WO2020058383A1 - Procédé et agencement permettant de déterminer de façon automatisée des paramètres hémodynamiques dans un vaisseau sanguin au niveau d'ondes impulsionnelles enregistrées de façon invasive - Google Patents

Procédé et agencement permettant de déterminer de façon automatisée des paramètres hémodynamiques dans un vaisseau sanguin au niveau d'ondes impulsionnelles enregistrées de façon invasive Download PDF

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WO2020058383A1
WO2020058383A1 PCT/EP2019/075127 EP2019075127W WO2020058383A1 WO 2020058383 A1 WO2020058383 A1 WO 2020058383A1 EP 2019075127 W EP2019075127 W EP 2019075127W WO 2020058383 A1 WO2020058383 A1 WO 2020058383A1
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Prior art keywords
pulse wave
signal
pressure
pulse
blood vessel
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PCT/EP2019/075127
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German (de)
English (en)
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Verena Dittrich
Chris Stockmann
Andreas Mainka
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Redwave Medical GmbH
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Priority to AU2019344027A priority Critical patent/AU2019344027A1/en
Publication of WO2020058383A1 publication Critical patent/WO2020058383A1/fr

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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
    • A61B5/68—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
    • 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
    • A61B5/026—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
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7235—Details of waveform analysis
    • 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
    • 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
    • A61B5/7246—Details of waveform analysis using correlation, e.g. template matching or determination of similarity
    • 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
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/20—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for computer-aided diagnosis, e.g. based on medical expert systems

