Publication number | USRE33834 E |

Publication type | Grant |

Application number | US 07/556,101 |

Publication date | Mar 3, 1992 |

Filing date | Jul 20, 1990 |

Priority date | May 10, 1984 |

Fee status | Paid |

Publication number | 07556101, 556101, US RE33834 E, US RE33834E, US-E-RE33834, USRE33834 E, USRE33834E |

Inventors | Glenfield Warner |

Original Assignee | Sylvia Warner, Priyamvada Sankar |

Export Citation | BiBTeX, EndNote, RefMan |

Patent Citations (3), Referenced by (8), Classifications (14), Legal Events (2) | |

External Links: USPTO, USPTO Assignment, Espacenet | |

US RE33834 E

Abstract

A non-invasive method, and an apparatus, for determining heart-related parameters in patients. The method and apparatus determine pulse pressure, time constant of the arterial system, systolic and diastolic pressure, peripheral resistance, cardiac output and mean arterial blood pressure.

Claims(18)

1. Apparatus for determining the magnitude of heart-related parameters in a patient;

comprising;

means for detecting blood volume, and thereby blood volume variation, in said patient, and for providing a signal representative of said blood volume, and thereby said blood volume variation;

said means for detecting being attachable to said patient to thereby detect said blood volume, and thereby said blood volume variation;

said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said minimum amplitude and said maximum amplitude, a maximum rate of change of said signal being representative of the maximum rate of increase of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum rate of change of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period;

means for measuring said maximum amplitude, said minimum aplitude, said maximum rate of change of said signal, said first difference, said second different, said first time interval, and said second time interval; and

means for calculating the magnitude of selected ones of said parameters, said means for calculating being connected to both said means for detecting and means for measuring;

wherein means for calculating calculates the magnitude of the pulse pressure parameter in accordance with the following expression; ##EQU17## wherein P_{pi} =pulse pressure during cycle i

K_{pp} =constant determined by a first calibration

r_{1} =constant

r_{2} =constant

R_{il} =(ΔV_{iVm} /ΔV_{i})

where ΔV_{iVm} =volume change at time t_{iVm} during cycle i corresponding to maximum rate of volume change, V_{imax}

ΔV_{i} =maximum volume change during cycle i

Δt_{iVm} =time interval from start of cycle i to time of maximum rate of volume change V_{imax}.

2. Apparatus for determining the magnitude of heart-related parameters in a patient;

comprising;

means for detecting blood volume, and thereby blood volume variation, in said patient, and for providing a signal representative of said blood volume, and thereby said blood volume variation;

said means for detecting being attachable to said patient to thereby .Iadd.detect .Iaddend.said blood volume, and thereby said blood volume variation;

said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said minimum amplitude and said maximum amplitude, a maximum rate of change of said signal being representative of the maximum rate of increase of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum rate of change of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period;

means for measuring said maximum amplitude, said minimum .[.aplitude,.]. .Iadd.amplitude, .Iaddend.said maximum rate of change of said signal, said first difference, said second .[.different,.]. .Iadd.difference, .Iaddend.said first time interval, and said second time interval; and

means for calculating the magnitude of selected ones of said parameters, said means for calculating being connected to both said means for detecting and means for measuring;

wherein means for calculating .[.calculates.]. .Iadd.calculates .Iaddend.the magnitude of the mean arterial blood pressure, P_{mi} parameter in accordance with the following expression: ##EQU18## where K_{4} =constant determined for each subject

b_{3} =constant

P_{mmi} =pseudo mean arterial blood pressure during cycle i

.[.Δ_{i} .]. .Iadd.ΔV_{i} .Iaddend.=maximum volume change during cycle i ##EQU19##

3. Apparatus for determining the magnitude of heart-related parameters in a patient;

comprising;

means for detecting blood volume, and thereby blood volume variation, in said patient, and for providing a signal representative of said blood volume, and thereby said blood volume variation;

said means for detecting being attachable to said patient to thereby detect said blood volume, and thereby said blood volume variation;

said volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said minimum amplitude and said maximum amplitude, a maximum rate of change of said signal being representative of the maximum rate of increase of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum rate of change of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period;

means for measuring said maximum amplitude, said minimum .[.aplitude,.]. .Iadd.amplitude, .Iaddend.said maximum rate of change of said signal, said first difference, said second .[.different,.]. .Iadd.difference, .Iaddend.said first time interval, and said second time interval; and

means for calculating the magnitude of selected ones of said parameters, said means for calculating being connected to both said means for detecting and means for measuring;

wherein means for calculating calculates the magnitude of the systolic pressure (P_{si}) parameter in accordance with the following expression:

P_{si}=P_{mi}+(1-g_{0})P.sub. pi

wherein

g_{0} =constant.

