WO2022059752A1

WO2022059752A1 - Monitoring system, cardiac function inspection system, monitoring method, and program

Info

Publication number: WO2022059752A1
Application number: PCT/JP2021/034188
Authority: WO
Inventors: 知紀八田; 知樹櫨田; 慶春江指
Original assignee: テルモ株式会社
Priority date: 2020-09-18
Filing date: 2021-09-16
Publication date: 2022-03-24

Abstract

This monitoring system can access a storage that stores an individual difference coefficient obtained from the relationship between an aortic pressure value obtained by measuring the ascending aorta pressure and a first blood pressure value obtained for the arterial pressure downstream of the ascending aorta. The monitoring system comprises a controlling part that acquires, upon receiving input of a second blood pressure value newly obtained for the arterial pressure downstream of the ascending aorta, the individual difference coefficient from the storage and estimates the ascending aorta pressure from the second blood pressure value using the individual difference coefficient.

Description

Monitoring system, cardiac function test system, monitoring method, and program

This disclosure relates to monitoring systems, cardiac function testing systems, monitoring methods, and programs.

Patent Document 1 discloses a technique for estimating left intracranial pressure from heart sounds, brachial cuff pressure, and K sound. "K" is an abbreviation for Korotkoff.

U.S. Patent Application Publication No. 2015/0265163

Acute exacerbations are a problem for patients with heart failure. LVEDP is known as an index showing a sign of exacerbation at an early stage. LVEDP is the terminal pressure of left ventricular dilatation.

There are two methods for measuring left ventricular pressure, one is by a pigtail catheter and the other is by an implantable device, both of which are invasive. Therefore, the burden on the patient is large.

The technique disclosed in Patent Document 1 relates to an algorithm for estimating left ventricular pressure, but it is known that there are individual differences in the state of blood vessels and cardiac function, and the estimation accuracy of left ventricular pressure is known. It is thought that it affects.

According to Non-Patent Document 1, as shown in FIGS. 3, 5, and 6, in a triangle 41 which is a right triangle, one of the two sides sandwiching the right angle is PEP, and the other is the difference obtained by subtracting LVEDP from AoDP. Then, the inclination of the hypotenuse corresponds to the contractility of the left ventricle. PEP is the prodromal time, that is, the time from the end of left ventricular diastole to the aortic diastole. AoDP is the diastolic pressure of the aorta, that is, the ascending aortic pressure when the aortic valve is opened.

It is conceivable to calculate LVEDP according to the theory proposed in Non-Patent Document 1, but a means for following minimal invasiveness is required for AoDP, which changes daily. Here, "minimally invasive" includes non-invasive.

The purpose of this disclosure is to follow minimal invasion of ascending aortic pressure.

The monitoring system as one aspect of the present disclosure is an individual obtained from the relationship between the aortic pressure value obtained by measuring the ascending aortic pressure and the first blood pressure value obtained for the arterial pressure downstream of the ascending aorta. It is a monitoring system that can access the storage that stores the difference coefficient, and when it receives the input of the second blood pressure value newly obtained for the arterial pressure downstream of the ascending aorta, the individual difference coefficient is acquired from the storage. , A control unit for estimating the ascending aortic pressure from the second blood pressure value using the individual difference coefficient.

In one embodiment, the individual difference coefficient is the ratio of the aortic pressure value to the first blood pressure value, and the control unit sets the product of the second blood pressure value and the individual difference coefficient as the ascending aortic pressure. Calculated as an estimated value of.

As one embodiment, the aortic pressure value is the aortic diastolic pressure.

As one embodiment, the arterial pressure downstream of the ascending aorta is any of brachial artery pressure, radial artery pressure, femoral artery pressure, carotid artery pressure, and ankle dorsal artery pressure.

As one embodiment, the storage stores the individual difference coefficient for each individual, and when the control unit receives the input of the individual identifier together with the input of the second blood pressure value, the individual difference coefficient is input as the individual difference coefficient. Obtain the coefficient corresponding to the identifier.

As one embodiment, the storage is obtained from the relationship between the aortic pressure value, the left ventricular pressure value obtained by measuring the left ventricular pressure, and the first time value obtained by measuring the precursor time. Further storing the contractile ability parameter, when the control unit receives the input of the newly obtained data by measuring the heart, the value of the precursor time is used as the second time value from the input data. At the same time, the contractility parameter is acquired from the storage, and the contractility parameter is used to estimate the left ventricular pressure from the estimated value of the ascending aorta pressure and the second time value.

As one embodiment, the contractility parameter is a parameter showing the relationship between the first time value and the difference between the aortic pressure value and the left ventricular pressure value.

In one embodiment, the contractility parameter is the ratio of the difference between the aortic pressure value and the left ventricular pressure value to the first time value, and the control unit has the estimated value of the ascending aortic pressure and the said. The difference between the product of the second time value and the contractility parameter is calculated as the estimated value of the left ventricular pressure.

As one embodiment, the left ventricular pressure value is the left ventricular end-diastolic pressure.

As one embodiment, the data includes the results of electrocardiographic measurement and cardiac sound measurement.