Definitions

  • the invention relates to a method for the automated determination of hemodynamic parameters in a blood vessel on invasively recorded pulse waves by analyzing these pulse waves and / or pulse waves selected from the entirety, but at least one pulse wave according to claim 1.
  • Cardiovascular events strongly define human mortality worldwide. In order to identify the associated risk at an early stage and prevent such an event, numerous hemodynamic parameters are collected and evaluated. For example, the elasticity or stiffness of the arteries is an independent predictor of cardiovascular events
  • PWV pulse wave velocity
  • Parameters make it possible, individually and / or from their entirety, to obtain specific information about the rigidity of the arterial wall of the vessel.
  • pulse waves are different with regard to
  • Pulse wave parameters e.g. B. times, amplitudes, shapes or relevant points are analyzed. All parameters generated from the analysis of pulse waves are to be referred to below as “pulse wave parameters” or “PWP”.
  • PWV pulse wave velocity
  • a measurement of the stiffness of the arterial vessel wall which is customary as the gold standard according to the current state of the art comprises an invasive measurement of the PWV and further PWPs at two measurement points in the aorta with the aid of a cardiac catheter.
  • the cardiac catheter is usually inserted through an access via the femoral artery (A. femoralis). There is then a recording of pressure waves, which are caused by the regular contraction of the heart, at two points invasively in the blood vessel,
  • the further procedure is usually as follows:
  • the time difference between the R wave in the registered ECG and the base point of the pressure wave registered via the catheter results in a so-called transit time (TT).
  • the transit time describes the time required for the pressure wave to travel from the contraction of the heart to the respective measuring point.
  • the measuring point then gives the running time of the pressure waves between the first
  • Measuring point and the second measuring point The distance between the first measuring point and the second measuring point is determined by withdrawing the catheter from the blood vessel, the withdrawal length of which being recorded. The PWV in the blood vessel can then be determined from the detected transit time difference at the two measuring points and the withdrawal length of the catheter.
  • Non-invasive measuring systems are required, which are used in everyday life, outside of a catheter laboratory and sometimes also outside of a doctor's office.
  • Non-invasive measurement systems require validation, which can only be achieved by invasive measurements as described.
  • the invasive measurement method is increasingly changing. For cardiac catheter examinations, access via the
  • Wrist artery radial artery selected.
  • the invasive determination of the PWV and some other PWPs is not possible by withdrawing the catheter.
  • the withdrawal length i.e. the distance from the measuring point in the ascending artery to the bifurcation
  • the measuring points must be measured or determined as precisely as possible. This is often only possible to an insufficient extent under real measurement conditions.
  • the evaluation should take place automatically and should therefore be easy, quick and delegable.
  • the interoperator variability of the measurement process is to be reduced and thus the objectivity of the measurement is increased.
  • the Accuracy of the invasive gold standard method can be increased.
  • the task is solved with an automated method
  • the method for invasively measuring a pulse wave velocity in a blood vessel is carried out with the following method steps:
  • a pressure measuring catheter with a pressure measuring sensor is inserted up to a designated measuring point within the blood vessel. This is followed by recording and storing a pressure curve over time and recording at least one pulse wave signal at this measuring point.
  • At least one pulse wave signal is analyzed to determine the PWPs, hereinafter using the example of the PWV. This is done in at least two different ways, which can also be combined if necessary, and to make the determination more robust:
  • z. B a so-called wave separation method (wave separation) applied.
  • Pulse wave fundamental signal component and the pulse wave echo component determined in the pulse wave signal This time offset is given by means of a
  • a PWV is calculated from the reference distance between an echo point of the blood vessel system and the position of the pressure measurement sensor in the blood vessel system.
  • a PWV z. B. determined with the help of the so-called wave analysis.
  • the models of the Bramwell-Hill model and a given pressure / flow model of the blood vessel system have proven to be suitable, but are not limited to this.
  • the basic idea of the method is therefore to determine the pressure profile over time
  • Determination of relevant points and areas on the signal to determine further PWPs e.g. B. the augmentation index, augmentation pressure and cardiac output is performed.
  • a signal filtering of the stored temporal pressure curve is carried out using a high and / or a low pass filter to detect the pulse wave signal.
  • a occurs when the pulse wave signal is detected
  • the extraction of the pulse wave echo component according to the wave decomposition method takes place in an advantageous embodiment such that the classified pulse wave is broken down into a forward signal component and a backward signal component on the detected pulse waves to extract the pulse wave echo component.
  • the forward signal component is the basic pulse wave signal
