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1. 发明授权

US08202224B2 System and method for calibrating cardiac pressure measurements derived from signals detected by an implantable medical device 有权
标题翻译：用于校准由可植入医疗装置检测的信号导出的心脏压力测量的系统和方法
公开(公告)号：US08202224B2
公开(公告)日：2012-06-19
申请号：US12109304
申请日：2008-04-24
申请人： Dan E. Gutfinger , Neal L. Eigler , Dorin Panescu , James S. Whiting
发明人： Dan E. Gutfinger , Neal L. Eigler , Dorin Panescu , James S. Whiting
IPC分类号： A61B5/0205 , A61B5/021 , A61B5/02
CPC分类号： A61B5/053 , A61B5/0215 , A61B5/6846
摘要： Various techniques are provided for calibrating and estimating left atrial pressure (LAP) using an implantable medical device, based on impedance, admittance or conductance parameters measured within a patient. In one example, default conversion factors are exploited for converting the measured parameters to estimates of LAP. The default conversion factors are derived from populations of patients. In another example, a correlation between individual conversion factors is exploited to allow for more efficient calibration. In yet another example, differences in thoracic fluid states are exploited during calibration. In still yet another example, a multiple stage calibration procedure is described, wherein both invasive and noninvasive calibration techniques are exploited. In a still further example, a therapy control procedure is provided, which exploits day time and night time impedance/admittance measurements.
摘要翻译：提供了各种技术，用于基于在患者体内测量的阻抗，导纳或电导参数，使用可植入医疗装置校准和估计左心房压力（LAP）。在一个示例中，利用默认转换因子将测量参数转换为LAP估计。默认的转换因子来源于患者群体。在另一个示例中，利用各个转换因子之间的相关性来允许更有效的校准。在另一个例子中，在校准过程中利用了胸部流体状态的差异。在另一个示例中，描述了多阶段校准过程，其中利用侵入性和非侵入性校准技术。在另一个实例中，提供了一种治疗控制程序，其利用白天的时间和夜间阻抗/导纳测量。

2. 发明授权

US07794404B1 System and method for estimating cardiac pressure using parameters derived from impedance signals detected by an implantable medical device 有权
标题翻译：使用由可植入医疗装置检测的阻抗信号导出的参数来估计心脏压力的系统和方法
公开(公告)号：US07794404B1
公开(公告)日：2010-09-14
申请号：US11559235
申请日：2006-11-13
申请人： Dan E. Gutfinger , Neal L. Eigler , Dorin Panescu , James S. Whiting
发明人： Dan E. Gutfinger , Neal L. Eigler , Dorin Panescu , James S. Whiting
IPC分类号： A61B5/02
CPC分类号： A61B5/053 , A61B5/021 , A61B5/6846
摘要： Techniques are provided for estimating left atrial pressure (LAP) or other cardiac pressure parameters based on various parameters derived from impedance signals. In particular, effective LAP is estimated based on one or more of: electrical conductance values, cardiogenic pulse amplitudes, circadian rhythm pulse amplitudes, or signal morphology fractionation values, each derived from the impedance signals detected by the implantable device. Predetermined conversion factors stored within the device are used to convert the various parameters derived from the electrical impedance signal into LAP values or other appropriate cardiac pressure values. The conversion factors may be, for example, slope and baseline values derived during an initial calibration procedure performed by an external system, such as an external programmer. In some examples, the slope and baseline values may be periodically re-calibrated by the implantable device itself.
摘要翻译：提供了基于从阻抗信号导出的各种参数来估计左心房压力（LAP）或其他心脏压力参数的技术。特别地，基于以下中的一个或多个估计有效的LAP：电导值，心源性脉搏幅度，昼夜节奏脉搏幅度或信号形态分级值，每个来自由可植入装置检测的阻抗信号。存储在装置内的预定转换因子用于将从电阻抗信号导出的各种参数转换为LAP值或其他适当的心脏压力值。转换因子可以是例如由外部系统（诸如外部编程器）执行的初始校准过程期间导出的斜率和基线值。在一些示例中，可以通过可植入装置本身周期性地重新校准斜率和基线值。