4. Apparatus for determining the magnitude of heart-related parameters in a patient;

comprising:means for detecting blood volume, and thereby blood volume variation, in said patient, and for providing a signal representative of said blood volume, and thereby said blood volume variation; means for calculating the magnitude of selected ones of said parameters, said means for calculating being connected to both said means for detecting and means for measuring;

said means for detecting being attachable to said patient to thereby detect said blood volume, and thereby said blood volume variation;

said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said minimum amplitude and said maximum amplitude, a maximum rate of change of said signal being representative of the maximum rate of increase of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum rate of change of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period;

means for measuring said maximum amplitude, said minimum .[.aplitude,.]. .Iadd.amplitude, .Iaddend.said maximum rate of change of said signal, said first difference, said second .[.different,.]. .Iadd.difference, .Iaddend.said first time interval, and said second time interval; and

wherein means for calculating calculates the magnitude of the systolic pressure (P_{si}) parameter in accordance with the following expression:

P_{si}=P_{mi}+(1-g_{i})P.sub. pi

wherein:

g_{i} =(ΔV_{iAV} /ΔV_{i})

P_{pi} =pulse pressure during cycle i

ΔV_{i} =represented by said first difference

ΔV_{iAV} =represented by the difference between said minimum amplitude and an amplitude equal to the average value of a pulse in a cycle i.

5. Apparatus for determining the magnitude of heart-related parameters in a patient;

comprising;means for detecting blood volume, and thereby blood volume variation, in said patient, and for providing a signal representative of said blood volume, and thereby said blood volume variation; said means for detecting being attachable to said patient to thereby detect said blood volume, and thereby said blood volume variation; means for measuring said maximum amplitude, said minimum .[.aplitude,.]. .Iadd.amplitude, .Iaddend.said maximum rate of change of said signal, said first difference, said second .[.different,.]. .Iadd.difference, .Iaddend.said first time interval, and said second time interval; and means for calculating the magnitude of selected ones of said parameters, said means for calculating being connected to both said means for detecting and means for measuring;

said blood volume variation being .[.cycle.]. .Iadd.cyclic .Iaddend.in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said minimum amplitude and said maximum amplitude, a maximum rate of change of said signal being representative of the maximum rate of increase of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum rate of change of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period;

wherein means for calculating calculates the magnitude of the arterial blood pressure, P_{mi} parameter in accordance with the following expression: ##EQU20## where K_{4} =constant determined for each subject

b_{3} =constant

P_{mmi} =pseudo mean arterial blood pressure during cycle i

ΔV_{i} =maximum volume change during cycle i ##EQU21## P_{o} =constant where

G(t)=a function of t.

6. A method for determining the magnitude of heart-related parameters in a patient;

comprising:

detecting blood volume, and thereby blood volume variation, in said patient and providing a signal representative of said blood volume, and thereby said blood volume variation;

said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said maximum amplitude and said minimum amplitude, a maximum rate of change of said signal being representative of the maximum rate of change of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum change of rate of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period;

measuring said maximum amplitude, said minimum amplitude, said maximum rate of change of said signal, said first difference, said second difference, said first time interval, and said second time interval; and

calculating the magnitude of the pulse pressure parameter in accordance with the following expression: ##EQU22## wherein P_{pi} =pulse pressure during cycle i

K_{pp} =constant determined by a first calibration

r_{1} =constant

r_{2} =constant

R_{il} =(ΔV_{iVm} /ΔV_{i})

where

.[.ΔV_{iVm} =volume change at time t_{iVm} during cycle i corresponding to maximum rate of volume change, V_{imax}.].

.Iadd.ΔV_{iVm} =volume change at time t_{iVm} during cycle i corresponding to maximum rate of volume change, V_{imax} .Iaddend.

ΔV_{i} =maximum volume change during cycle i

Δt_{iVm} =time interval from start of cycle i to time of maximum rate of volume change V_{imax}.