  • the reverse signal component is the pulse wave echo signal.
  • Reverse signal component determines a time difference as a time offset.
  • the time difference can be determined via the identified base points of the basic pulse wave signal and the pulse wave echo signal or via the cross-correlation method.
  • a reflection distance related to a body size to a prominent point that generates a pressure echo within the blood vessel system can be used as the given reference distance.
  • a weighted PWV can be determined from the PWV value determined via the wave decomposition method with the PWV value determined via the wave analysis.
  • An arrangement for executing a method comprises a measurement sensor which can be inserted and placed in the blood vessel, an evaluation and storage unit for receiving, storing and processing the data of the pressure data recorded by the measurement sensor and a control implemented in the evaluation and control unit - and
  • the measurement sensor is considered an indirect one
  • the evaluation and control unit can also have an interface for connecting an EKG detection device. In this way, the pulse wave data can be monitored and evaluated together with EKG data.
  • the evaluation and control unit can expediently be a
  • FIG. 1 to 10 serve to illustrate this.
  • PWPs pulse wave parameters
  • PWV pulse wave velocity
  • the basic principle of the method is a so-called single-point measurement carried out at only one location.
  • the temporal signal curve of the pressure at the measuring point is recorded and evaluated.
  • the aim of the method is to determine and evaluate a pulse wave echo, which results from the interaction of blood flow, blood pressure and the course of the arteries, e.g. from the aortic bifurcation located downstream of the body with the aorta forking into the left and right femoral artery.
  • this is done in such a way that a number of parameters, e.g. B. a number of functions and support points and their intervals can be determined. So z. B. at a known reflection distance using the determined time intervals on the PWV.
  • the method is carried out, for example, using the following basic method steps, which are explained in more detail below.
  • An invasive measurement in an arterial blood vessel is assumed here as an example.
  • pressure curves over time are measured. These pressure curves over time represent arterial pressure curves. For this purpose, these pressure curves are recorded and stored in a human artery using a measuring unit. The pressure curve measurement is carried out invasively.
  • the measuring process takes place, for example, in such a way that in connection with a
  • Cardiac catheterization access via the artery on the wrist (A.
  • At least one pressure curve course i.e. a pulse wave recorded.
  • the length of this time interval can be 10 seconds, for example.
  • the individual pulse wave signals are extracted from pressure curves. This is done with the following steps:
  • the signals are stored with the pressure fluctuations, i.e. with the pressure profiles.
  • the recorded signals are first cleaned of interference by filters.
  • filters For example, high-pass and / or low-pass filters can be used for this purpose.
  • the frequencies of 0.5 Hz for the high-pass filter and 50 Hz for the low-pass filter have been found to be suitable, but are not limited to this.
  • the base point method e.g. B. using the intersecting tangent method or the upstroke method.
  • the intersecting tangent method or the upstroke method.
  • Determining the pulse waves is not limited to these methods.
  • the detected base points of the pulse waves are important parameters when determining the pulse wave speed.
  • the detected pulse waves are then classified.
  • the shape of the individual pulse waves is analyzed. This allows a classification in at least one class, which has a significant influence on the
  • a signal analysis is carried out on the classified pulse wave signals.
  • Class-specific physiological points and properties of the pulse wave signal are determined, such as ejection duration ED (heart ejection time), a so-called inflection point IP (arrival of the reflected wave) or a characteristic impedance Zc (wave resistance).
  • ED heart ejection time
  • IP arrival of the reflected wave
  • Zc characteristic impedance
  • the points PI (First Shoulder) and P2 (Second Shoulder) have emerged as useful support points for the classification.
  • the empirical wavelet transform (EWT) together with differentiation and Fourier transforms are particularly suitable for signal analysis.
  • Dynamic time equalization (DTW) has proven to be particularly suitable for the classification.
  • the analysis steps described are not limited to these methods.
  • Wave decomposition methods each determine a pulse wave basic signal component and a pulse wave echo component, whose time offset from one another is determined.
  • Both signal components can be determined and the pulse wave echo component can be extracted, for example, by determining a so-called flow curve.
  • This flow curve can be used statistically averaged, for example, as a triangle starting at the base point (F), the maximum at the inflection point (IP) and the end at the level of ejection duration ED.
  • a more robust method is the so-called reservoir excess model. The excess curve determined can be used as a flow curve. Subsequently, the classified
  • Pulse waves into the respective forward waves (after ejection), i.e. in the forward signal component and the backward waves (after reflection on the vessel walls and vessel branches), i.e. into the reverse signal component.
  • the forward signal component is then the pulse wave basic signal component, the
