WO2012093266A1 - Apparatus and method of assessing a narrowing in a fluid filled tube - Google Patents
Apparatus and method of assessing a narrowing in a fluid filled tube Download PDFInfo
- Publication number
- WO2012093266A1 WO2012093266A1 PCT/GB2012/050024 GB2012050024W WO2012093266A1 WO 2012093266 A1 WO2012093266 A1 WO 2012093266A1 GB 2012050024 W GB2012050024 W GB 2012050024W WO 2012093266 A1 WO2012093266 A1 WO 2012093266A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- pressure
- backward
- originating
- time window
- component
- Prior art date
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Classifications
-
- 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
-
- 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
- A61B5/02007—Evaluating blood vessel condition, e.g. elasticity, compliance
-
- 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
- A61B5/02108—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics
- A61B5/02125—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics of pulse wave propagation time
-
- 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
- A61B5/02—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
- A61B5/026—Measuring blood flow
- A61B5/0285—Measuring or recording phase velocity of blood waves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
- A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
- A61B5/1076—Measuring physical dimensions, e.g. size of the entire body or parts thereof for measuring dimensions inside body cavities, e.g. using catheters
-
- 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
- A61B5/7264—Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems
-
- 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
- A61B5/7271—Specific aspects of physiological measurement analysis
- A61B5/7278—Artificial waveform generation or derivation, e.g. synthesising signals from measured signals
-
- 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
- A61B5/026—Measuring blood flow
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
- A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
- A61B5/6852—Catheters
Definitions
- This invention relates to an apparatus and method of assessing a narrowing in a fluid filled tube.
- a fluid filled tube or vessel formed with a constriction or narrowing can be analysed to measure the magnitude of the constriction or narrowing.
- vasodilators such as adenosine or dipyridamole.
- vasodilators are necessarv to minimise resistance from the distal vascular bed to accurately estimate the drop in pressure across a stenosis. It would be preferable not to have to use vasodilators.
- Distal pressure arises from resistance of the microcirculation, in addition to active compression of small microcirculatory vessels which permeate the myocardium.
- backward-originating pressure When flow is measured simultaneously at different sites, it is possible to separate the pressure components arising from the distal myocardium (backward-originating pressure), from those arising from the proximal end (forward-originating pressure),
- dP is the differential of pressure
- p density of blood
- c wave
- dil is the differential of flow velocity
- a further aspect of the present invention provides a processor configured to assess a narrowing in a fluid filled tube having a fluid flow pressure wave having a backward-originating pressure component and a forward-originating pressure component without taking a flow velocity measurement, the processor: analysing pressure measurements taken in a tube; separating the pressure components into the backward-originating pressure component and the forward-originating pressure component; identifying a time window when the differential of flow velocity (dil) is minimal or absent; and deriving the backward and forward pressure components for pressure measurements taken in at least the time window.
- a yet further aspect of the present invention provides a data storage medium carrying a computer program to assess a narrowing in a fluid filled tube having a fluid flow pressure wave having a backward-originating pressure component and a forward-originating pressure component without taking a flow velocity measurement, the program: analysing pressure measurements taken in a tube; separating the pressure components into the backward-originating pressure component and the forward-originating pressure component; identifying a time window when the differential of flow velocity (dU) is minimal or absent; and deriving the backward and forward pressure components for pressure measurements taken in at least the time window.
- dU differential of flow velocity
- FIGURE 2 is a schematic not-to-scale diagram of an apparatus embodying the present invention
- FIGURE 3 is a flow diagram illustrating a method embodying the present invention
- FIGURE 4 shows an example of a free wave period in a cardiac environment, which free wave period is used in an apparatus and method embodying the present invention.
- This invention provides an apparatus and method of assessing a narrowing in a fluid filled tube by measuring the pressure in the tube and does not require a measurement of flow velocity, fluid flow rate, in addition to the pressure measurement.
- an apparatus 1 embodying the invention comprises a probe 2 such as an intra-arterial pressure wire (WaveWire or Combowire (Volcano Corp.) or Radi pressure wire (St Jude Medical) with a pressure measurement transducer 3 - i.e. a device measuring pressure (P), and a processor 4 to analyse and operate on the pressure measurements.
- a signal line 5 relays the pressure measurement signal from the transducer 3 to the processor 4.
- the signal line 5 is illustrated both as a wired connection 5 and as a wireless connection 5' - either configuration is available.
- the processor 4 operates on the pressure measurements received from the transducer 3 in accordance with a number of algorithms which are discussed in greater detail below.
- the apparatus 1 may be provided in the following configurations or combination of configurations, but these are not an exhaustive list of configurations:
- a stand-alone device incorporating a probe with pressure measurement capacity in wired connection with a processor to provide on-device analysis
- a device incorporating a probe with pressure measurement capacity in wireless connection with a processor to provide analysis at the processor;
- the apparatus is configured using the processor 4 in the haemodynamic equipment, such as in McKesson equipment - Horizon CardiologyTM, a cardiovascular information system (CVIS).