As an embodiment, the data includes the result of echocardiographic measurement.

As one embodiment, the storage further stores the result of the echocardiographic measurement, and when the control unit receives the input of the new echocardiographic measurement result, the input result is stored in the storage. The comparison is made, and the contractility parameter is corrected according to the comparison result.

As one embodiment, the aortic pressure value and the left ventricular pressure value are values obtained by performing a catheter examination.

As an embodiment, the monitoring system further includes a storage unit corresponding to the storage.

The cardiac function test system as one aspect of the present disclosure is acquired by an aortic pressure waveform acquisition device that acquires an aortic pressure waveform, a blood pressure measuring device that measures an arterial pressure downstream of the ascending aorta, and the aortic pressure waveform acquisition device. A calculation that calculates the aortic pressure value from the aortic pressure waveform, calculates the ratio of the aortic pressure value to the blood pressure value obtained as the measurement result of the blood pressure measuring device as an individual difference coefficient, and stores the individual difference coefficient in the storage. Equipped with a device.

As one embodiment, the cardiac function test system further includes a left ventricular pressure waveform acquisition device for acquiring a left ventricular pressure waveform, and the arithmetic unit is obtained from the left ventricular pressure waveform acquired by the left ventricular pressure waveform acquisition device. The left ventricular pressure value is acquired, and the value of the precursor time is calculated as a time value from the aortic pressure waveform acquired by the aortic pressure waveform acquisition device, and the time value, the aortic pressure value, and the left ventricular pressure value are calculated. A parameter indicating the relationship with the difference between the above is calculated as a contractility parameter, and the contractility parameter is stored in the storage.

The monitoring method as one aspect of the present disclosure is an individual obtained from the relationship between the aortic pressure value obtained by measuring the ascending aortic pressure and the first blood pressure value obtained for the arterial pressure downstream of the ascending aorta. It is a monitoring method using a computer that can access a storage that stores the difference coefficient, and when the computer receives an input of a newly obtained second blood pressure value for an arterial pressure downstream of the ascending aorta, the storage is used. The individual difference coefficient is acquired, and the computer estimates the ascending aortic pressure from the second blood pressure value using the individual difference coefficient.

The program as one aspect of the present disclosure is an individual difference obtained from the relationship between the aortic pressure value obtained by measuring the ascending aortic pressure and the first blood pressure value obtained for the arterial pressure downstream of the ascending aorta. When a computer accessible to the storage for storing the coefficient receives an input of a second blood pressure value newly obtained for the arterial pressure downstream of the ascending aorta, the process of acquiring the individual difference coefficient from the storage and the process of acquiring the individual difference coefficient are performed. Using the individual difference coefficient, the process of estimating the ascending aortic pressure from the second blood pressure value is executed.

According to the present disclosure, it is possible to follow the minimal invasiveness to the ascending aortic pressure.

It is a block diagram which shows the structure of the system which concerns on embodiment of this disclosure. It is a flowchart which shows the operation of the cardiac function test system which concerns on embodiment of this disclosure. It is a figure which shows the theory applied in embodiment of this disclosure. It is a flowchart which shows the operation of the monitoring system which concerns on embodiment of this disclosure. It is a figure which shows an example of the change of the triangle in the embodiment of this disclosure. It is a figure which shows another example of the change of a triangle in the embodiment of this disclosure.

Hereinafter, embodiments of the present disclosure will be described with reference to the figures.

In each figure, the same or corresponding parts are given the same reference numerals. In the description of the present embodiment, the description will be omitted or simplified as appropriate for the same or corresponding parts.

The configuration of the system 10 according to the present embodiment will be described with reference to FIG.

The system 10 according to the present embodiment includes a cardiac function test system 20 and a monitoring system 30.

The cardiac function test system 20 includes a blood pressure measuring device 21, an aortic pressure waveform acquisition device 22, a left ventricular pressure waveform acquisition device 23, a waveform data acquisition device 24, and a calculation device 25.

The blood pressure measuring device 21 is a device that measures the arterial pressure downstream of the ascending aorta. As the measuring method, any method may be used, but in the present embodiment, a non-invasive method using a cuff or an invasive method using an A-line is used. "A" is an abbreviation for arterial. In the present embodiment, the blood pressure measuring device 21 measures the brachial artery pressure or the radial artery pressure as the arterial pressure downstream of the ascending aorta, but the femoral artery pressure, the carotid artery pressure, the dorsalis pedis artery pressure, or other central artery. External blood pressure may be measured. Extracentral arterial blood pressure such as brachial artery pressure, radial artery pressure, femoral artery pressure, carotid artery pressure, and dorsalis pedis pressure corresponds to so-called "peripheral blood pressure".

The aortic pressure waveform acquisition device 22 is a device that acquires an aortic pressure waveform. Any method may be used as the acquisition method, but in the present embodiment, an open blood method using a pressure sensor catheter is used.

The left ventricular pressure waveform acquisition device 23 is a device that acquires a left ventricular pressure waveform. Any method may be used as the acquisition method, but in the present embodiment, an open blood method using a pressure sensor catheter is used.