  • the reverse signal component then represents the pulse wave echo component in the individual pulse wave signal.
  • the time difference between the first and second pulse wave signal In the next step, the time difference between the
  • Pulse wave fundamental signal component and the pulse wave echo signal component determined.
  • the time difference can be determined using the identified footpoints of the pulse wave echo signal component
  • Pulse wave basic signal and the pulse wave echo signal take place.
  • the method of cross correlation which is caused by shifting the two signals
  • Pulse wave basic signal and the pulse wave echo signal in each other determines the time difference, however, has proven to be more robust.
  • the determination or determination of a length is required.
  • This length forms a reference distance for the determination of the PWV and goes as Evaluation parameters in the signal processing. In particular, this is the distance between the position of the pressure measurement sensor and the echo point in the blood vessel system, which causes the pulse wave echo signal component.
  • This reference distance can either be measured and then leads to the specification, in particular, of an arterial length, which is used as suitable for the reflection. However, it can also be used e.g. B. determine an effective reflection distance (EfRD) based on the body size of the person examined.
  • EfRD effective reflection distance
  • the PWV can be determined by using the wave analysis without specifying a distance.
  • Bramwell-Hill model and a pressure / flow model of the blood vessel system have been found to be suitable, but are not limited to this. This means that the determination of the retreat length can be omitted.
  • the relationship between volume and pressure (PV relation) reflects, for example, the so-called arterial compliance, which is required in the Bramwell-Hill model.
  • the PU loop which reflects the relationship between the flow velocity and the pressure in the artery, the PWV can be derived at a local point via the increase at the beginning.
  • the Korteweg equation which takes into account the dependency of blood pressure via the elasticity module of the blood vessel wall, is also suitable.
  • the method is advantageously carried out independently of the platform.
  • the measuring unit consists of a
  • Measuring sensor which is connected to a control and storage unit.
  • This measuring sensor can be used directly or indirectly invasively and placed at the desired location in the artery.
  • a liquid-filled catheter with access via the radial artery is placed in the ascending artery and connected to a pressure sensor.
  • the pressure domes belonging to the catheter and the control and storage unit are located outside the measuring point, i.e. especially outside of the body.
  • an EKG detection device is used directly or indirectly invasively and placed at the desired location in the artery.
  • EKG an electrocardiogram
  • An interface for exporting the data can also be provided, as can a GUI interface for displaying the information, such as, for example, the pressure signals and certain parameters, such as, for. B. the foot points PO, the transit time TT, the ejection time of the heart ED, the inflection point IP, the pulse wave peaks z. B. PI and PI and / or the wave resistance Zc.
  • a GUI interface for displaying the information such as, for example, the pressure signals and certain parameters, such as, for. B. the foot points PO, the transit time TT, the ejection time of the heart ED, the inflection point IP, the pulse wave peaks z. B. PI and PI and / or the wave resistance Zc.
  • An interface for performing updates is also useful.
  • Calibration of the measuring system should be provided before each measurement (e.g.
  • the method mentioned and the example arrangement described are used for extracting and analyzing aortic pulse waves and for determining hemodynamic parameters (PWPs) of pulse wave analysis, such as B.
  • PWPs hemodynamic parameters
  • Pulse wave speed used.
  • Fig. 2 shows an exemplary measured pressure curve in a blood vessel
  • Fig. 4 is an illustration of individual, detected over the base points
  • Fig. 9 shows an exemplary representation of prominent points in a
  • Fig. 10 shows an exemplary wave decomposition of a pulse wave in the
  • the arrangement includes a catheter 1, a pressure sensor 2 and a control and storage unit 3.
  • Pressure sensors form a measuring sensor unit. In the example given here, it is used indirectly invasively and placed at the desired location in the artery.
  • One embodiment provides that a
  • an EKG detection device 6 can be provided, via which an EKG (an electrocardiogram) is parallel
  • control and evaluation program 7 can be provided, which carries out the steps described in the method for processing, processing and evaluating the stored pressure signals.
  • Evaluation program can be imported and updated externally in the evaluation and control unit.
  • An interface 8 can also be provided for carrying out updates.
  • an interface 9 for exporting the data is useful, as is a device-internal or external GUI interface for a display 10 or an external evaluation unit 11, for example a PC, with an external evaluation program 12 for displaying the information, such as, for example, the pressure signals and certain parameters, such as B. determined foot points F, a transit time TT, an ejection time of the heart ED, an inflection point IP and / or the support points of pulse wave peaks such. B. PI and P2.
  • a switch 13 can be provided with which a procedure for calibrating or for calibrating the measuring system can be triggered before each measurement. This applies in particular to pressure calibration.