- CVIS cardiovascular information system
- dP+ is determined by dP + p c dU.
- dU is large during parts of the cardiac cycle when significant proportions of wave energy are present (i.e. during left ventricular contraction).
- dU tends to zero. This can be a single moment or sample in time, or a multiple moments or samples in time. At such times, the dU term can be cancelled and dP+ or dP, estimated using the dP term alone.
- Figure 4 shows an example of dU fluctuating over a cycle.
- dU tends to zero
- the window is identified for example by being: heuristically learnt by the processor; linked to characteristics of the pressure waveform; or a certain time window after another event in the waveform e.g. starting at a predetermined time (250ms) after event of dil max and lasting for a predetermined period (150ms) - note di) max can be reliably observed from pressure measurements of the waveform.
- the wave free period is identifiable using online analysis in real time or can be identified using offline analysis.
- Another example for identifying the wave free period is to base its identification on characteristics of the pressure waveform. This is advantageous because identification is not tied to fixed time points.
- Another example for identifying the free wave period is:
- the free wave period is specified as a predetermined portion mid-window between these two time points.
- the free wave period is identified as the mid 3/5 window between these two time points.
- reliable measurements are taken in the window where dU varies less than +/- 2x10 "4 from the zero crossing, where dU max is 3x 0 "3 , where dU is 20% or less of dil max , preferably 10% or less, most preferably 5% or less.
- dU oscillates around the mean over the wave free period so its net contribution to separated pressures (i.e. P+) is minimised as the -ve contributions cancel the +ve contributions.
- the oscillations about the mean during the wave free period (the time window) in a cardiac environment are due to limitations in the measurement equipment which will not detect small changes accurately. Further this advance provides a measure of the severity of a constriction using the measure of isolated pressure ratio.
- such devices or probes in the cardiac field include signal lines from the probe which terminate either in a transmitter for relaying the measurement signal to a processor or a processor itself. If there is a flow sensor and a pressure sensor, then two different measurement devices are in/on the same probe and there are also two signal lines required to take the signal from the two distinct measurement devices.
- the loss, in examples of the invention, of the flow sensor from the system is extremely beneficial as it reduces the complexity of the device, can improve handling of the probe and can reduce the number of signal lines necessary to take the measurement signal(s) away from the measurement devices.
- there is only one measurement device - that of pressure measurement and the need for a flow sensor in addition to one or more pressure sensors is obviated.
- a single pressure sensor wire can be more manoeuvrable than a wire with both pressure and flow sensors. Having a flow sensor in addition to the pressure sensor is sub-optimal for guide wire design.
- Pressure-only measurements are taken relative to the constriction. Multiple measurements can be taken in preference to one measurement.
- the probe 2 can be moved relative to the constriction, in which case, multiple measurements would be taken.
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Engineering & Computer Science (AREA)
- Physics & Mathematics (AREA)
- Cardiology (AREA)
- Veterinary Medicine (AREA)
- General Health & Medical Sciences (AREA)
- Biophysics (AREA)
- Pathology (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- Public Health (AREA)
- Physiology (AREA)
- Vascular Medicine (AREA)
- Artificial Intelligence (AREA)
- Hematology (AREA)
- Psychiatry (AREA)
- Signal Processing (AREA)
- Computer Vision & Pattern Recognition (AREA)
- Dentistry (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Evolutionary Computation (AREA)
- Fuzzy Systems (AREA)
- Mathematical Physics (AREA)
- Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
- Testing Of Devices, Machine Parts, Or Other Structures Thereof (AREA)
- Measuring Volume Flow (AREA)
- Measuring Fluid Pressure (AREA)
- Examining Or Testing Airtightness (AREA)
Abstract
Description
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Priority Applications (11)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
BR112013017430A BR112013017430A2 (en) | 2011-01-06 | 2012-01-06 | method, apparatus and processor configured to evaluate a nip in a fluid-filled tube and data storage media |
KR1020137020712A KR101572337B1 (en) | 2011-01-06 | 2012-01-06 | Apparatus and method of assessing a narrowing in a fluid filled tube |
NZ613147A NZ613147A (en) | 2011-01-06 | 2012-01-06 | Apparatus and method of assessing a narrowing in a fluid filled tube |