The waveform data collecting device 24 collects the aortic pressure waveform acquired by the aortic pressure waveform acquisition device 22 and the left ventricular pressure waveform acquired by the left ventricular pressure waveform acquisition device 23 as waveform data, and outputs the waveform data. It is a device.

The arithmetic unit 25 is a computer that executes processing such as data analysis, cardiac function calculation, and individual difference coefficient calculation. The arithmetic unit 25 is, for example, a dedicated device, a general-purpose device such as a PC, or a server device belonging to a cloud computing system or other computing system. "PC" is an abbreviation for personal computer. The arithmetic unit 25 can communicate with the blood pressure measuring device 21, the waveform data collecting device 24, and the monitoring system 30 directly or via a network such as a LAN or the Internet. "LAN" is an abbreviation for local area network.

The data analysis executed by the arithmetic unit 25 is a process of analyzing the waveform data output from the waveform data acquisition device 24. The cardiac function calculation executed by the calculation device 25 calculates the aortic pressure value, the left ventricular pressure value, and the prodromal time value based on the result of data analysis, and the contractility parameter is calculated from the relationship between the calculated three values. Is the process of finding. The aortic pressure value is specifically the aortic diastolic pressure, that is, AoDP. The left ventricular pressure value is specifically the left ventricular end-diastolic pressure, that is, LVEDP. The prodromal time, i.e., PEP, is calculated as the time from the point corresponding to the LVEDP to the onset of the onset of the aortic pressure waveform by synchronizing the left ventricular pressure waveform with the aortic pressure waveform. In this embodiment, the left ventricular pressure and the aortic pressure are measured simultaneously by the dual pressure sensor catheter, but the left ventricular pressure and the aortic pressure are measured separately, and then another ECG, A line, or PPG is used. It may be synchronized with reference to the pulse wave. "ECG" is an abbreviation for electrocardiogram. "PPG" is an abbreviation for photoplethysmogram. In the triangle 41 shown in FIG. 3, FIG. 5, or FIG. 6, if one of the two sides sandwiching the right triangle is PEP and the other is the difference obtained by subtracting LVEDP from AoDP, the inclination of the hypotenuse corresponds to the contractility of the left ventricle. In the present embodiment, the contractility parameter is a parameter representing this inclination, but may be a parameter representing an approximate curve from the time point corresponding to the LVEDP to the rising point of the start of the aortic pressure waveform in the left ventricular pressure waveform.

The individual difference coefficient calculation executed by the arithmetic unit 25 is a process of obtaining the individual difference coefficient from the relationship between the aortic pressure value calculated by the cardiac function calculation and the blood pressure value obtained as the measurement result of the blood pressure measuring device 21. .. The individual difference coefficient is specifically the ratio of AoDP divided by the blood pressure value.

The aortic pressure value, left ventricular pressure value, contractility parameter, blood pressure value, and individual difference coefficient are stored in the storage as test data. The storage is provided in the monitoring system 30 in this embodiment, but may be connected to the monitoring system 30 as external storage.

The monitoring system 30 is a computer that executes afterload calculation and LVEDP calculation. The monitoring system 30 is, for example, a dedicated device, a general-purpose device such as a PC, or a server device belonging to a cloud computing system or other computing system.

The afterload calculation executed by the monitoring system 30 is a process of estimating the ascending aortic pressure from the blood pressure value newly obtained by the blood pressure measurement using the individual difference coefficient stored in the storage. In the blood pressure measurement, the arterial pressure downstream of the ascending aorta is measured in the same manner as the measurement by the blood pressure measuring device 21. As the measuring method, any method may be used, but in the present embodiment, a non-invasive method using a cuff or an invasive method using an A-line is used. A measurement method different from that of the blood pressure measuring device 21 may be used. In the present embodiment, the brachial artery pressure or the radial artery pressure is measured as the arterial pressure downstream of the ascending aorta according to the blood pressure measuring device 21, but the femoral artery pressure, the carotid artery pressure, the dorsalis pedis artery pressure, or the like. Extracentral arterial blood pressure may be measured. Instead of measuring the arterial pressure downstream of the ascending aorta, the arterial pressure downstream of the ascending aorta may be estimated to obtain a blood pressure value. As the estimation method, any method such as a method by PPG, a method by face image analysis, or a method by millimeter wave radar may be used. Specifically, the afterload calculation is a process of calculating the product of the individual difference coefficient multiplied by the blood pressure value as the estimated value of AoDP.

The LVEDP calculation performed by the monitoring system 30 identifies the PEP value from the newly obtained data from the preload measurement and estimates the left ventricular pressure from the identified value using the contractility parameter stored in the storage. It is a process to do. The preload measurement is specifically an electrocardiographic measurement and a heart sound measurement, or an echocardiographic measurement. As for the method of specifying the PEP value from the electrocardiogram and the heart sound, and the method of specifying the PEP value from the echocardiography, a known method may be used. As another known method, a method of specifying the value of PEP from the electrocardiogram may be used. Specifically, the LVEDP calculation is a process of calculating the difference obtained by subtracting the product of the contractility parameter by the PEP value from the estimated value of AoDP calculated by the afterload calculation as the estimated value of LVEDP.

