Systems and methods for monitoring heart function

• US 8,870,780 B2
• Filed: 10/14/2009
• Issued: 10/28/2014
• Est. Priority Date: 10/15/2008
• Status: Active Grant

• Current Assignee: Board of Trustees of the Leland Stanford Junior University (Stanford Management Co.)
• Original Assignee: Board of Trustees of the Leland Stanford Junior University (Stanford Management Co.)
• Inventors: Inan, Omer T., Etemadi, Mozziyar, Giovangrandi, Laurent B., Kovacs, Gregory T., Wiard, Richard M.
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): CAREY, MICHAEL JAMES
• Application Number:
  US12/579,264
• Publication Number:
  US 20100094147A1
• Time in Patent Office: 1,840 Days
• Field of Search: 600/513, 600/514, 600/481, 600/508, 600/526, 600/527
• US Class Current: 600/481
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• CPC Class Codes: A61B 5/0024 for multiple sensor units attached to the patient, e.g. using a body or personal area network
• CPC Class Codes: A61B 5/0082 adapted for particular medical purposes
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 5/02416 using photoplethysmograph signals, e.g. generated by infrared radiation A61B5/14552 takes precedence
• 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: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/1102 Ballistocardiography
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/486 Bio-feedback A61B5/375 takes precedence
• CPC Class Codes: A61B 5/6829 Foot or ankle
• CPC Class Codes: A61B 5/6887 mounted on external non-worn devices, e.g. non-medical devices
• CPC Class Codes: A61B 5/7203 for noise prevention, reduction or removal
• CPC Class Codes: A61B 5/7207 of noise induced by motion artifacts
• CPC Class Codes: A61B 5/721 using a separate sensor to detect motion or using motion information derived from signals other than the physiological signal to be measured
• CPC Class Codes: A61B 5/7253 : characterised by using transforms
• CPC Class Codes: A61B 5/7285 : for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal A61B6/5205, A61B6/541, A61B8/5207, A61B8/543 take precedence
• CPC Class Codes: A61B 5/74 : Details of notification to user or communication with user or patient indicating measured values G01D7/00; user input means input or output arrangements for computers G06F3/00
• CPC Class Codes: G01G 19/50 : having additional measuring devices, e.g. for height

Abstract

Characteristics of a user'"'"'s heart are detected. In accordance with an example embodiment, a ballistocardiogram (BCG) sensor is used to detect heart characteristics of a user, and provide a BCG output indicative of the detected heart characteristics. The BCG output is further processed using data from one or more additional sensors, such as to reduce noise and/or otherwise process the BCG signal to characterize the user'"'"'s heart function.

Claims

1. A system for providing BCG (ballistocardiogram) data from a user who is susceptible to movement, the system comprising:

a BCG capture device including a heart-characteristic sensor configured and arranged to capture, from the user, a BCG signal for a plurality of a heartbeats from the user and indicative of physical cardiovascular movement of the user while the user stands at a stationary position,

including mechanical output of the user'"'"'s heart;

a secondary sensor configured and arranged to detect an indication of a physiologic characteristic of the user, and to provide an output characterizing the detected indication; and

a processor circuit, responsive to the BCG capture device and the secondary sensor, the processor circuit being configured to,

provide a BCG waveform reference for the BCG signal; and

estimate, using the BCG waveform reference, the BCG signal relative to noise present in the BCG signal and due to movement of the user while the user stands at a stationary position and thereby generate an output BCG signal indicative of a condition of the user'"'"'s heart.

2. The system of claim 1, wherein

the BCG capture device includes a weighing scale, and

the secondary sensor includes an electrocardiogram (ECG) sensor configured and arranged to detect an ECG signal from the user, the detected signal being indicative of a physiologic characteristic of the user, and to provide an output characterizing the physiologic characteristic to the processor circuit.

3. The system of claim 1, wherein

the secondary sensor includes an electrocardiogram (ECG) sensor configured and arranged to detect an ECG signal from the user, the detected signal being useful for characterizing the physiologic characteristic of the user, and to provide an output characterizing the physiologic characteristic to the processor circuit, and

the processor circuit is configured with an algorithm for processing the captured BCG signal to generate the output BCG signal, using the detected ECG signal as an input to the algorithm.

4. The system of claim 1, wherein

the secondary sensor includes an electrocardiogram (ECG) sensor configured and arranged to detect an ECG signal from the user and to provide an output characterizing the detected ECG signal, and

the processor circuit is configured to use an output of the secondary sensor to process the captured BCG signal by filtering and averaging the BCG signal to generate the output BCG signal.

5. The system of claim 1, wherein

the secondary sensor includes an electrocardiogram (ECG) sensor configured and arranged to detect an ECG signal from the user and to provide an output characterizing the detected ECG signal, and

the processor circuit is configured to generate the output BCG signal by generating at least one of an ensemble-average and a triggered-moving average of the captured BCG signal using the detected ECG signal, wherein said at least one of the ensemble-average and a triggered-moving average is used by the processor circuit to provide the BCG waveform reference.

