JP4611972B2 - 心室圧測定値に基づいて心室後負荷を推定する方法及び装置 - Google Patents
心室圧測定値に基づいて心室後負荷を推定する方法及び装置 Download PDFInfo
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- JP4611972B2 JP4611972B2 JP2006503631A JP2006503631A JP4611972B2 JP 4611972 B2 JP4611972 B2 JP 4611972B2 JP 2006503631 A JP2006503631 A JP 2006503631A JP 2006503631 A JP2006503631 A JP 2006503631A JP 4611972 B2 JP4611972 B2 JP 4611972B2
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/021—Measuring pressure in heart or blood vessels
- A61B5/0215—Measuring pressure in heart or blood vessels by means inserted into the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7235—Details of waveform analysis
- A61B5/7239—Details of waveform analysis using differentiation including higher order derivatives
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
- A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
- A61N1/36564—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by blood pressure
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- Radiology & Medical Imaging (AREA)
- Artificial Intelligence (AREA)
- Computer Vision & Pattern Recognition (AREA)
- Psychiatry (AREA)
- Signal Processing (AREA)
- Electrotherapy Devices (AREA)
- Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
Description
本発明の方法、及び、本発明のデバイスは、独立請求項で特徴付けられる一方、本発明の好ましい実施形態は、従属請求項で述べられる。本発明は、好ましくは埋め込み可能医療デバイス(IMD)によって、心室後負荷の短期に又は長期継続的に蓄積された推定値から心不全状態を評価するという重要な利点を有する。
α=(tb−ta)/(tc−ta)
β=(Pb−Pc)/(tb−tc)
に従って、記憶された値及び時間から心室後負荷の指数α及び/又はβの推定値の計算を行う。
こうした血圧データ点の収集及び指数α及びβの計算は図3に示される。ステップS100〜S104は、図2においてV−EVENTの宣言をもたらす正常洞調律(NSR)R波の検出を示し、ステップS106〜S116は、本発明による、デジタル化したVprs及び関連する時間データの処理を示す。ステップS114及びS116における計算した指数α及びβの記憶は、傾向を示す指数値の圧縮によって、又は、決定される1つの指数のみを毎日記憶することによって、又は、計算された指数α及びβの移動平均を記憶することによって、利用可能なメモリに対処するのが容易になることができる。NSRにおいて、R波は、心室血圧波が生ずる前に、図1及び図2に示すように規定された心室センスベクトルにわたって検知されるため、V−EVENTを使用して、V−EVENTに続く時間窓について圧力検知を可能にし、それによって、IMD電池の電流ドレインを減らすことができる。したがって、ステップS106〜S110における心室血圧データの収集及び処理、並びに、ステップS114及びS116に示す指数α及びβの決定は、ステップS102〜S104において心拍数がNSRを示すと判定される時にのみ起こることが好ましい。さらに、心室後負荷の指数α及び/又はβの決定を、ステップS102において規定の頻脈性不整脈心拍数より低いと判定される心拍数のNSR事象に制限することが望ましい場合がある。
Claims (10)
- 血液駆出相中に心室からの血液の駆出に対する抵抗を呈する心室後負荷の指数をデバイスにより導出する方法であって、
心室内の血圧の心室圧値のセットを、前記心室の前記血液駆出相中のサンプル時間に取得するステップと、
前記心室圧値のセットから、最大正圧値Pb、最大正微分圧dP/dtPP、及び最大負微分圧dP/dtNPを決定するステップと、
前記心室圧値のセットに関連する前記サンプル時間から、最大正圧のサンプル時間tb、最大正微分圧dP/dtPPのサンプル時間ta、及び最大負微分圧dP/dtNPのサンプル時間tcを決定するステップと、
式α=(tb−ta)/(tc−ta)に従って、前記血液駆出相における最大正圧Pbの相対タイミングの指数αを計算するステップと、
を含み、心室後負荷の大きさが、0〜1の範囲における指数αの値に比例する、心室後負荷の指数をデバイスにより導出する方法。 - 前記心室圧値のセットから、前記最大負微分圧dP/dtNPに関連する減少圧Pcを決定するステップと、
式β=(Pc−Pb)/(tc−tb)に従って、前記血液駆出相における早期駆出圧の傾斜の指数βを計算するステップと、
をさらに含み、心室後負荷の大きさが前記指数βの大きさに比例する、請求項1に記載の心室後負荷の指数をデバイスにより導出する方法。 - 血液駆出相中に心室からの血液の駆出に対する抵抗を呈する心室後負荷の指数をデバイスにより導出する方法であって、
心室内の血圧の心室圧値のセットを、前記心室の前記血液駆出相中のサンプル時間に取得するステップと、
前記心室圧値のセットから、最大正圧値Pb、最大負微分圧dP/dtNP、及び、最大負微分圧dP/dtNPに関連する減少圧Pcを決定するステップと、
前記心室圧値のセットに関連する前記サンプル時間から、最大正圧のサンプル時間tb、及び最大負微分圧dP/dtNPのサンプル時間tcを決定するステップと、
式β=(Pc−Pb)/(tc−tb)に従って、前記血液駆出相における早期駆出圧の傾斜の指数βを計算するステップと、