The monitoring system 30 includes a control unit 31, a storage unit 32, a communication unit 33, an input unit 34, and an output unit 35.

The control unit 31 includes at least one processor, at least one programmable circuit, at least one dedicated circuit, or any combination thereof. The processor is a general-purpose processor such as a CPU or GPU, or a dedicated processor specialized for a specific process. "CPU" is an abbreviation for central processing unit. "GPU" is an abbreviation for graphics processing unit. The programmable circuit is, for example, an FPGA. "FPGA" is an abbreviation for field-programmable gate array. The dedicated circuit is, for example, an ASIC. "ASIC" is an abbreviation for application specific integrated circuit. The control unit 31 executes processing related to the operation of the monitoring system 30 while controlling each unit of the monitoring system 30. The control unit 31 executes afterload calculation and LVEDP calculation.

The storage unit 32 includes at least one semiconductor memory, at least one magnetic memory, at least one optical memory, or any combination thereof. The semiconductor memory is, for example, RAM or ROM. "RAM" is an abbreviation for random access memory. "ROM" is an abbreviation for read only memory. The RAM is, for example, an SRAM or a DRAM. "SRAM" is an abbreviation for static random access memory. "DRAM" is an abbreviation for dynamic random access memory. The ROM is, for example, EEPROM. "EEPROM" is an abbreviation for electrically erasable programmable read only memory. The storage unit 32 functions as, for example, a main storage device, an auxiliary storage device, or a cache memory. The storage unit 32 stores data used for the operation of the monitoring system 30 and data obtained by the operation of the monitoring system 30. The storage unit 32 corresponds to storage in this embodiment.

The communication unit 33 includes at least one communication interface. The communication interface is, for example, a LAN interface, an interface compatible with mobile communication standards such as LTE, 4G standard, or 5G standard, or an interface compatible with short-range wireless communication such as Bluetooth (registered trademark). "LTE" is an abbreviation for Long Term Evolution. "4G" is an abbreviation for 4th generation. "5G" is an abbreviation for 5th generation. The communication unit 33 receives the data used for the operation of the monitoring system 30, and also transmits the data obtained by the operation of the monitoring system 30.

The input unit 34 includes at least one input interface. The input interface is, for example, a physical key, a capacitance key, a pointing device, a touch screen integrally provided with a display, a photographing device such as a camera, or a microphone. The input unit 34 receives an operation for inputting data used for the operation of the monitoring system 30. The input unit 34 may be connected to the monitoring system 30 as an external input device instead of being provided in the monitoring system 30. As the connection method, for example, any method such as USB, HDMI (registered trademark), or Bluetooth (registered trademark) can be used. "USB" is an abbreviation for Universal Serial Bus. "HDMI (registered trademark)" is an abbreviation for High-Definition Multimedia Interface.

The output unit 35 includes at least one output interface. The output interface is, for example, a display or a speaker. The display is, for example, an LCD or an organic EL display. "LCD" is an abbreviation for liquid crystal display. "EL" is an abbreviation for electroluminescence. The output unit 35 outputs the data obtained by the operation of the monitoring system 30. The output unit 35 may be connected to the monitoring system 30 as an external output device instead of being provided in the monitoring system 30. As the connection method, for example, any method such as USB, HDMI (registered trademark), or Bluetooth (registered trademark) can be used.

The function of the monitoring system 30 is realized by executing the program according to the present embodiment on the processor as the control unit 31. That is, the function of the monitoring system 30 is realized by software. The program causes the computer to function as the monitoring system 30 by causing the computer to perform the operation of the monitoring system 30. That is, the computer functions as the monitoring system 30 by executing the operation of the monitoring system 30 according to the program.

The program can be stored on a non-temporary computer-readable medium. The non-temporary computer readable medium is, for example, a flash memory, a magnetic recording device, an optical disk, a photomagnetic recording medium, or a ROM. The distribution of the program is performed, for example, by selling, transferring, or renting a portable medium such as an SD card, DVD, or CD-ROM in which the program is stored. "SD" is an abbreviation for Secure Digital. "DVD" is an abbreviation for digital versatile disc. "CD-ROM" is an abbreviation for compact disc read only memory. The program may be distributed by storing the program in the storage of the server and transferring the program from the server to another computer. The program may be provided as a program product.

The computer temporarily stores the program stored in the portable medium or the program transferred from the server in the main storage device, for example. Then, the computer reads the program stored in the main storage device by the processor, and executes the processing according to the read program by the processor. The computer may read the program directly from the portable medium and perform processing according to the program. The computer may sequentially execute processing according to the received program each time the program is transferred from the server to the computer. The process may be executed by a so-called ASP type service that realizes the function only by the execution instruction and the result acquisition without transferring the program from the server to the computer. "ASP" is an abbreviation for application service provider. The program includes information used for processing by a computer and equivalent to the program. For example, data that is not a direct command to the computer but has the property of defining the processing of the computer corresponds to "a program-like data".

