Systems and methods for determining cardiac output using pulmonary artery pressure measurements

• US 8,591,423 B2
• Filed: 09/10/2009
• Issued: 11/26/2013
• Est. Priority Date: 10/10/2008
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Doron, Eyal
• Primary Examiner(s): Natnithithadha, Navin
• Assistant Examiner(s): WEARE, MEREDITH H
• Application Number:
  US12/557,384
• Publication Number:
  US 20100094144A1
• Time in Patent Office: 1,538 Days
• Field of Search: 600/485, 600/486
• US Class Current: 600/486
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36571 controlled by blood flow rate, e.g. blood velocity or cardiac output

Abstract

Systems and methods for determining cardiac output are disclosed. An illustrative method of determining cardiac output includes sensing an arterial pressure waveform using a pressure sensor located within a pulmonary artery, identifying a valve closure time associated with the pulmonary valve using the sensed arterial pressure waveform, estimating stroke volume using the systolic portion of the arterial pressure waveform and the valve closure time, and obtaining a measure of cardiac output based on the estimated stroke volume.

Claims

1. A method of determining cardiac output within a patient'"'"'s heart, the method comprising:

sensing an arterial pressure waveform using a pressure sensor located within a pulmonary artery of the patient in order to sense the arterial pressure waveform on a right side of the patient'"'"'s heart;

identifying the systolic portion of the arterial pressure waveform sensed by the pressure sensor;

identifying the beginning of a cardiac cycle and correlating the systolic portion of the arterial pressure waveform with the beginning of the cardiac cycle;

identifying an estimate of the valve closure time of the pulmonary valve using the arterial pressure waveform, wherein identifying the estimate of the valve closure time of the pulmonary valve includes;

determining a first point, the first point comprising a positive-going zero of a second derivative of the arterial pressure waveform;

determining a second point, the second point comprising a point of maximum positive value of the second derivative of the arterial pressure waveform; and

determining a midpoint in time between the first point and the second point, wherein the midpoint provides the estimate of the valve closure time of the pulmonary valve;

estimating the stroke volume using the systolic portion of the arterial pressure waveform and the estimate of the pulmonary valve closure time; and

obtaining a measure of cardiac output based at least in part on the estimated stroke volume.

2. The method of claim 1, further including determining the left atrial filling pressure within the heart based on an estimate of diastolic pulmonary artery pressure from the arterial pressure waveform.

3. The method of claim 2, wherein identifying the systolic portion of the arterial pressure waveform includes subtracting the left atrial filling pressure from the arterial pressure waveform.

4. The method of claim 1, wherein identifying the beginning of a cardiac cycle includes identifying an increase in blood pressure from the arterial pressure waveform.

5. The method of claim 1, wherein identifying the beginning of a cardiac cycle includes sensing an ECG signal associated with the heart.

6. The method of claim 1, wherein identifying the beginning of a cardiac cycle includes sensing an acceleration associated with the heart.

7. The method of claim 1, wherein estimating the stroke volume is based at least in part on a measure of arterial compliance.

8. The method of claim 1, wherein obtaining a measure of the cardiac output based at least in part on the estimated stroke volume includes sensing a heart rate associated with the heart, and multiplying the sensed heart rate by the stroke volume.

9. The method of claim 1, wherein the method comprises an algorithm or routine operable on an implantable device or an external device in communication with the pressure sensor.

10. The method of claim 1, wherein the method comprises an algorithm or routine operable within a processor of the pressure sensor.

11. The method of claim 1, further comprising evaluating one or more additional hemodynamic parameters.

12. The method of claim 11, wherein the one or more additional hemodynamic parameters includes a measure of pulmonary vascular resistance.

13. A method of determining one or more hemodynamic parameters associated with the operation of a patient'"'"'s heart, the method comprising:

sensing an arterial pressure waveform using a pressure sensor located within a pulmonary artery of the patient in order to sense the arterial pressure waveform on a right side of the patient'"'"'s heart;

identifying the beginning of a cardiac cycle and correlating the arterial pressure waveform sensed by the pressure sensor with the beginning of the cardiac cycle;

identifying an estimate of the valve closure time of the pulmonary valve using the arterial pressure waveform, wherein identifying the estimate of the valve closure time of the pulmonary valve includes;

determining a first point, the first point comprising a positive-going zero of a second derivative of the arterial pressure waveform;

determining a second point, the second point comprising a point of maximum positive value of the second derivative of the arterial pressure waveform; and

determining a midpoint in time between the first point and the second point, wherein the midpoint provides the estimate of the valve closure time of the pulmonary valve; and

obtaining at least one hemodynamic parameter associated with the patient'"'"'s heart based at least in part on the estimate of the valve closure time.

14. A system for determining cardiac output within a patient'"'"'s heart, the system comprising:

a pressure sensor located within a pulmonary artery of the patient, the pressure sensor adapted to sense right side arterial blood pressure within the artery and transmit an arterial pressure waveform signal;

a monitoring device in communication with the pressure sensor, the monitoring device including a processor adapted to determine cardiac output based at least in part on the arterial pressure waveform signal; and

wherein the processor is adapted to determine cardiac output based at least in part on a valve closure time associated with the pulmonary valve, wherein the processor is further adapted to determine an estimate of the valve closure time of the pulmonary valve by;

determining a first point, the first point comprising a positive-going zero of a second derivative of the arterial pressure waveform;

determining a second point, the second point comprising a point of maximum positive value of the second derivative of the arterial pressure waveform; and

determining a midpoint in time between the first point and the second point, wherein the midpoint provides the estimate of the valve closure time of the pulmonary valve.

15. The system of claim 14, wherein the monitoring device comprises an external monitor.

16. The system of claim 14, wherein the monitoring device comprises an implantable medical device.

17. The system of claim 16, wherein the implantable medical device is a pulse generator.

18. The system of claim 14, wherein the pressure sensor is a remote pressure sensor adapted to wirelessly transmit the arterial pressure waveform signal to the monitoring device.