3. 发明申请

US20080262361A1 SYSTEM AND METHOD FOR CALIBRATING CARDIAC PRESSURE MEASUREMENTS DERIVED FROM SIGNALS DETECTED BY AN IMPLANTABLE MEDICAL DEVICE 有权
标题翻译：用于校准由可植入医疗器械检测的信号衍生的心脏压力测量的系统和方法
公开(公告)号：US20080262361A1
公开(公告)日：2008-10-23
申请号：US12109304
申请日：2008-04-24
申请人： Dan E. Gutfinger , Neal L. Eigler , Dorin Panescu , James S. Whiting
发明人： Dan E. Gutfinger , Neal L. Eigler , Dorin Panescu , James S. Whiting
IPC分类号： A61B5/0215
CPC分类号： A61B5/053 , A61B5/0215 , A61B5/6846
摘要： Various techniques are provided for calibrating and estimating left atrial pressure (LAP) using an implantable medical device, based on impedance, admittance or conductance parameters measured within a patient. In one example, default conversion factors are exploited for converting the measured parameters to estimates of LAP. The default conversion factors are derived from populations of patients. In another example, a correlation between individual conversion factors is exploited to allow for more efficient calibration. In yet another example, differences in thoracic fluid states are exploited during calibration. In still yet another example, a multiple stage calibration procedure is described, wherein both invasive and noninvasive calibration techniques are exploited. In a still further example, a therapy control procedure is provided, which exploits day time and night time impedance/admittance measurements.
摘要翻译：提供了各种技术，用于基于在患者体内测量的阻抗，导纳或电导参数，使用可植入医疗装置校准和估计左心房压力（LAP）。在一个示例中，利用默认转换因子将测量参数转换为LAP估计。默认的转换因子来源于患者群体。在另一个示例中，利用各个转换因子之间的相关性来允许更有效的校准。在另一个例子中，在校准过程中利用了胸部流体状态的差异。在另一个示例中，描述了多阶段校准过程，其中利用侵入性和非侵入性校准技术。在另一个实例中，提供了一种治疗控制程序，其利用白天的时间和夜间阻抗/导纳测量。

4. 发明授权

US08504152B2 System and method for estimating cardiac pressure based on cardiac electrical conduction delays using an implantable medical device 有权
公开(公告)号：US08504152B2
公开(公告)日：2013-08-06
申请号：US11779350
申请日：2007-07-18
申请人： Brian Jeffrey Wenzel , Dan E. Gutfinger , Mihir Naware , Xiaoyi Min , Jeffery Siou , Anders Bjorling , Dorin Panescu
发明人： Brian Jeffrey Wenzel , Dan E. Gutfinger , Mihir Naware , Xiaoyi Min , Jeffery Siou , Anders Bjorling , Dorin Panescu
IPC分类号： A61N1/365
CPC分类号： A61B5/02156 , A61B5/0215 , A61B5/72 , A61N1/365 , A61N1/36564 , A61N1/36578 , A61N1/3682 , A61N1/3684 , A61N1/37258
摘要： Techniques are provided for estimating left atrial pressure (LAP) or other cardiac performance parameters based on measured conduction delays. In particular, LAP is estimated based interventricular conduction delays. Predetermined conversion factors stored within the device are used to convert the various the conduction delays into LAP values or other appropriate cardiac performance parameters. The conversion factors may be, for example, slope and baseline values derived during an initial calibration procedure performed by an external system, such as an external programmer. In some examples, the slope and baseline values may be periodically re-calibrated by the implantable device itself. Techniques are also described for adaptively adjusting pacing parameters based on estimated LAP or other cardiac performance parameters. Still further, techniques are described for estimating conduction delays based on impedance or admittance values and for tracking heart failure therefrom.