A part or all the functions of the monitoring system 30 may be realized by a programmable circuit or a dedicated circuit as the control unit 31. That is, some or all the functions of the monitoring system 30 may be realized by hardware.

The operation of the cardiac function test system 20 according to the present embodiment will be described with reference to FIG. This operation corresponds to the cardiac function test method according to the present embodiment.

In step S101, the blood pressure measuring device 21 measures the arterial pressure downstream of the ascending aorta. Specifically, the blood pressure measuring device 21 measures the blood pressure non-invasively by a cuff attached to the upper arm or the wrist. Alternatively, the blood pressure measuring device 21 measures the blood pressure invasively by the A line.

In step S102, a catheter examination is performed. As a result, the left ventricular pressure waveform acquisition device 23 acquires the left ventricular pressure waveform as shown in FIG. The aortic pressure waveform acquisition device 22 acquires an aortic pressure waveform as shown in FIG.

In step S103, the arithmetic unit 25 acquires the left ventricular pressure value from the left ventricular pressure waveform acquired by the left ventricular pressure waveform acquisition device 23. That is, the arithmetic unit 25 acquires the left ventricular pressure value obtained by performing the catheter examination in step S102. Specifically, the arithmetic unit 25 acquires the LVEDP value from the left ventricular pressure waveform invasively acquired by the pressure sensor catheter. In the example of FIG. 3, the point A is extracted as the point corresponding to the LVEDP.

In step S104, the arithmetic unit 25 calculates the aortic pressure value from the aortic pressure waveform acquired by the aortic pressure waveform acquisition device 22. That is, the arithmetic unit 25 calculates the aortic pressure value obtained by performing the catheter examination in step S102. Further, the arithmetic unit 25 calculates the value of the precursor time from the aortic pressure waveform acquired by the aortic pressure waveform acquisition device 22 as the first time value. Specifically, the arithmetic unit 25 calculates PEP and AoDP by time-synchronizing the left ventricular pressure waveform and the aortic pressure waveform obtained invasively by the pressure sensor catheter, respectively. In the example of FIG. 3, the point B is extracted as the point corresponding to AoDP. The line segment AC is extracted as the line segment corresponding to PEP.

In step S105, the arithmetic unit 25 calculates a parameter indicating the relationship between the first time value and the difference between the aortic pressure value and the left ventricular pressure value as the contractility parameter. In the present embodiment, the arithmetic unit 25 calculates the ratio of the difference between the aortic pressure value and the left ventricular pressure value with respect to the first time value as the contractility parameter. Specifically, the arithmetic unit 25 calculates Ctr by the following equation when Ctr is used as a contractility parameter.
Ctr = (AoDP-LVEDP) / PEP
In the example of FIG. 3, the slope of the hypotenuse of the triangle 41 corresponding to the right triangle ABC is calculated as Ctr. As an example of modification, Ctr is calculated as a curve that approximates the left ventricular pressure waveform in the time from the time point corresponding to the LVEDP to the rising point of the beginning of the aortic pressure waveform, as in the curve AB before linearization in FIG. May be done.

In step S106, the arithmetic unit 25 calculates the ratio of the aortic pressure value to the first blood pressure value obtained as the measurement result of the blood pressure measuring device 21 as an individual difference coefficient. The first blood pressure value may be the highest value, the lowest value, or another value such as an intermediate value of the blood pressure obtained as a measurement result. Specifically, the arithmetic unit 25 calculates AoDP / pBPRef as an individual difference coefficient when pBPRef is the first blood pressure value.

In steps S105 and S106, the arithmetic unit 25 may store the contractility parameter and the individual difference coefficient in the storage, respectively, but in the present embodiment, in step S106, the arithmetic unit 25 has the contractility parameter and the individual difference. Store the coefficients together in the storage. Specifically, the arithmetic unit 25 uses the Ctr calculated in step S105 and the individual difference coefficient calculated in step S106 as inspection data together with the LVEDP value acquired in step S103 and the PEP and AoDP calculated in step S104. Collectively send to the monitoring system 30. The communication unit 33 of the monitoring system 30 receives the inspection data. The storage unit 32 of the monitoring system 30 stores the inspection data received by the communication unit 33.

As a result, the storage unit 32 of the monitoring system 30 is an individual obtained from the relationship between the aortic pressure value obtained by measuring the ascending aorta pressure and the first blood pressure value obtained for the arterial pressure downstream of the ascending aorta. Store the difference coefficient. The storage unit 32 has a contractility parameter obtained from the relationship between the aortic pressure value, the left ventricular pressure value obtained by measuring the left ventricular pressure, and the first time value obtained by measuring the precursor time. Further memorize.

The operation of the monitoring system 30 according to the present embodiment will be described with reference to FIG. This operation corresponds to the monitoring method according to the present embodiment.

