JP5166396B2 - 心音に基づく血行動態安定性の評価 - Google Patents
心音に基づく血行動態安定性の評価 Download PDFInfo
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- JP5166396B2 JP5166396B2 JP2009502827A JP2009502827A JP5166396B2 JP 5166396 B2 JP5166396 B2 JP 5166396B2 JP 2009502827 A JP2009502827 A JP 2009502827A JP 2009502827 A JP2009502827 A JP 2009502827A JP 5166396 B2 JP5166396 B2 JP 5166396B2
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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
- A61B5/02028—Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
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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
- A61B5/024—Detecting, measuring or recording pulse rate or heart rate
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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
- A61B5/024—Detecting, measuring or recording pulse rate or heart rate
- A61B5/02405—Determining heart rate variability
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B7/00—Instruments for auscultation
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- 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
- A61N1/3621—Heart stimulators for treating or preventing abnormally high heart rate
-
- 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
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- 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
- A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
- A61N1/39—Heart defibrillators
- A61N1/3956—Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
- A61N1/3962—Implantable devices for applying electric shocks to the heart, e.g. for cardioversion in combination with another heart therapy
- A61N1/39622—Pacing therapy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B7/00—Instruments for auscultation
- A61B7/02—Stethoscopes
- A61B7/04—Electric stethoscopes
-
- 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
- A61N1/3627—Heart stimulators for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
-
- 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
- A61N1/36578—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 mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
-
- 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
- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/37211—Means for communicating with stimulators
- A61N1/37235—Aspects of the external programmer
- A61N1/37247—User interfaces, e.g. input or presentation means
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- 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
- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/37211—Means for communicating with stimulators
- A61N1/37252—Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
- A61N1/37282—Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data characterised by communication with experts in remote locations using a network
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- Health & Medical Sciences (AREA)
- Cardiology (AREA)
- Life Sciences & Earth Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Public Health (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Veterinary Medicine (AREA)
- Animal Behavior & Ethology (AREA)
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- Radiology & Medical Imaging (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Physics & Mathematics (AREA)
- Pathology (AREA)
- Hematology (AREA)
- Electrotherapy Devices (AREA)
- Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
- Measuring And Recording Apparatus For Diagnosis (AREA)
Description
優先権の利益が、2006年3月29日に出願された米国特許出願第11/277773号に対して本明細書によって請求され、その出願は、参照により本明細書に組み込まれる。