EP12700299.6A EP2661216B1 (en) | 2011-01-06 | 2012-01-06 | Apparatus and method of assessing a narrowing in a fluid filled tube |
EP18206377.6A EP3505057A1 (en) | 2011-01-06 | 2012-01-06 | Apparatus and method of assessing a narrowing in a fluid filled tube |
CA2823811A CA2823811A1 (en) | 2011-01-06 | 2012-01-06 | Apparatus and method of assessing a narrowing in a fluid filled tube |
JP2013547911A JP6165634B2 (en) | 2011-01-06 | 2012-01-06 | Device for evaluating a stenosis in a tube filled with fluid |
CN201280004879.6A CN103796577B (en) | 2011-01-06 | 2012-01-06 | Assess the apparatus and method of the section shrinkage in fluid filling pipe |
RU2013136699/14A RU2013136699A (en) | 2011-01-06 | 2012-01-06 | DEVICE AND METHOD FOR EVALUATING A TAPE IN A FILLED LIQUID TUBE |
ES12700299T ES2706731T3 (en) | 2011-01-06 | 2012-01-06 | Apparatus and method to evaluate a narrowing in a tube filled with fluid |
IL227351A IL227351A0 (en) | 2011-01-06 | 2013-07-04 | Apparatus and method of characterising a narrowing in a fluid filled tube |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
GBGB1100137.7A GB201100137D0 (en) | 2011-01-06 | 2011-01-06 | Apparatus and method of assessing a narrowing in a fluid tube |
GB1100137.7 | 2011-01-06 |
Publications (1)
Publication Number | Publication Date |
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WO2012093266A1 true WO2012093266A1 (en) | 2012-07-12 |
Family
ID=43663843
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/GB2012/050024 WO2012093266A1 (en) | 2011-01-06 | 2012-01-06 | Apparatus and method of assessing a narrowing in a fluid filled tube |
Country Status (14)
Country | Link |
---|---|
US (5) | US9026384B2 (en) |
EP (2) | EP3505057A1 (en) |
JP (2) | JP6165634B2 (en) |
KR (1) | KR101572337B1 (en) |
CN (1) | CN103796577B (en) |
BR (1) | BR112013017430A2 (en) |
CA (1) | CA2823811A1 (en) |
CR (1) | CR20130379A (en) |
ES (1) | ES2706731T3 (en) |
GB (1) | GB201100137D0 (en) |
IL (1) | IL227351A0 (en) |
NZ (1) | NZ613147A (en) |
RU (1) | RU2013136699A (en) |
WO (1) | WO2012093266A1 (en) |
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WO2013028613A2 (en) | 2011-08-20 | 2013-02-28 | Volcano Corporation | Devices, systems, and methods for assessing a vessel |
WO2013109815A1 (en) | 2012-01-19 | 2013-07-25 | Volcano Corporation | Interface devices, systems, and methods for use with intravascular pressure monitoring devices |
WO2016008809A1 (en) | 2014-07-15 | 2016-01-21 | Koninklijke Philips N.V. | Devices, systems, and methods and associated display screens for assessment of vessels with multiple sensing components |
WO2016009335A1 (en) | 2014-07-14 | 2016-01-21 | Koninklijke Philips N.V. | Devices and methods for assessment of vessels |
WO2016038493A1 (en) | 2014-09-11 | 2016-03-17 | Koninklijke Philips N.V. | Bedside controller for assessment of vessels and associated devices, systems, and methods |
WO2016075590A1 (en) | 2014-11-14 | 2016-05-19 | Koninklijke Philips N.V. | Percutaneous coronary intervention (pci) planning interface and associated devices, systems, and methods |
US9364153B2 (en) | 2014-02-20 | 2016-06-14 | Koninklijke Philips N.V. | Devices, systems, and methods and associated display screens for assessment of vessels |
WO2016092403A1 (en) | 2014-12-08 | 2016-06-16 | Koninklijke Philips N.V. | Automated identification and classification of intravascular lesions |
US9775524B2 (en) | 2011-01-06 | 2017-10-03 | Medsolve Limited | Apparatus and method of assessing a narrowing in a fluid filled tube |
US9820660B2 (en) | 2013-10-18 | 2017-11-21 | Volcano Corporation | Devices, systems, and methods for assessing a vessel with optimized proximal and distal pressure measurements obtained without the use of a hyperemic agent |
US9895108B2 (en) | 2012-08-31 | 2018-02-20 | Volcano Corporation | Pressure sensing intravascular devices with reduced drift and associated systems and methods |
US10307070B2 (en) | 2014-04-04 | 2019-06-04 | St. Jude Medical Coordination Center Bvba | Intravascular pressure and flow data diagnostic systems, devices, and methods |
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US11051779B2 (en) | 2018-09-13 | 2021-07-06 | Siemens Healthcare Gmbh | Processing image frames of a sequence of cardiac images |
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CN103796577B (en) | 2017-10-17 |
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US20120278008A1 (en) | 2012-11-01 |
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IL227351A0 (en) | 2013-09-30 |
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ES2706731T3 (en) | 2019-04-01 |
US20220354370A1 (en) | 2022-11-10 |
US9026384B2 (en) | 2015-05-05 |
KR101572337B1 (en) | 2015-11-26 |
EP2661216B1 (en) | 2018-11-21 |
JP2017200591A (en) | 2017-11-09 |
US10624544B2 (en) | 2020-04-21 |
US20180160914A1 (en) | 2018-06-14 |
US20150230714A1 (en) | 2015-08-20 |
CN103796577A (en) | 2014-05-14 |
NZ613147A (en) | 2015-06-26 |
RU2013136699A (en) | 2015-02-20 |
CA2823811A1 (en) | 2012-07-12 |
US11389068B2 (en) | 2022-07-19 |
JP2014504923A (en) | 2014-02-27 |
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