In step S107, when the control unit 31 measures the heart and receives the input of the newly obtained data, the control unit 31 specifies the value of the precursor time from the input data as the second time value, and the storage unit 32. Obtain the contractility parameter from. The input data includes the results of electrocardiographic and heart sound measurements, or the results of echocardiographic measurements. The data may be input by being received by the communication unit 33, or may be input via the input unit 34. Specifically, the control unit 31 acquires the PEP value from the electrocardiogram and the heart sound obtained by the non-invasive measurement. Alternatively, the control unit 31 acquires the PEP value from the echocardiography obtained by the non-invasive measurement. Further, the control unit 31 acquires the Ctr included in the inspection data stored in the storage unit 32.

In step S108, when the control unit 31 receives the input of the newly obtained second blood pressure value for the arterial pressure downstream of the ascending aorta, the control unit 31 acquires the individual difference coefficient from the storage unit 32. The second blood pressure value may be input by being received by the communication unit 33, or may be input via the input unit 34. The second blood pressure value may be the highest value, the lowest value, or another value such as an intermediate value of the blood pressure obtained as a measurement result, but which value is applied as the second blood pressure value is the second. 1 Determined according to blood pressure value. Specifically, the control unit 31 acquires a blood pressure value non-invasively measured by a cuff attached to the upper arm or wrist. Alternatively, the control unit 31 acquires the blood pressure value measured invasively by the A line. Further, the control unit 31 acquires the individual difference coefficient included in the inspection data stored in the storage unit 32.

In step S109, the control unit 31 estimates the ascending aortic pressure from the second blood pressure value using the individual difference coefficient. Specifically, the control unit 31 calculates the product of the second blood pressure value and the individual difference coefficient as an estimated value of the ascending aorta pressure. More specifically, when tAoDP is an estimated value of AoDP and pBPd is a second blood pressure value, the control unit 31 calculates tAoDP by the following equation.
tAoDP = pBPd × individual difference coefficient

The control unit 31 may output an estimated value of the ascending aortic pressure. For example, the control unit 31 may display tAoDP on a display as an output unit 35. Alternatively, the control unit 31 may output the tAoDP by voice from the speaker as the output unit 35. Alternatively, the control unit 31 may transmit tAoDP to the communication unit 33. The communication unit 33 may transmit tAoDP directly or to another device via a network such as a LAN or the Internet.

In step S110, the control unit 31 estimates the left ventricular pressure from the estimated value of the ascending aortic pressure and the second time value using the contractility parameter. Specifically, the control unit 31 calculates the difference between the estimated value of the ascending aortic pressure and the product of the second time value and the contractility parameter as the estimated value of the left ventricular pressure. More specifically, the control unit 31 calculates the estimated value of LVEDP by the following equation when PEPd is set as the second time value.
LVEDP = tAoDP-Ctr × PEPd
For example, assuming that the contractility is constant and the LVEDP is also constant, as shown in FIG. 5, the increase in blood pressure appears in the form of a longer PEP in the changed triangle 42. Further, assuming that the contractile ability is constant and the blood pressure is also constant, as shown in FIG. 6, the shortening of PEP appears in the form of an increase in LVEDP in the changed triangle 43.

The control unit 31 may output an estimated value of the left ventricular pressure. For example, the control unit 31 may display the estimated value of LVEDP on the display as the output unit 35. Alternatively, the control unit 31 may output the estimated value of the LVEDP by voice from the speaker as the output unit 35. Alternatively, the control unit 31 may cause the communication unit 33 to transmit the estimated value of the LVEDP. The communication unit 33 may transmit the estimated value of LVEDP directly or via a network such as LAN or the Internet to another device.

As an application example of this embodiment, the flow shown in FIG. 2 may be carried out when performing a catheter examination in a hospital, and the flow shown in FIG. 4 may be carried out when performing daily monitoring inside or outside the hospital. For example, if the flow shown in FIG. 2 is performed before the patient with heart failure is discharged and the test data is stored in the storage, and the test data is used to perform the flow shown in FIG. 4 after discharge, one invasive test can be performed. Based on the results, it becomes possible to perform chronic phase management with minimal invasiveness. During the period of chronic phase management, the implementation result of the flow of FIG. 4 may be analyzed as trend data, and the prescription of the drug may be adjusted according to the analysis result. Alternatively, the data may be monitored and an alarm may be notified when an abnormality is detected. Further, the inspection data may be updated by periodically carrying out the flow of FIG. 2 such as one year.

As described above, in the present embodiment, the aortic pressure waveform acquisition device 22 of the cardiac function test system 20 acquires the aortic pressure waveform. The blood pressure measuring device 21 of the cardiac function test system 20 measures the arterial pressure downstream of the ascending aorta. The arithmetic unit 25 of the cardiac function test system 20 calculates the aortic pressure value from the aortic pressure waveform acquired by the aortic pressure waveform acquisition device 22. The arithmetic unit 25 calculates the ratio of the aortic pressure value to the blood pressure value obtained as the measurement result of the blood pressure measuring device 21 as an individual difference coefficient. The arithmetic unit 25 stores the individual difference coefficient in the storage.