7. A method for determining the magnitude of heart-related parameters in a patient;

comprising:

detecting blood volume, and thereby blood volume variation, in said patient and providing a signal representative of said blood volume, and thereby said blood volume variation;

said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said maximum amplitude and said minimum amplitude, a maximum rate of change of said signal being representative of the maximum rate of change of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum change of rate of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period;

measuring said maximum amplitude, said minimum amplitude, said maximum rate of change of said signal, said first difference, said second difference, said first time interval, and said second time interval; and

calculating the magnitude of the mean .[.artial.]. .Iadd.arterial .Iaddend.pressure P_{mi} in accordance with the following expression: ##EQU23## where K_{4} =constant determined for each subject

b_{3} =constant

P_{mmi} =pseudo mean arterial blood pressure during cycle i

ΔV_{i} =maximum volume change during cycle i

ΔV_{imax} =maximum time rate of change of ΔV_{i} =V_{imax} ##EQU24##

8. A method for determining the magnitude of heart-related parameters in a patient;

comprising:

detecting blood volume, and thereby blood volume variation, in said patient and providing a signal representative of said blood volume, and thereby said blood volume variation;

said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said maximum amplitude and said minimum amplitude, a maximum rate of change of said signal being representative of the maximum rate of change of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum change of rate of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period;

measuring said maximum amplitude, said minimum amplitude, said maximum rate of change of said signal, said first difference, said second difference, said first time interval, and said second time interval; and

calculating the magnitude of the systolic pressure (P_{si} parameter in accordance with the following expression:

P_{si}=P_{mi}+(1-g_{0})P.sub. pi

wherein

g_{0} =constant.

9. A method for determining the magnitude of heart-related parameters in a patient;

comprising:said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said maximum amplitude and said minimum amplitude, a maximum rate of change of said signal being representative of the maximum rate of change of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum change of rate of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period; measuring said maximum amplitude, said minimum amplitude, said maximum rate of change of said signal, said first difference, said second difference, said first time interval, and said second time interval; and

detecting blood volume, and thereby blood volume variation, in said patient and providing a signal representive of said blood volume, and thereby said blood volume variation;

calculating the magnitude of the systolic pressure (P_{si}) parameter in accordance with the following expression:

P_{si}=P_{mi}+(1-g_{i})P.sub. pi

wherein:

g_{i} =(ΔV_{iAV} /ΔV_{i})

P_{pi} =pulse pressure during cycle i

ΔV_{i} =represented by said first difference

ΔV_{iAV} =represented by the difference between said minimum amplitude and an amplitude equal to the average value of a pulse in a cycle i.

10. A method for determining the magnitude of heart-related parameters in a patient;

comprising:detecting blood volume, and thereby blood volume variation, in said patient and providing a signal representative of said blood volume, and thereby said blood volume variation; said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said maximum amplitude and said minimum amplitude, a maximum rate of change of said signal being representative of the maximum rate of change of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum change of rate of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period; measuring said maximum amplitude, said minimum amplitude, said maximum rate of change of said signal, said first difference, said second difference, said first time interval, and said second time interval; and

calculating the magnitude of the arterial blood pressure, P_{mi} parameter in accordance with the following expression: ##EQU25## where

K_{4} =constant determined for each subject

b_{3} =constant

P_{mmi} =pseudo mean arterial blood pressure during cycle i

ΔV_{i} =maximum volume change during cycle i

ΔV_{imax} =maximum time rate of change of V_{i} =V_{imax}

P_{o} =constant

G(t)=a function of t and T.

11. Apparatus for determining the magnitude of heart-related parameters in a patient;

comprising:means for detecting blood volume, and thereby blood volume variation, in said patient, and for providing a signal representative of said blood volume, and thereby said blood volume variation; said means for detecting being attachable to said patient to thereby detect said blood volume, and thereby said blood volume variation; said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said minimum amplitude and said maximum amplitude, a maximum rate of change of said signal being representative of the maximum rate of increase of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum rate of change of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period; means for measuring said maximum amplitude, said minimum .[.aplitude,.]. .Iadd.amplitude, .Iaddend.said maximum rate of change of said signal, said first difference, said second .[.different,.]. .Iadd.difference, .Iaddend.said first time interval, and said second time interval; and means for calculating the magnitude of selected ones of said parameters, said means for calculating being connected to both said means for detecting and means for measuring;

wherein means for calculating calculates the magnitude of the pulse pressure parameter in accordance with the following expression: ##EQU26## wherein P_{pi} =pulse pressure during cycle i

K_{pp} =constant determined by a first calibration

r_{1} =constant

r_{2} =constant

R_{i1} =ΔV_{iVm} /ΔV_{i}

where

ΔV_{iVm} =volume change at preselected time t_{iVm} during cycle i

ΔV_{i} =maximum volume change during cycle i

Δt_{iVm} =time interval from start of cycle i to preselected time of t_{iVm}.

