signal at least one hemodynamic parameter based upon at least one ventricular pressure value during a portion of the pressure waveform signal between a peak ventricular pressure and a beginning of a next ventricular pumping cycle, wherein the processor derives a ventricular suction parameter based upon a difference between diastasis ventricular pressure and minimum ventricular pressure.

15. An implantable medical device, comprising:

an input circuit that receives a pressure waveform signal representative of a pressure (P) sensed within a ventricle of a patient'"'"'s heart as a function of time (t); and

a processor that derives from the pressure waveform signal at least one hemodynamic parameter based upon at least one ventricular pressure value during a portion of the pressure waveform signal between a peak ventricular pressure and a beginning of a next ventricular pumping cycle, wherein the processor derives a transvalve pressure gradient parameter based upon a difference between ventricular diastolic pressure and minimum ventricular pressure.