The monitoring system 30 is a storage that stores an individual difference coefficient obtained from the relationship between the aortic pressure value obtained by measuring the ascending aorta pressure and the first blood pressure value obtained for the arterial pressure downstream of the ascending aorta. It is accessible. Upon receiving the input of the newly obtained second blood pressure value for the arterial pressure downstream of the ascending aorta, the control unit 31 of the monitoring system 30 acquires the individual difference coefficient from the storage. The control unit 31 estimates the ascending aortic pressure from the second blood pressure value using the individual difference coefficient.

According to this embodiment, it is possible to follow the minimal invasiveness to the ascending aortic pressure.

In the present embodiment, the left ventricular pressure waveform acquisition device 23 of the cardiac function test system 20 acquires the left ventricular pressure waveform. The arithmetic unit 25 acquires the left ventricular pressure value from the left ventricular pressure waveform acquired by the left ventricular pressure waveform acquisition device 23, and obtains the value of the precursor time from the aortic pressure waveform acquired by the aortic pressure waveform acquisition device 22. Calculated as a time value. The arithmetic unit 25 calculates a parameter indicating the relationship between the time value and the difference between the aortic pressure value and the left ventricular pressure value as a contractility parameter. The arithmetic unit 25 stores the contractility parameter in the storage.

The storage further includes the contractility parameter obtained from the relationship between the aortic pressure value, the left ventricular pressure value obtained by measuring the left ventricular pressure, and the first time value obtained by measuring the precursor time. Remember. When the control unit 31 measures the heart and receives the input of the newly obtained data, the control unit 31 specifies the value of the precursor time as the second time value from the input data and acquires the contractility parameter from the storage. do. The control unit 31 estimates the left ventricular pressure from the estimated value of the ascending aorta pressure and the second time value using the contractility parameter.

According to this embodiment, it is possible to correct the error of the individual difference factor when estimating the aortic pressure and the left ventricular pressure from the aortic pressure outside the central artery with the open blood test information. Therefore, the estimation accuracy of aortic pressure and left ventricular pressure is improved.

In this embodiment, the LVEDP and related numerical values are calculated by the individual difference coefficient using the open blood test information. Specifically, tAoDP is obtained from the central extraarterial blood pressure value measured daily using the individual difference coefficient obtained from the relationship between the AoDP obtained by catheterization and the central extraarterial blood pressure value measured at that time. Calculated. Here, AoDP is a value indicating afterload. LVEDP is calculated from the value of PEP by non-invasive sensing, the value of tAoDP, and the contractility parameter obtained by catheterization. The extracentral arterial blood pressure value may be a blood pressure value obtained by a non-open blood measurement with a cuff, or an arterial pressure value obtained by an open blood measurement from the A line. The extracentral arterial blood pressure value and the PEP value may be the average value of the values obtained by a plurality of measurements. Contractility may be measured by echo instead of catheterization.

According to this embodiment, AoDP can be calculated accurately only by the blood pressure value outside the central artery and the individual difference coefficient. Since LVEDP can be calculated from tAoDP, the PEP value obtained by sensing such as electrocardiogram and cardiac sound, and the contractility parameter obtained at the time of examination, complicated calculation is not required and accuracy can be expected to be improved. ..

As a modification of this embodiment, the storage may store the individual difference coefficient for each individual. In this modification, when the control unit 31 of the monitoring system 30 receives the input of the individual identifier together with the input of the second blood pressure value, the control unit 31 acquires the coefficient corresponding to the input identifier as the individual difference coefficient.

According to this modification, the monitoring system 30 can be commonly used for a plurality of patients.

As another modification of this embodiment, the storage may further store the result of echocardiography measurement. In this modification, when the control unit 31 of the monitoring system 30 receives the input of the new echocardiographic measurement result, the input result is compared with the result stored in the storage. The control unit 31 corrects the contractility parameter according to the comparison result.

According to this modification, it will be possible to calibrate the contractility parameter in the future by obtaining the correlation between the contractility parameter and the echo data when calculating the contractility parameter.

The present disclosure is not limited to the above-described embodiment. For example, two or more blocks described in the block diagram may be integrated, or one block may be divided. Instead of executing the two or more steps described in the flow chart in chronological order according to the description, they may be executed in parallel or in a different order according to the processing power of the device that executes each step, or as necessary. good. Other changes are possible without departing from the spirit of this disclosure.

10 System 20 Cardiac function test system 21 Blood pressure measurement device 22 Aortic pressure waveform acquisition device 23 Left ventricular pressure waveform acquisition device 24 Waveform data acquisition device 25 Computing device 30 Monitoring system 31 Control unit 32 Storage unit 33 Communication unit 34 Input unit 35 Output unit 41 triangle 42 triangle 43 triangle