12. A method for determining the magnitude of heart-related parameters in a patient;

comprising:detecting blood volume, and thereby blood volume variation, in said patient and providing a signal representative of said blood volume, and thereby said blood volume variation; measuring said maximum amplitude, said minimum amplitude, said maximum rate of change of said signal, said first difference, said second difference, said first time interval, and said second time interval; and

said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said maximum amplitude and said minimum amplitude, a maximum rate of change of said signal being representative of the maximum rate of .[.charge.]. .Iadd.change .Iaddend.of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum change of rate of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period;

calculating the magnitude of the pulse pressure parameter in accordance with the following expression: ##EQU27## wherein P_{pi} =pulse pressure during cycle i

K_{pp} =constant determined by a first calibration

r_{1} =constant

r_{2} =constant

R_{i1} =(ΔV_{iVm} /V_{i})

where

ΔV_{iVm} =volume change at preselected time t_{iVm} during cycle i

ΔV_{i} =maximum volume change during cycle i

Δt_{iVm} =time interval from start of cylcle i to predetermined time of t_{iVm}.

13. Apparatus for determining the magnitude of heart-related parameters in a patient;

comprising;means for detecting blood volume, and thereby blood volume variation, in said patient, and for providing a signal representative of said blood volume, and thereby said blood volume variation; said means for detecting being attachable to said patient to thereby detect said blood volume, and thereby said blood volume variation; said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said minimum amplitude and said maximum amplitude, a maximum rate of change of said signal being representative of the maximum rate of increase of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum rate of change of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period; means for calculating the magnitude of selected ones of said parameters, said means for calculating being connected to both said means for detecting and means for measuring;

means for measuring said maximum amplitude, said minimum amplitude, said maximum rate of change of said signal, said first difference, said second different, said first time interval, and said second time interval; and

wherein the means for calculating calculates the magnitude of the mean pressure parameter in accordance with the following expression:

(1) P'_{mi} =K_{1} r_{ic} ^{a}

where

K_{1} =calibration constant

.[.P'_{mi} =(P_{s} +P_{d})/2-P_{o}.].

P_{si} =systolic blood pressure, in cycle i

.[.P_{mi} =(P_{s} +P_{d})/2.].

P_{di} =diastolic blood pressure, in cycle i

a=constant

P_{o} =constant.

14. A method for determining the magnitude of heart-related parameters in a patient;

comprising:said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said maximum amplitude and said minimum amplitude, a maximum rate of change of said signal being representative of the maximum rate of change of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum change of rate of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period; measuring said maximum amplitude, said minimum amplitude, said maximum rate of change of said signal, said first difference, said second difference, said first time interval, and said second time interval; and

detecting blood volume, and thereby blood volume variation, in said patient and providing a signal .[.representation.]. .Iadd.representative .Iaddend.of said blood volume, and thereby said blood volume variation;

calculating the magnitude of mean pulse pressure in accordance with the following expression:

.[.(1) P_{mi} =K_{1} r_{ic} ^{a}.].

.Iadd.(1) P'_{mi} =K_{l} r_{ic} a .Iaddend.

where

K_{1} =calibration constant

.[.P'_{mi} =(P_{s} +P_{d})/2-P_{o}.].

.Iadd.P'_{mi} =(P_{si} +P_{di})/2-P_{o} .Iaddend.

P_{si} =systolic blood pressure, in cycle i

.[.P_{mi} =(P_{s} +P_{d})/2.].

.Iadd.P_{mi} =(P_{si} +P_{di})/2 .Iaddend.

P_{di} =diastolic blood pressure, in cycle i

a=constant

P_{o} =constant.

15. Apparatus for determining the magnitude of heart-related parameters in a patient;

comprising;means for detecting blood volume, and thereby blood volume variation, in said patient, and for providing a signal representative of said blood volume, and thereby said blood volume variation; said means for detecting being attachable to said patient to thereby detect said blood volume, and thereby said blood volume variation; said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said minimum amplitude and said maximum amplitude, a maximum rate of change of said signal being representative of the maximum rate of increase of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum rate of change of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period; means for calculating the magnitude of selected ones of said parameters, said means for calculating being connected to both said means for detecting and means for measuring;

means for measuring said maximum amplitude, said minimum amplitude, said maximum rate of change of said signal, said first difference, said second .[.different,.]. .Iadd.difference, .Iaddend.said first time interval, and said second time interval; and

wherein the means for calculating calculates implicitly the magnitude of the mean pulse pressure in accordance with the following expression: ##EQU28## where P_{mo} =constant at calibration

φ_{1i} +φ_{2i} =PP_{i} =pulse pressure during cycle i

k=constant

j=constant

P_{si} =P_{mo} +φ_{2i} +P_{o}

P_{di} =P_{mo} -φ_{1i} +P_{o}

P_{mi} =(P.sub. si +P_{di})/2

P_{o} =constant

r_{i} =ratio of exponentials

K_{3} =coefficient (variable or constant).