を含み、心室後負荷の大きさが前記指数βの大きさに比例する、心室後負荷の指数をデバイスにより導出する方法。 - 前記計算した指数αをデータ記憶メモリに記憶するステップを含む請求項1に記載の心室後負荷の指数をデバイスにより導出する方法。
- 前記計算した指数βをデータ記憶メモリに記憶するステップを含む請求項2又は3に記載の心室後負荷の指数をデバイスにより導出する方法。
- 調整可能な治療送出動作モード及びパラメータに従って治療を送出するために患者の体内に埋め込まれるようになっており、圧力信号処理回路機構と結合される圧力センサと、治療を送出する治療送出手段とを備える埋め込み可能医療デバイスの作動方法であって、
請求項1又は4に記載の心室後負荷の指数を導出する方法を実行するステップと、
前記指数値αを最小にするために、治療送出動作モード又はパラメータのうちの1つを調整するステップと、
を備えることを特徴とする埋め込み可能医療デバイスの作動方法。 - 調整可能な治療送出動作モード及びパラメータに従って治療を送出するために患者の体内に埋め込まれるようになっており、圧力信号処理回路機構と結合される圧力センサと、治療を送出する治療送出手段とを備える埋め込み可能医療デバイスの作動方法であって、
請求項2、3又は5いずれか1項に記載の心室後負荷の指数を導出する方法を実行するステップと、
前記指数βの大きさを最小にするために、治療送出動作モード又はパラメータのうちの1つを調整するステップと、
を備えることを特徴とする埋め込み可能医療デバイスの作動方法。 - 血液駆出相中に心室からの血液の駆出に対する抵抗を呈する心室後負荷の指数を導出する装置であって、請求項1〜7のいずれか一つに記載の方法ステップを実行する手段を備える心室後負荷の指数を導出する装置。
- 患者の体内に埋め込まれるようになっており、圧力信号処理回路機構と結合される圧力センサと、データ記憶のためのメモリとを備える埋め込み可能心臓モニタであって、請求項8に記載の装置を備える埋め込み可能心臓モニタ。
- 調整可能な治療送出動作モード及びパラメータに従って治療を送出するために患者の体内に埋め込まれるようになっており、圧力信号処理回路機構と結合される圧力センサと、治療を送出する治療送出手段とを備える埋め込み可能医療デバイスであって、請求項8に記載の装置を備える埋め込み可能医療デバイス。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US10/376,064 US6887207B2 (en) | 2003-02-26 | 2003-02-26 | Methods and apparatus for estimation of ventricular afterload based on ventricular pressure measurements |
PCT/US2004/004624 WO2004075745A1 (en) | 2003-02-26 | 2004-02-17 | Methods and apparatus for estimation of ventricular afterload based on ventricular pressure measurements |
Publications (2)
Publication Number | Publication Date |
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JP2006519055A JP2006519055A (ja) | 2006-08-24 |
JP4611972B2 true JP4611972B2 (ja) | 2011-01-12 |
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Application Number | Title | Priority Date | Filing Date |
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JP2006503631A Expired - Fee Related JP4611972B2 (ja) | 2003-02-26 | 2004-02-17 | 心室圧測定値に基づいて心室後負荷を推定する方法及び装置 |
Country Status (6)
Country | Link |
---|---|
US (1) | US6887207B2 (ja) |
EP (1) | EP1599133B1 (ja) |
JP (1) | JP4611972B2 (ja) |
CA (1) | CA2516948A1 (ja) |
DE (1) | DE602004020193D1 (ja) |
WO (1) | WO2004075745A1 (ja) |
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-
2003
- 2003-02-26 US US10/376,064 patent/US6887207B2/en not_active Expired - Lifetime
-
2004
- 2004-02-17 EP EP04711883A patent/EP1599133B1/en not_active Expired - Lifetime
- 2004-02-17 WO PCT/US2004/004624 patent/WO2004075745A1/en active Application Filing
- 2004-02-17 CA CA002516948A patent/CA2516948A1/en not_active Abandoned
- 2004-02-17 DE DE602004020193T patent/DE602004020193D1/de not_active Expired - Lifetime
- 2004-02-17 JP JP2006503631A patent/JP4611972B2/ja not_active Expired - Fee Related
Also Published As
Publication number | Publication date |
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DE602004020193D1 (de) | 2009-05-07 |
WO2004075745A1 (en) | 2004-09-10 |
EP1599133A1 (en) | 2005-11-30 |
CA2516948A1 (en) | 2004-09-10 |
JP2006519055A (ja) | 2006-08-24 |
US6887207B2 (en) | 2005-05-03 |
EP1599133B1 (en) | 2009-03-25 |
US20040167410A1 (en) | 2004-08-26 |
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