  • a procedure makes sense with which the damping coefficients differ
  • the data can also z. B. about the access of the A. Radialis raised and without the influence of the R peaks of the EKG
  • PEP variability is understood to mean fluctuations in the time between the electrical excitation of the heart (R peak in the ECG) and the actual start of ejection (foot point). This scatter leads to a blur in the PWV determination by the withdrawal method
  • the signal should be recorded in a sufficient resolution and sampling rate so that details in the pulse waves are retained.
  • a sampling rate of 1,000 Hz and a processing width of 12 bits have been found to be suitable, but these parameters are not limited to this.
  • the measured value quantity of the temporal pressure curve is then transformed either in the control and storage unit itself or in the external evaluation unit to a uniform standard so that its processing
  • the signal of the temporal pressure curve can, for example, be sampled up to a sampling frequency of 1,000 Hz.
  • a sampling frequency of 1,000 Hz For this sampling process you can
  • polynomials of degree 3 are determined for two neighboring sample points (xi, y and (x; + i , y; + i ):
  • the signal can be resampled. If the output signal is sampled to a sampling frequency of 1,000 Hz, the following applies in this case:
  • Signal interference can be eliminated by using suitable filters.
  • the recorded signals are first cleaned of interference by filters.
  • filters For example, high-pass and low-pass filters can be used for this.
  • the frequencies of 0.5 Hz for the high-pass filter and 50 Hz for the low-pass filter have been found to be suitable, but are not limited to this.
  • the individual cardiac cycles i.e. the individual pulse wave signals, in particular their start and end, are identified and extracted. Carrying out the first time derivative with a subsequent determination of the base point has turned out to be suitable, but is not limited to this.
  • FIG. 3 illustrates the footpoint method "intersecting tangent" used in the method for extracting the individual pulse waves PW from the signal curve.
  • footpoint method described here by way of example, all turning points w (i) in the signal curve are determined with a positive increase in the first derivation from the fact that the value of the first temporal derivation of the pressure curve PPW is extremal in its place:
  • variable w denotes the respective positions of the "positive"
  • the result is a set of all the determined peaks, ie peaks, within the pulse-like signal component.
  • the base points F of the individual pulse waves PW are located, for example, with the aid of intersecting tangents in the vicinity of each individual maximum in the 1st derivative, that is to say in the vicinity of the previously determined inflection point.
  • the first local minimum M in the time range before the individual pulse wave is sought. This local minimum M has a horizontal tangent t M.
  • the intersection S between the horizontal tangent t M and the regression line, ie the tangent t w is calculated.
  • This intersection point S projected onto the signal curve, is then the base point F of the pulse wave PW. This point can also be adjusted subsequently.
  • Fig. 4 shows the correspondingly extracted pulse waves PW in the registered
  • This sorted sequence of peaks is analyzed step by step. Each peak is then recorded as a turning point relevant for the signal evaluation if its minimum height is greater than 0 and if its distance from all turning points already detected is greater than a defined time interval with respect to a predetermined sample rate FS.
  • Each peak w (i) from the sequence s (i) is therefore a turning point idx if the following conditions (a) and (b) are fulfilled at the same time:
  • Condition (b) expresses that a peak w (i) must have a certain minimum distance D from a peak idx (j) that has already been identified. This minimum distance is independent of the sample rate. In the present example, this is, for example, 350 ms.
  • a subsequent ascending sorting of idx puts the indices in the correct chronological order.
  • the 1st derivative can be calculated using the "Savitzsky-Goley" method.
  • the pulse wave signals PW thus extracted are subsequently analyzed further.
  • the essential core of the signal processing is the separation of the individual pulse wave signal PW into a pulse wave basic signal PG and into one
  • Pulse wave echo signal PE Pulse wave echo signal PE.
  • FIG. 5 shows the basic principle of the wave decomposition method of the individual extracted pulse wave signal PW into the pulse wave basic signal PG and the pulse wave echo signal PE.
  • the pulse wave signal PG describes the
  • Pulse wave echo signal PE can be registered. Both signal components have a time offset T from one another. This time offset allows one, for example
  • the shape of the pulse wave signals can be further analyzed and classified.
  • FIGS 6, 7 and 8 show examples of different categories of
  • Pulse waves These differ in particular in their form.
  • the pulse waves are classified accordingly. Decisive for the classification are the different forms in the course of each individual pulse wave signal PW, or the existence of points and features of a first shoulder PI and a second shoulder P2 of each individual pulse peak, as well as a strength of a dicrotia or incision I of the respective pulse wave.
  • the first and the second shoulder of each individual pulse wave peak in each individual pulse wave individual signal describe the strength of the "double summit" of a peak. It describes the change in the
  • This reflected component is the pulse wave echo component.