6. The system of claim 1, wherein

the secondary sensor includes a photoplethysmography sensor configured and arranged to detect a photoplethysmography signal from the user and to provide an output characterizing the detected photoplethysmography signal, and

the processor circuit is configured to generate the output BCG signal by generating an ensemble-average, or triggered moving average, of the detected BCG signal using the detected photoplethysmography signal.

7. The system of claim 1, wherein

the secondary sensor includes a noise sensor configured to detect noise in the user'"'"'s environment, including using a strain gage that is configured to detect noise by detecting user movement along a particular motion axis, and a heart characteristic sensor configured to detect a physiologic characteristic of the user'"'"'s heart, and

the processor circuit is configured to generate the output BCG signal by using the detected noise to mitigate noise in the captured BCG and using the detected heart characteristic to modify the captured BCG signal.

8. The system of claim 1, wherein the BCG capture device includes a weighing scale including the heart-characteristic sensor, and

the processor circuit is configured to process the captured BCG signal, using previously-obtained data including cardiac output data for the user and both RMS power and an ensemble-average amplitude of the BCG signal, to generate an output BCG signal indicative of the cardiac output of the user'"'"'s heart.

9. The system of claim 1, wherein the BCG capture device includes a weighing scale including the heart-characteristic sensor,

the processor circuit is configured to receive cardiac data indicative of at least one of cardiac output and stroke volume obtained from the user, and

process the captured BCG signal, using the received cardiac data and both RMS power and an ensemble-average amplitude of the BCG signal, to generate an output BCG signal indicative of the cardiac output of the user'"'"'s heart.

10. The system of claim 1, wherein

the BCG capture device includes a weighing scale including the heart-characteristic sensor, and

the processor circuit is configured to compare the captured BCG signal to a baseline value, which is based upon cardiac output data for the user and both rms power and an ensemble-average amplitude of the BCG signal, to generate an output BCG signal indicative of the cardiac output and stroke volume of the user.

11. The system of claim 1,

where the secondary sensor is an electrocardiogram (ECG) sensor configured and arranged to detect an ECG signal from the user and to provide an output characterizing the detected ECG signal, and

the processor circuit is configured to use pacing artifacts in the output from the ECG sensor to process the captured BCG signal by triggered averaging, ensemble averaging, or otherwise filtering the BCG signal.

12. The system of claim 1, wherein

the secondary sensor includes an implantable cardiac resynchronization therapy (CRT) device that provides an output having respective left and right ventricular pacing pulse timing components, and

the processor is configured to use the CRT output to process a left ventricular component of the BCG signal using the left ventricular pacing pulse timing component, and a right ventricular component of the BCG signal using the right ventricular pacing pulse timing component, for deconvolving the BCG signal via at least one of synchronous averaging or filtering, the left and right ventricular pacing pulse timing components being statistically uncorrelated temporally due to variation in inter-ventricular timing delay as is present in CRT.

13. The system of claim 1,

where the BCG capture device is an accelerometer within an implantable device, and

the processor circuit filters the BCG signal using a pacing pulse timing output of the implantable device to determine a diagnostic characteristic of the BCG sensor.

14. The system of claim 1,

wherein the BCG capture device includes an implantable device having an accelerometer, and

the processor circuit is configured to automatically set cardiac pace parameters for the user based on an output from the accelerometer.

15. The system of claim 1, wherein the processor circuit is configured to generate an output to set cardiac resynchronization therapy (CRT) pace parameters for the user, using at least one of a maximum amplitude or minimum ECG R-wave to BCG J-wave interval of the output BCG signal.

16. The system of claim 1, wherein the processor circuit is configured to generate an output BCG signal indicative of BCG signal variations due to changes in cardiac resynchronization therapy (CRT) parameters used by an implantable CRT device to regulate the user'"'"'s heart, to provide an indication of cardiac responsiveness to CRT parameters.

17. The system of claim 1, wherein

the BCG capture device is integrated with a bodyweight sensing scale,

the secondary sensor is integrated with handlebar electrodes coupled to the scale, the electrodes and secondary sensor being configured to detect at least one of an electrocardiogram (ECG) or photoplethysmography characteristic of the user, and

the processor circuit is configured to generate output BCG signals over time to provide an indication of at least one of cardiac output and stroke volume for subsequent determination of a treatment need for the user.

18. The system of claim 17, wherein

the scale includes a memory that stores baseline data including at least one of RMS BCG data and ensemble average BCG amplitude data, and

the processor circuit is configured to generate output BCG signals based upon the stored baseline data.

19. The system of claim 18, wherein

the processor circuit is configured to use recorded changes in the user'"'"'s bodyweight over time for determining the treatment need for the user.

20. The system of claim 1, wherein

the BCG capture device is integrated with a bodyweight sensing scale,

the secondary sensor is integrated with a detachable component connected to the scale and is configured to detect a photoplethysmography characteristic of the user, and

the processor circuit is configured to generate output BCG signals over time to provide an indication of at least one of cardiac output and stroke volume for determining a treatment need for the user.

21. The system of claim 20, wherein

the scale includes a memory that stores baseline data including at least one of RMS BCG data and ensemble average BCG amplitude data, and

the processor circuit is configured to generate output BCG signals based upon the stored baseline data.