Claims

A storage-accessible monitoring that stores the individual difference coefficient obtained from the relationship between the aortic pressure value obtained by measuring the ascending aorta pressure and the first blood pressure value obtained for the arterial pressure downstream of the ascending aorta. It ’s a system,
Upon receiving the input of the newly obtained second blood pressure value for the arterial pressure downstream of the ascending aorta, the individual difference coefficient is obtained from the storage, and the individual difference coefficient is used to obtain the individual difference coefficient from the second blood pressure value. A monitoring system with a control unit that estimates ascending aortic pressure.
The individual difference coefficient is the ratio of the aortic pressure value to the first blood pressure value.
The monitoring system according to claim 1, wherein the control unit calculates the product of the second blood pressure value and the individual difference coefficient as an estimated value of the ascending aorta pressure.
The monitoring system according to claim 1 or 2, wherein the aortic pressure value is an aortic diastolic pressure.
The arterial pressure downstream of the ascending aorta is any one of brachial artery pressure, radial artery pressure, femoral artery pressure, carotid artery pressure, and ankle dorsal artery pressure, according to any one of claims 1 to 3. Monitoring system.
The storage stores the individual difference coefficient for each individual, and stores the individual difference coefficient for each individual.
When the control unit receives an input of an individual identifier together with the input of the second blood pressure value, the control unit acquires a coefficient corresponding to the input identifier as the individual difference coefficient, which is any one of claims 1 to 4. The monitoring system described in the section.
The storage is a contractility parameter obtained from the relationship between the aortic pressure value, the left ventricular pressure value obtained by measuring the left ventricular pressure, and the first time value obtained by measuring the precursor time. To remember more,
When the control unit receives the input of the newly obtained data by measuring the heart, the control unit specifies the value of the precursor time as the second time value from the input data, and the contractile ability from the storage. The one according to any one of claims 1 to 5, wherein a parameter is acquired and the left ventricular pressure is estimated from the estimated value of the ascending aorta pressure and the second time value using the contractile ability parameter. Monitoring system.
The monitoring system according to claim 6, wherein the contractility parameter is a parameter showing the relationship between the first time value and the difference between the aortic pressure value and the left ventricular pressure value.
The contractility parameter is the ratio of the difference between the aortic pressure value and the left ventricular pressure value to the first time value.
According to claim 6 or 7, the control unit calculates the difference between the estimated value of the ascending aorta pressure and the product of the second time value and the contractile ability parameter as the estimated value of the left ventricular pressure. The monitoring system described.
The monitoring system according to any one of claims 6 to 8, wherein the left ventricular pressure value is the left ventricular end-diastolic pressure.
The monitoring system according to any one of claims 6 to 9, wherein the data includes the results of electrocardiographic measurement and cardiac sound measurement.
The monitoring system according to any one of claims 6 to 9, wherein the data includes the result of echocardiography measurement.
The storage further stores the results of echocardiographic measurements.
When the control unit receives an input of a new echocardiographic measurement result, the input result is compared with the result stored in the storage, and the contractility parameter is corrected according to the comparison result. The monitoring system according to any one of claims 11.
The monitoring system according to any one of claims 6 to 12, wherein the aortic pressure value and the left ventricular pressure value are values obtained by performing a catheter examination.
The monitoring system according to any one of claims 1 to 13, further comprising a storage unit corresponding to the storage.
Aortic pressure waveform acquisition device that acquires aortic pressure waveform,
A blood pressure measuring device that measures the arterial pressure downstream of the ascending aorta,
The aortic pressure value is calculated from the aortic pressure waveform acquired by the aortic pressure waveform acquisition device, and the ratio of the aortic pressure value to the blood pressure value obtained as the measurement result of the blood pressure measuring device is calculated as an individual difference coefficient. A cardiac function test system equipped with an arithmetic device that stores the individual difference coefficient in storage.
Further equipped with a left ventricular pressure waveform acquisition device that acquires the left ventricular pressure waveform,
The calculation device acquires the left ventricular pressure value from the left ventricular pressure waveform acquired by the left ventricular pressure waveform acquisition device, and obtains the value of the precursor time from the aortic pressure waveform acquired by the aortic pressure waveform acquisition device. Claim 15 that calculates as a time value, calculates a parameter showing the relationship between the time value and the difference between the aortic pressure value and the left ventricular pressure value as a contractility parameter, and stores the contractility parameter in the storage. Cardiac function test system described in.
A computer accessible to a storage that stores an individual difference coefficient obtained from the relationship between the aortic pressure value obtained by measuring the ascending aorta pressure and the first blood pressure value obtained for the arterial pressure downstream of the ascending aorta. It is a monitoring method using
When the computer receives the input of the newly obtained second blood pressure value for the arterial pressure downstream of the ascending aorta, the individual difference coefficient is obtained from the storage.
A monitoring method in which the computer estimates the ascending aortic pressure from the second blood pressure value using the individual difference coefficient.
A computer accessible to a storage that stores an individual difference coefficient obtained from the relationship between the aortic pressure value obtained by measuring the ascending aorta pressure and the first blood pressure value obtained for the arterial pressure downstream of the ascending aorta. To,
Upon receiving the input of the newly obtained second blood pressure value for the arterial pressure downstream of the ascending aorta, the process of acquiring the individual difference coefficient from the storage and the process of acquiring the individual difference coefficient.
A program for executing a process of estimating the ascending aortic pressure from the second blood pressure value using the individual difference coefficient.