  • the so-called Inflection Point IP is located between the double peaks of the pulse wave signal.
  • the correct position of IP has z.
  • each individual pulse wave can be classified into form classes.
  • the number of calculation functions i.e. the number of classes, is k, where k is a natural number greater than 0.
  • the assignment to a class can be made according to the "nearest neighbor" principle. For example, the one belonging to a pulse wave
  • the shape of the individual pulse wave differs from the shoulderless calculation function more than from that
  • the class specification thus specifies which functions, which are classified according to certain properties, profiles or symmetries, must be used in order to “fit” the individual pulse wave signal.
  • Classification possibility Another possibility to assign to a class is to carry out the similarity analysis with the help of a dynamic time equalization (DTW).
  • DTW dynamic time equalization
  • the period lengths of the individual pulse wave signals and their times are designed to be invariant and thus enable a comparison. This comparison makes the forms of the pulse waves comparable with one another and with respect to the calculation functions and can be assigned to the classes.
  • a class-specific algorithm can be specified for each of these classes, which determines the hemodynamic parameters for the class.
  • the pulse wave signals shown in FIGS. 6, 7 and 8 can be categorized into three different classes.
  • the pulse wave single signals PW of the pulse wave signals in Fig. 6 are e.g.
  • pulse waveforms belong to a class of one
  • the individual pulse wave signals of the pulse wave signals in FIG. 7 are e.g. B. also two peaks with a peak PI and a peak P2 and a minimum located between them.
  • the characteristics of the amplitude of the peaks PI and P2 have interchanged in comparison to the embodiment in Fig. 6.
  • the peak PI now has a higher amplitude than P2. Incision I clearly describes the end of expectoration from the heart. This pulse waveform can therefore
  • the individual pulse wave signals of the pulse wave signals in FIG. 8 are e.g. B. single-peaked and do not have clear peaks for PI and P2. Due to the
  • c and Ci + i are the coefficients of the two nearest neighbors.
  • FIG. 9 shows an exemplary representation of shape features which are detected on a single pulse wave signal by function classes and which can thus be classified. It shows an exemplary representation of a pulse wave with the points F (base point), PI, P2, IP (inflection point; arrival of the reflected wave) and ED (ejection duration; ejection time of the heart; F to incisal I). These class-specific physiological points and properties are among others determined in the signal and serve as useful support in determining the pulse wave velocity and the PWPs.
  • the signal processing is not limited to this.
  • the pulse wave ejected here is the above-mentioned pulse wave basic signal component PG and the reflected pulse wave is the pulse wave echo component PE.
  • the so-called flow curve and the curve of the so-called reservoir pressure can also be determined and shown here.
  • the reservoir pressure curve RP is calculated from the Ascendens pressure curve AP using a reservoir excess model based on the 3-element wind boiler model.
  • the flow curve FLW (Flow) is obtained by subtracting the reservoir pressure curve RP from the Ascendens curve AP.
  • a forward wave FW (P f ) and a backward wave BW (P b ) are separated by means of the flow curve (Q) and the ascendent curve (P).
  • the values Q of the flow curve and the Ascendens curve P depend on the values P f of the
  • the size z is a characteristic impedance of the blood vessel and serves as a scaling coefficient of the flow curve Q.
  • the backward wave BW is the returning component of the pulse wave reflected at an echo point in the blood vessel
  • the forward wave FW is the result of the amount of blood expelled from the heart in the blood vessel Flow direction moving component of the pulse wave.
  • the Forward Wave FW represents the forward signal component of the
  • Pulse wave signal the backward wave BW represents the reverse signal component of the pulse wave signal PW.
  • a so-called transit time TT can be determined in different ways. Firstly, the difference in the base points between the backward wave and the forward wave. Since the base points in the backward wave only Cross-correlation is a suitable alternative.
  • the TT represents the required degree of shift of the backward wave towards the forward wave.
  • Dynamic time equalization has proven to be suitable.
  • Another method for determining the TT can be determined via the time interval between the first zero crossings of the averaged forward and backward wave.
  • the “mean” function here means that the mean value for the forward wave Pf and the backward wave Pb are calculated and then subtracted from the overall signal Pb or Pf. The signal thus swings around the value zero Zero crossings are then used to determine the TT.
  • the length of the blood vessel for determining the PWV for example the aortic length, is measured independently. Alternatively, this can also be estimated using the following formula.
  • the aortic length (distance) in relation to the height of the person (height) results from the
  • the pulse wave speed PWV then results from the aortic length
  • E inc is the modulus of elasticity of the wall of the blood vessel, h the wall thickness of the blood vessel, r the clear radius of the blood vessel lumen and p the density of the blood fluid.
  • E 0 corresponds to E inc at an initial pressure of zero.
  • SBP corresponds to the systolic blood pressure, which is derived from the higher the amplitude of the respective pulse wave.