16. A method for determining the magnitude of heart-related parameters in a patient;

comprising:detecting blood volume, and thereby blood volume variation, in said patient and providing a signal representative of said blood volume, and thereby said blood volume variation; measuring said maximum amplitude, said minimum amplitude, said maximum rate of change of said signal, said first difference, said second difference, said first time interval, and said second time interval; and

said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said maximum amplitude and the said minimum amplitude, a maximum rate of change of said signal being representative of the maximum rate of change of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum change of rate of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period;

wherein the means for calculating calculates implicitly the magnitude of mean pulse pressure in accordance with the following .[.expressure.]. .Iadd.expression.Iaddend.: ##EQU29## where P_{mo} =constant at calibration

φ_{1i} +φ_{2i} =PP_{i} =pulse pressure during cycle i

k=constant

j=constant

.[.P_{2i} =P_{mo} +φ_{2i} +P_{o}.].

.Iadd.P_{si} =P_{mo} +φ_{2i} +P_{o} .Iaddend.

P_{di} =P_{mo} -φ_{1i} +P_{o}

P_{mi} =(P.sub. si +P_{di})/2

P_{o} =constant

r_{i} =ratio of exponentials

K_{3} =coefficient (variable or constant). .Iadd.

17. Apparatus for determining the magnitude of heart-related parameters in a patient;means for detecting blood volume, and thereby blood volume variation, in said patient, and for providing a signal representative of said blood volume, and thereby said blood volume variation; said means for detecting being attachable to said patient to thereby detect said blood volume, and thereby said blood volume variation; means for calculating the magnitude of selected ones of said parameters, said means for calculating being connected to both said means for detecting and means for measuring;

comprising:

said blood variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said minimum amplitude and said maximum amplitude, a maximum rate of change of said signal being representative of the maximum rate of increase of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum rate of change of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period;

means for measuring said maximum amplitude; said minimum amplitude, said maximum rate of change of said signal, said first difference, said second difference, said first time interval, and said second time interval; and

wherein means for calculating calculates the magnitude of the pulse pressure parameter in accordance with the following expression; ##EQU30## where PP_{i} =Pulse Pressure-- P_{s} -P_{d}

P_{s} =Systolic blood pressure

P_{d} =diastolic blood pressure

k=constant

K'=constant..Iaddend. .Iadd.

18. A method for determining the magnitude of heart-related parameters in a patient;detecting blood volume, and thereby blood volume variation, in said patient and providing a signal representative of said blood volume, and thereby said blood volume variation; said blood volume variation being cyclic in nature whereby said signal comprises a cyclic curve having, in each cycle of variation, a variable slope, a maximum amplitude representative of the maximum amount of blood volume, a minimum amplitude representative of the minimum amount of blood volume, a first time interval between said maximum amplitude and said minimum amplitude, a maximum rate of change of said signal being representative of the maximum rate of change of blood volume, a second time interval between the minimum amplitude and the time of the maximum rate of change of said signal, a first difference in amplitude between said maximum amplitude and said minimum amplitude, a second difference in amplitude between the maximum amplitude and the amplitude at the time of maximum change of rate of said signal being representative of the difference in volume between the maximum amount of blood volume and the volume at the time of maximum rate of change of said blood volume, and a pulse repetition period; measuring said maximum amplitude, said minimum amplitude, said maximum rate of change of said signal, said first difference, said second difference, said first time interval, and said second time interval; and

comprising:

calculating the magnitude of the mean arterial pressure P_{mi} in accordance with the following expression: ##EQU31## where PP_{i} =Pulse Pressure=P_{s} -P_{d}

P_{s} =Systolic blood pressure

P_{d} =Diastolic blood pressure

k=constant

K'=constant.

Description

This .Iadd.application is a reissue of application Ser. No. 105,803, filed Oct. 8, 1987, now U.S. Pat. No. 4,834,107, which .Iaddend.application is a continuation-in-part application Ser. No. 059,520, filed June 8, .Iadd.now abandoned .Iaddend. which is a continuation-in-part application Ser. No. 807,693, filed Dec. 11, 1985, now abandoned which is a continuation-in-part of parent application Ser. No. 608,955, filed May 10, 1984, now all abandoned.