22. The system of claim 20, wherein

the processor circuit is configured to generate an output characterizing a treatment condition for the user based upon recorded changes in the user'"'"'s bodyweight and the output BCG signals that are generated over a time period.

23. The system of claim 1, wherein the processor circuit is configured to generate an output BCG signal indicative of BCG RMS power to provide an indication of cardiac fitness.

24. The system of claim 1, wherein

the BCG capture device is integrated with a bodyweight sensing scale,

the secondary sensor is configured to detect at least one of an electrocardiogram (ECG) and photoplethysmography characteristic of the user, and

the processor circuit is configured to generate output BCG signals over time to provide an indication of at least one of cardiac output and stroke volume for setting a cardiac pacing parameter for the user, using the detected characteristic from the secondary sensor as an input for at least one of filtering and averaging the output BCG signals.

25. The system of claim 1, wherein

the secondary sensor is configured to generate an ECG signal using characteristics detected from the user, and

the processor is configured to modify coefficients of a transform function used to generate the output BCG signal, based upon the ECG signal.

26. The system of claim 1, wherein the secondary sensor includes an electromyogram (EMG) sensor that is configured to detect motion of the user standing on the BCG capture device.

27. The system of claim 1, wherein the secondary sensor includes a foot-to-foot ECG sensor.

28. The system of claim 1, wherein the secondary sensor includes an optical plethysmograph.

29. The system of claim 1, wherein the secondary sensor includes an accelerometer arranged to be affixed to the waist or chest of the user.

30. The system of claim 1, wherein the secondary sensor includes a geophone configured to detect vibrations to which the BCG capture device is exposed.

31. The system of claim 1, wherein the secondary sensor includes a foot-to-foot impedance cardiogram sensor.

32. The system of claim 1, wherein the processor circuit is configured to use detected noise characteristics from the secondary sensor to mitigate noise via heart rate-triggered ensemble averaging.

33. The system of claim 1, wherein the processor circuit is configured to use detected noise characteristics for adaptive noise cancellation in the BCG signal, using a signal from the secondary sensor as a noise reference.

34. The system of claim 1, wherein the processor circuit is configured to use detected noise characteristics to adaptively enhance the BCG signal.

35. The system of claim 1, wherein the secondary sensor is configured to detect noise that includes interference present in the BCG signal.

36. The system of claim 1, wherein the processor circuit is configured to generate the output BCG signal for characterizing the responsiveness of the user'"'"'s heart to parametric adjustments made to stimulus applied to the heart via cardiac resynchronization therapy (CRT).

37. The system of claim 1, wherein the processor circuit is configured to generate the output BCG signal indicative of the cardiac output of the user'"'"'s heart.

38. The system of claim 1, wherein the processor circuit is configured to generate the output BCG signal indicative of the left ventricular mass (LVM) of the user'"'"'s heart.

39. The system of claim 1, wherein the secondary sensor includes a non-contact (RF) sensor configured to measure at least one of heart or chest-wall movement.

40. The system of claim 1, wherein the processor circuit is further configured to generate the BCG waveform reference by determining an average BCG waveform for a heartbeat.

41. The system of claim 1, wherein the processor circuit is further configured to estimate the BCG signal relative to noise present in the BCG signal by applying the BCG waveform reference to individual heartbeats identified from the detected indication of the physiologic characteristic of the user.

42. The system of claim 1, wherein the secondary sensor is further configured and arranged to produce an electrocardiogram (ECG) signal and another signal.

43. The system of claim 1, wherein the secondary sensor is further configured and arranged to function as a strain gauge and to also produce another signal.

44. A system for providing BCG (ballistocardiogram) data from a user who is susceptible to movement, the system comprising:

means, including a heart-characteristic sensor, for capturing from a user a BCG signal for a plurality of heartbeats from the user and indicative of physical movement of the user while the user stands at a stationary position, including mechanical output of the user'"'"'s heart;

a secondary sensor for detecting an indication of a physiologic characteristic of the user and for providing an output characterizing the detected indication; and

a processor, responsive to the BCG signal and the secondary sensor, for providing a BCG waveform reference for the BCG signal, and

estimating, using the BCG waveform reference, the BCG signal relative to noise present in the BCG signal and due to the movement of the user while the user stands at a stationary position and thereby generating an output BCG signal indicative of a condition of the user'"'"'s heart.

45. A method for providing BCG (ballistocardiogram) data from a user who is susceptible to movement, the method comprising:

using a heart-characteristic sensor to capture from a user a BCG signal for a plurality of heartbeats from the user and indicative of physical movement of the user while the user stands at a stationary position including mechanical output of the user'"'"'s heart;

detecting another indication of a physiologic characteristic of the user and for providing an output characterizing the detected indication; and

responsive to the steps of using and detecting another indication,

providing a BCG waveform reference for the BCG signal, and

estimating, using the BCG waveform reference, the BCG signal relative to noise present in the BCG signal and due to movement of the user while the user stands at a stationary position and thereby generating an output BCG signal indicative of a condition of the user'"'"'s heart.