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  • Health & Medical Sciences (AREA)
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  • Heart & Thoracic Surgery (AREA)
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  • Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)

Abstract

L'invention concerne un procédé permettant de déterminer de façon automatisée des paramètres hémodynamiques dans un vaisseau sanguin au niveau d'ondes impulsionnelles enregistrées de façon invasive, par l'analyse desdites ondes impulsionnelles et/ou d'ondes impulsionnelles choisies parmi la totalité, ou d'au moins une onde impulsionnelle. La mesure et/ou la détection invasives des paramètres d'ondes impulsionnelles, en particulier de la vitesse d'ondes impulsionnelles, sont réalisées à l'aide des étapes de procédé suivantes : introduction d'un cathéter de mesure de pression à l'aide d'un capteur de mesure de pression jusqu'à un point de mesure prévu au sein du vaisseau sanguin, enregistrement et mémorisation d'une variation temporelle de la pression et détection d'un signal d'ondes impulsionnelles au niveau du point de mesure, identification et classification des ondes impulsionnelles individuelles à partir du signal d'ondes impulsionnelles, analyse des ondes impulsionnelles au regard de différentes propriétés, par ex. périodes, amplitudes, formes et/ou points pertinents, détermination de la vitesse d'ondes impulsionnelles, d'une part, au moyen d'un procédé de définition d'ondes par détection et calcul d'un décalage temporel à l'aide d'un écart de référence donné entre une composante de signal de base d'ondes impulsionnelles et la composante d'écho d'ondes impulsionnelles du système de vaisseau sanguin dans le signal d'ondes impulsionnelles, détermination de la vitesse d'ondes impulsionnelles, d'autre part, au moyen d'une analyse d'ondes sans tenir compte de l'écart de référence par l'intermédiaire d'un modèle de pression/flux donné et d'un modèle de pression/volume du système de vaisseau sanguin.
PCT/EP2019/075127 2018-09-19 2019-09-19 Procédé et agencement permettant de déterminer de façon automatisée des paramètres hémodynamiques dans un vaisseau sanguin au niveau d'ondes impulsionnelles enregistrées de façon invasive WO2020058383A1 (fr)

Priority Applications (1)

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AU2019344027A AU2019344027A1 (en) 2018-09-19 2019-09-19 Method and arrangement for determining haemodynamic parameters in a blood vessel in an automated manner on the basis of invasively recorded pulse waves

Applications Claiming Priority (4)

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DE102018122938 2018-09-19
DE102018122938.0 2018-09-19
DE102019125062.5A DE102019125062A1 (de) 2018-09-19 2019-09-18 Verfahren zum automatisierten Bestimmen von hämodynamischen Parametern in einem Blutgefäß an invasiv aufgezeichneten Pulswellen
DE102019125062.5 2019-09-18

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WO2020058383A1 true WO2020058383A1 (fr) 2020-03-26

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CN113197557B (zh) * 2021-04-07 2023-07-07 季华实验室 人体脉搏分析方法、计算机可读存储介质及系统

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1236435A1 (fr) * 2001-03-01 2002-09-04 Pulsion Medical Systems AG Dispositif, programme informatique et cathéter veineux central pour la surveillance hémodynamique
US20070106162A1 (en) * 2004-02-18 2007-05-10 Miklos Illyes Apparatus and method for measuring hemodynamic parameters
DE102011114666A1 (de) * 2011-09-30 2013-04-04 Pulsion Medical Systems Se Vorrichtung zur hämodynamischen Überwachung

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1236435A1 (fr) * 2001-03-01 2002-09-04 Pulsion Medical Systems AG Dispositif, programme informatique et cathéter veineux central pour la surveillance hémodynamique
US20070106162A1 (en) * 2004-02-18 2007-05-10 Miklos Illyes Apparatus and method for measuring hemodynamic parameters
DE102011114666A1 (de) * 2011-09-30 2013-04-04 Pulsion Medical Systems Se Vorrichtung zur hämodynamischen Überwachung

Non-Patent Citations (2)

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Title
NICHOLS W W ET AL: "ARTERIAL ELASTANCE AND WAVE REFLECTION AUGMENTATION OF SYSTOLIC BLOOD PRESSURE: DELETERIOUS EFFECTS AND IMPLICATIONS FOR THERAPY", JOURNAL OF CARDIOVASCULAR PHARMACOLOGY AND THERAPEUTICS, CHURCHILL LIVINGSTONE, NAPERVILE, IL, US, vol. 6, no. 1, 1 January 2001 (2001-01-01), pages 5 - 21, XP008028712, ISSN: 1074-2484 *
STYCZYNSKI GRZEGORZ ET AL: "Echocardiographic Assessment of Aortic Pulse-Wave Velocity: Validation against Invasive Pressure Measurements", JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, MOSBY-YEAR BOOK, INC. ST. LOUIS, MO, US, vol. 29, no. 11, 7 September 2016 (2016-09-07), pages 1109 - 1116, XP029800382, ISSN: 0894-7317, DOI: 10.1016/J.ECHO.2016.07.013 *

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