1. Field of the Invention

The invention relates to a non-invasive method of measuring arterial blood pressure and cardiac output. The invention also relates to an apparatus for carrying out the method.

2. Description of Prior Art

Non-invasive methods and apparatus for measuring arterial blood pressure and cardiac output are known in the art. Once such method and apparatus is illustrated in U.S. Pat. No. 4,030,485, Warner, issued June 21, 1977. A second such method and apparatus is taught in U.S. Pat. No. 4,418,700, Warner, issued Dec. 6, 1983. The present invention constitutes an improvement and refinement of the method and apparatus as taught in the latter patent.

The invention relates to a non-invasive method, and an apparatus for determining heart-related parameters in patients. The method and apparatus determine pulse pressure, time constant of the arterial system, systolic and diastolic pressure, peripheral resistance, and cardiac output and means arterial blood pressure.

The invention will be better understood by an examination of the following description together with the accompanying drawings in which:

FIG. 1 is a block diagram of the apparatus for carrying out the inventive method;

FIG. 2 is a typical sensor output of the system as illustrated in FIG. 1;

FIG. 3 illustrates arterial blood pressure pulses;

FIGS. 4, 4a and 4b illustrate a blood volume pulse;

FIG. 5 illustrates a blood volume pulse and a blood pressure pulse to illustrate the ratio g; and

FIG. 6 is a simplified flowchart for a computer program for performing calculations in accordance with the invention.

As seen in FIG. 1, an apparatus in accordance with the invention comprises a volume sensor such as a photo-electric plethysmograph S, an amplifier A_{1}, an analog to digital converter A_{2}, a microcomputer M and a display device D. The plethysmograph sensor S is attached to, for example, the earlobe of a subject. The sensor could also be attached to other suitable parts of the body such as the forehead, fingertips or toes.

As is known, the plethysmograph, detects changes in blood volume of the region to which it is attached. A typical sensor output signal is shown in FIG. 2. As seen in FIG. 2, the output signal has a pulsating component and a DC component.

The output of the sensor is applied to the plethysmograph amplifier A_{1} where it is amplified and filtered and the DC component is discarded. The output of A_{1} has a DC component, but this is not directly related to the sensor DC component.

The output of A_{1} is fed to the analog to digital (A/D) converter A_{2} which digitizes the signal. In a preferred embodiment, the sampling rate is 100 per second.

Microcomputer M accepts signals from A_{2} and processes them according to the instructions it contains. These instructions are schematically represented in the simplified flowchart of FIG. 6.

The computer quantities are then displayed on a CRT monitor D or other suitable display means.

THEORY

Arterial blood pressure pulses are shown in FIG. 3. The shape of these curves vary according to the site where they are measured. The highest pressure reached during a cycle i is called the arterial systolic blood pressure, P_{si}. The lowest pressure reached during the same cycle is called the arterial diastolic blood pressure, P_{di}. The pressure rise from P_{di} to p_{si} in the same cycle is the pulse pressure, p_{pi}.

By definition

p_{si}-p_{di}=p_{pi}(1)

To find P_{pi}

A plethysmographic pulse is shown in FIG. 4. The minimum value at the beginning of the pulse is V_{imin}. The maximum value of the pulse is V_{imax}. As the pulse volume rises from V_{imin} to V_{imax}, the time rate of volume change reaches a maximum V_{imax} at time t_{iVm}. The pulse volume at time t_{iVm} is V_{iVm}.

let ##EQU1##

In addition to finding the values of V_{iVm} corresponding to V_{imax}, see U.S. Pat. No. 4,418,700, Warner, values of V_{iVm} are also found corresponding to V_{imax} ^{-1}, V_{imax} ^{-2}, . . . V_{imax} ^{-k}, where k is a function of V_{imax}.

All of the values of V_{iVm} corresponding to the time rates of volume change lying between and including V_{imax} and v_{imax} ^{-k} are averaged and used to compute ΔV_{iVm}.

The average value of V_{iV} m is ##EQU2## where n0=number of values of V_{iV}.sbsb.0 m corresponding to V_{imax} ##EQU3## nk=number of values of V_{iV}.sbsb.k m corresponding to V_{imax} ^{-k}

k=(V_{imax/m}) (integral values only)+1

m=constant . . . a preferred value of m=20

l=constant . . . a preferred value of l=1 ##EQU4## K_{pp} =constant determined by a first calibration r_{1} =constant . . . preferably equal to 0

r_{2} =constant . . . preferably equal to 0

0≦α≦1

R_{i1} can now be defined, as per equation (2) above, but using the average value of V_{iVm} so that equation (2) can be rewritten ##EQU5##

From FIG. 4 ##EQU6## wherein

R'_{i}=1-R_{i}

or

R_{i}=1-R'_{i}

No other calibration should be required with different subjects. However, if desired, K_{pp} can be determined for each subject.