以下の同一出願人による米国特許出願が関連し、かつ全部が参照により全体として組み込まれる:2004年7月28日に出願された出願第10/900570号「DETERMINING A PATIENT’S POSTURE FROM MECHANICAL VIBRATIONS OF THE HEART」、2003年11月6日に出願された出願第10/703175号「A DUAL USE SENSOR FOR RATE RESPONSIVE PACING AND HEART SOUND MONITORING」、2002年12月30日に出願された出願第10/334694号「METHOD AND APPARATUS FOR MONITORING OF DIASTOLIC HEMODYNAMICS」、2003年12月24日に出願された出願第10/746874号「A THIRD HEART SOUND ACTIVITY INDEX FOR HEART FAILURE MONITORING」、2005年1月18日に出願された出願第11/037275号「METHOD FOR CORRECTION OF POSTURE DEPENDENCE ON HEART SOUNDS」、2005年5月16日に出願された出願第11/129050号「METHOD AND APPARATUS FOR CARDIAC PROTECTION PACING」、及び2005年6月8日に出願された出願第11/148107号「ISCHEMIA DETECTION USING HEART SOUND SENSOR」、各々は、参照によって本明細書に組み込まれる。
Claims (15)
- 埋め込み型医療装置(IMD)を備えたシステムであって、
前記埋め込み型医療装置(IMD)は、
患者の心臓の機械的活動と関連した、少なくとも1つの心音を表す電気信号を生成するために操作可能な埋め込み型心音センサと、
心音信号を生成するために前記心音センサに連結されていて、かつ、試料採取された心音信号を得るためのサンプリング回路を含む心音センサインタフェース回路と、
頻脈性不整脈検出器と、
前記心音センサインタフェース回路と前記頻脈性不整脈検出器とに連結されたコントローラ回路とを含んでいて、
前記コントローラ回路は、血行動態安定性評価モジュールを含んでいて、
前記血行動態安定性評価モジュールは、
心室頻脈性不整脈の少なくとも1つの発症が被検者において検出されることを決定し、かつ、
線形予測を使用して、前記心音信号から前記心室頻脈性不整脈の血行動態安定性の測定を得るようになっていて、前記血行動態安定性の測定は、測定された心音中に得られる試料採取された心音信号のディジタル化された試料に自己相関関数を適用することを含むことによって得られる大動脈圧の代理測定を含み、かつ、
前記血行動態安定性の測定に基づいて、前記心室頻脈性不整脈の間に血行圧力が安定しているか否か判断するように構成される、
ことを特徴とするシステム。 - 前記血行動態安定性評価モジュールは、心音信号から得られた血行動態安定性の前記測定のベースラインを確立するためのベースラインモジュールを含み、かつ、
前記血行動態安定性評価モジュールは、血行動態安定性の前記ベースライン測定からの測定された変化が規定の閾値を超える時、前記心室頻脈性不整脈を不安定であると見なすように更に構成される、請求項1に記載のシステム。 - 前記ベースラインモジュールが、血行動態安定性の前記測定の中心傾向を決定することによって血行動態安定性の前記測定のベースラインを確立するように構成される、請求項3に記載のシステム。
- 前記システムは、心室収縮間の心室時間間隔を提供するための前記コントローラ回路に連結されたタイマ回路を更に含み、
前記血行動態安定性評価モジュールは、心室時間間隔の変動の測定を得るための心室収縮変動モジュールを含み、
前記血行動態安定性モジュールは、前記心音信号から得られた血行動態安定性の前記測定のベースラインを確立するためのベースラインモジュールを含み、かつ、
血行動態安定性の前記ベースライン測定からの測定された変化が規定の安定性測定閾値を超え、かつ心室時間間隔の変動の前記測定が規定の変動閾値を超える両方の時、前記血行動態安定性評価モジュールは、前記心室頻脈性不整脈を不安定であると見なすように更に構成される、請求項1に記載のシステム。 - 前記システムは、前記コントローラ回路に連結された衝撃回路を更に含み、かつ、
前記コントローラ回路は、前記血行動態安定性評価モジュールによって得られた血行動態安定性の前記測定に従って規定の衝撃刺激の付与を遅延させるように構成される、請求項1に記載のシステム。 - 前記システムは、前記コントローラ回路に連結された抗頻脈性不整脈ペーシング(ATP)回路を更に含み、かつ、前記コントローラ回路は、
心室頻脈性不整脈発症を検出後、規定のATP療法を開始し、かつ、
血行動態安定性の前記測定に従って前記ATP療法の持続時間を延長するように構成される請求項1に記載のシステム。 - 前記コントローラ回路に連結された少なくとも1つの埋め込み型心臓信号感知回路を含み、前記埋め込み型心臓信号感知回路は、患者の心臓活動を表す電気心臓信号を生成するように構成され、かつ、前記血行動態安定性評価モジュールは、前記電気心臓活動信号と相関する心音信号から血行動態安定性の前記測定を得るように構成される、請求項1に記載のシステム。
- 前記コントローラ回路に連結された患者活動センサを含み、前記血行動態安定性評価モジュールは、患者活動と相関する心音信号から血行動態安定性の前記測定を得るように構成される、請求項1に記載のシステム。
- 前記心音センサインタフェース回路は、
低域フィルタ回路と、
低域フィルタ処理した心音信号の高周波数に信号利得を加えるためのプリエンファシス回路とを含む、請求項1に記載のシステム。 - 外部装置を含み、かつ、前記IMDは、前記コントローラ回路に連結された通信回路を含み、かつ、前記IMDは、心音信号から得られた少なくとも1つの血行動態安定性の測定に関する情報を外部装置に通信するように構成される、請求項1に記載のシステム。
- 前記外部装置はIMDプログラマである、請求項11に記載のシステム。
- 前記外部装置はネットワークと通信するサーバであり、かつ、前記サーバは、第3の装置を介して前記IMDと通信するように構成される、請求項11に記載のシステム。
- 心室収縮の間の心室時間間隔を与えるために、前記頻脈性不整脈検出器に接続されたタイマ回路を有し、
前記頻脈性不整脈検出器は、平均心室収縮速度が、規定の速度閾値よりも大きく平均心房収縮速度を超えたとき、頻脈性不整脈が起こったことを宣言するように構成されている、請求項1に記載のシステム。 - 前記心音センサは、加速度計、ひずみ計、及びマイクロホンのうちの少なくとも1つを含む、請求項1に記載のシステム。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/277,773 US7780606B2 (en) | 2006-03-29 | 2006-03-29 | Hemodynamic stability assessment based on heart sounds |
US11/277,773 | 2006-03-29 | ||
PCT/US2007/006345 WO2007126578A2 (en) | 2006-03-29 | 2007-03-13 | Hemodynamic stability assessment based on heart sounds |
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Publication Number | Publication Date |
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JP2009531131A JP2009531131A (ja) | 2009-09-03 |
JP2009531131A5 JP2009531131A5 (ja) | 2010-04-22 |
JP5166396B2 true JP5166396B2 (ja) | 2013-03-21 |
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JP2009502827A Expired - Fee Related JP5166396B2 (ja) | 2006-03-29 | 2007-03-13 | 心音に基づく血行動態安定性の評価 |
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Country | Link |
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US (2) | US7780606B2 (ja) |
EP (1) | EP1998850A2 (ja) |
JP (1) | JP5166396B2 (ja) |
WO (1) | WO2007126578A2 (ja) |
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WO2007126578A2 (en) | 2007-11-08 |
JP2009531131A (ja) | 2009-09-03 |
US7938781B2 (en) | 2011-05-10 |
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US7780606B2 (en) | 2010-08-24 |
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