To find mean blood pressure

The mean blood pressure P_{mi} during a cycle i is given by ##EQU7## b_{3} =exponent . . . the preferred value of b_{3} is equal to 0.5 K_{4} =constant determined at calibration for each subject. It is only necessary to find this constant once for each subject. The measurements carried out at different times on the same subject do not require separate calibration

P_{0} =constant . . . preferred 25 mmHg ##EQU8## where g_{i} =(ΔV_{iAV} /ΔV_{i})

ΔV_{iAV} =average value of ΔV_{i} over the time interval T_{i}

P_{di}=P_{si}-P_{pi}(8)

The variable g_{i} can take on a constant value g_{0} whose preferred value is 0.333.

Alternatively, mean blood pressure can be determined using the following expression: ##EQU9## (for definition of r_{i} see Equation 10 below); where

G(t)=a function of t, in a particular case,

G(t)=(φ_{c} /φ_{i})

φ_{c} =.[.(.].(1/Δt_{c}).[.).].^{Y}

φ_{i} =.[.(.].(1/Δt_{i}).[.).].^{Y}

Δt_{c} =(Δt'_{i}φc

Δt_{i} =Δt'_{i}φ

where

.[.T_{c} =T at calibration.]. .Iadd.Δt_{c} =Δt at calibration Δt'_{i}φ (see FIG. 4B) .Iaddend.

.[.t_{c} =t at calibration Δt'_{i}φ.sbsb.c (see FIG. 4B).].

.[.φ_{c} =(T_{c} /t_{c})=(T/t) at calibration.]. .Iadd.φ_{c} =(1/Δt)^{y} at calibration.Iaddend.

y=constant

The remainder of the terms in equation 5' are the same as similar terms in equation 5.

Determination of ratio R (FIG. 4b)

From FIG. 4b, the ratio R is

R_{i} =(ΔV_{it} /ΔV_{i})

where

ΔV_{it} =change in volume at predetermined time ti

ΔV_{i} =total volume change during cycle i

t_{i} =time such that Δt_{i} =K_{T} Δt'_{i}φ

K_{T} =constant

Estimation of pulse pressure, PP ##EQU10## where PP_{i} =pulse pressure=p_{s} -P_{d}

P_{s} =systolic blood pressure

P_{d} =diastolic blood pressure

k=constant

K'_{T} =constant ≃ K_{T}

In FIG. 4B

Δ V'_{i}=ΔV_{i}-ΔV_{it}##EQU11## wherein from the above equation: ##EQU12## multiply numerator and denominator by e^{kPP}i ##EQU13##

Determination of r

From FIG. 4

r_{i}= (V_{imax}/ΔV_{i})G(t)

where

V_{imax} =maximum time rate of volume increase in cycle i

ΔV_{i} =total volume increase during cycle i

From FIG. 4b

.[.r_{i}= (V_{it}ΔV_{i})G(t).].

.Iadd.r_{i} =(V_{it} /V_{i})G(t) .Iaddend.

V_{it} =time rate of increase of volume V_{i}(t) at time t_{i}

.[.ΔV_{i} =total volume increase of volume during.]. .Iadd.ΔV_{i} =total increase of volume during time interval Δt_{i}φ.Iaddend.

Estimation of Mean Blood Pressure

(1) P_{mi} '=K_{1} r_{ic} ^{a}

K_{1} =calibration constant

P_{mi} '=(P.sub. s +P_{d})/2-P_{o}

P_{si} =systolic blood pressure, in cycle i

P_{mi} =(P.sub. s +P_{d})/2

P_{di} =diastolic blood pressure, in cycle i

a=constant

P_{o} =constant

.[.(2) e^{kp} mi=K_{2} R_{ic} ^{b}.]. (2) .Iadd.e^{kp} mi=K_{2} r_{ic} ^{b} .Iaddend.

where

K_{2} =constant (calibration)

b=constant ##EQU14## where P_{mo} =constant at calibration

φ_{1i} +φ_{2i} =PP_{i} =pulse pressure during cycle i

k=constant

j=constant

solve equation by making LHS=RHS by varying φ_{1i} and φ_{2i} (φ_{2i} =PP_{i} -φ_{1i})

then

P_{si} =P_{mo} +φ_{2i} +P_{0}

P_{di} =P_{mo} -φ_{1i} +P_{o}

P_{mi} =(P.sub. si +P_{di})/2

P_{0} =constant

r_{i} =ratio of exponentials

K_{3} =coefficient (variable or constant)

Correction for r_{i}

r_{i} (corrected)=r_{ic} =r_{i} e^{m}(φ.sbsp.o^{-}φ.sbsp.i)

m=constant

φ_{0} =PP_{i} at calibration

φ_{i} =current value of PP_{i}.

Equation (9) above is only one form which this particular equation can take. By simple mathematical manipulations, the invention may take two other forms as per (10) and (11) below. What follows is the manipulations as well as the two other forms of the equation:

As above noted

φ_{2i}+φ_{1i}=PP_{i}=P_{si}-P_{di}

φ_{2i}+φ_{1i}=(P.sub. si -P_{o})-(P.sub. di -P_{o})

Let

P'_{si} =P_{si} -P_{o}

p'_{di} =P_{di} -P_{0}

φ_{2i} +φ_{1i} =P'_{si} -P'_{di}

add and subtract P_{mo} on RHS above

φ_{2i}+φ_{1i}=P'_{si}-P_{mo}+P_{mo}-P'_{di}(A)

φ_{2i} and φ_{1i} can take on any values in satisfying the above equation (A)

Put φ_{2i} =P'_{si} -P_{mo}

and φ_{1i} =P_{mo} -P'_{di} in equation (9)

then ##EQU15## simplifying the denominator ##EQU16##

To solve equation 11:

(1) Set P'_{di} =P'_{si} -PP_{i} and solve for P'_{si}

.Iadd.P'_{mi} =(P_{si} +P_{di})/2-P_{o} .Iaddend.

(2) Set P'_{si} =P'_{di} -PP_{i} and solve for P'_{di}

Although particular embodiments have been illustrated, this was for the purpose of describing, but not limiting, the invention. Various modifications, which will come readily to the mind of one skilled in the art, are within the scope of the invention as defined in the appended claims.

.Iadd.P_{mi} =(P_{si} +P_{di})/2 .Iaddend.

Patent Citations

Cited Patent | Filing date | Publication date | Applicant | Title |
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US4030485 * | Nov 12, 1974 | Jun 21, 1977 | Glenfield Warner | Method and apparatus for continuously monitoring systolic blood pressure |

US4425920 * | Oct 24, 1980 | Jan 17, 1984 | Purdue Research Foundation | Apparatus and method for measurement and control of blood pressure |

GB2092309A * | Title not available |

Referenced by

Citing Patent | Filing date | Publication date | Applicant | Title |
---|---|---|---|---|

US5365924 * | Jul 31, 1992 | Nov 22, 1994 | Frederick Erdman Association | Method and apparatus for non-invasive cardiovascular diagnosis |

US5542421 * | Aug 30, 1994 | Aug 6, 1996 | Frederick Erdman Association | Method and apparatus for cardiovascular diagnosis |

US5865755 * | Oct 11, 1996 | Feb 2, 1999 | Dxtek, Inc. | Method and apparatus for non-invasive, cuffless, continuous blood pressure determination |

US6986744 | Feb 2, 1999 | Jan 17, 2006 | Transonic Systems, Inc. | Method and apparatus for determining blood flow during a vascular corrective procedure |

US20050171446 * | Mar 25, 2005 | Aug 4, 2005 | Transonic Systems, Inc | Method and apparatus for determining a blood flow during a vascular access dysfunction corrective procedure |

WO1994010903A1 * | Nov 17, 1993 | May 26, 1994 | Kunig Horst E | Measuring myocardial impairment, dysfunctions, and sufficiency/insufficiency |

WO1995016391A1 * | Dec 15, 1994 | Jun 22, 1995 | Pulse Metric, Inc. | Method and apparatus for treating cardiovascular pathologies |

WO2010072416A1 * | Dec 23, 2009 | Jul 1, 2010 | Charite-Universitätsmedizin Berlin | Method and device for monitoring and improving arteriogenesis |

Classifications

U.S. Classification | 600/481, 600/507, 600/504, 600/531, 600/479 |

International Classification | A61B5/029, G06F17/00, A61B5/021 |

Cooperative Classification | A61B5/029, A61B5/021, A61B5/02007 |

European Classification | A61B5/02D, A61B5/021, A61B5/029 |

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Nov 12, 1996 | FPAY | Fee payment | Year of fee payment: 8 |

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