5. 发明申请

US20090018597A1 System and Method for Estimating Cardiac Pressure Based on Cardiac Electrical Conduction Delays Using an Implantable Medical Device 有权
公开(公告)号：US20090018597A1
公开(公告)日：2009-01-15
申请号：US11779350
申请日：2007-07-18
申请人： Brian Jeffrey Wenzel , Dan E. Gutfinger , Mihir Naware , Xiaoyi Min , Jeffery Siou , Anders Bjorling , Dorin Panescu
发明人： Brian Jeffrey Wenzel , Dan E. Gutfinger , Mihir Naware , Xiaoyi Min , Jeffery Siou , Anders Bjorling , Dorin Panescu
IPC分类号： A61N1/36
CPC分类号： A61B5/02156 , A61B5/0215 , A61B5/72 , A61N1/365 , A61N1/36564 , A61N1/36578 , A61N1/3682 , A61N1/3684 , A61N1/37258
摘要： Techniques are provided for estimating left atrial pressure (LAP) or other cardiac performance parameters based on measured conduction delays. In particular, LAP is estimated based interventricular conduction delays. Predetermined conversion factors stored within the device are used to convert the various the conduction delays into LAP values or other appropriate cardiac performance parameters. The conversion factors may be, for example, slope and baseline values derived during an initial calibration procedure performed by an external system, such as an external programmer. In some examples, the slope and baseline values may be periodically re-calibrated by the implantable device itself. Techniques are also described for adaptively adjusting pacing parameters based on estimated LAP or other cardiac performance parameters. Still further, techniques are described for estimating conduction delays based on impedance or admittance values and for tracking heart failure therefrom.

6. 发明授权

US08504153B2 System and method for estimating cardiac pressure based on cardiac electrical conduction delays using an implantable medical device 有权
公开(公告)号：US08504153B2
公开(公告)日：2013-08-06
申请号：US11779380
申请日：2007-07-18
申请人： Brian Jeffrey Wenzel , Dan E. Gutfinger , Mihir Naware , Xiaoyi Min , Jeffery Siou , Anders Bjorling , Dorin Panescu
发明人： Brian Jeffrey Wenzel , Dan E. Gutfinger , Mihir Naware , Xiaoyi Min , Jeffery Siou , Anders Bjorling , Dorin Panescu
IPC分类号： A61N1/365
CPC分类号： A61B5/02156 , A61B5/0215 , A61B5/72 , A61N1/365 , A61N1/36564 , A61N1/36578 , A61N1/3682 , A61N1/3684 , A61N1/37258
摘要： Techniques are provided for estimating left atrial pressure (LAP) or other cardiac performance parameters based on measured conduction delays. In particular, LAP is estimated based interventricular conduction delays. Predetermined conversion factors stored within the device are used to convert the various the conduction delays into LAP values or other appropriate cardiac performance parameters. The conversion factors may be, for example, slope and baseline values derived during an initial calibration procedure performed by an external system, such as an external programmer. In some examples, the slope and baseline values may be periodically re-calibrated by the implantable device itself. Techniques are also described for adaptively adjusting pacing parameters based on estimated LAP or other cardiac performance parameters. Still further, techniques are described for estimating conduction delays based on impedance or admittance values and for tracking heart failure therefrom.

7. 发明申请

US20090287267A1 System and Method for Estimating Cardiac Pressure Based on Cardiac Electrical Conduction Delays Using an Implantable Medical Device 有权
标题翻译：使用可植入医疗器械的基于心电导通延迟的估计心脏压力的系统和方法
公开(公告)号：US20090287267A1
公开(公告)日：2009-11-19
申请号：US11779380
申请日：2007-07-18
申请人： Brian Jeffrey Wenzel , Dan E. Gutfinger , Mihir Naware , Xiaoyi Min , Jeffery Siou , Anders Bjorling , Dorin Panescu
发明人： Brian Jeffrey Wenzel , Dan E. Gutfinger , Mihir Naware , Xiaoyi Min , Jeffery Siou , Anders Bjorling , Dorin Panescu
IPC分类号： A61N1/36
CPC分类号： A61B5/02156 , A61B5/0215 , A61B5/72 , A61N1/365 , A61N1/36564 , A61N1/36578 , A61N1/3682 , A61N1/3684 , A61N1/37258
摘要： Techniques are provided for estimating left atrial pressure (LAP) or other cardiac performance parameters based on measured conduction delays. In particular, LAP is estimated based interventricular conduction delays. Predetermined conversion factors stored within the device are used to convert the various the conduction delays into LAP values or other appropriate cardiac performance parameters. The conversion factors may be, for example, slope and baseline values derived during an initial calibration procedure performed by an external system, such as an external programmer. In some examples, the slope and baseline values may be periodically re-calibrated by the implantable device itself. Techniques are also described for adaptively adjusting pacing parameters based on estimated LAP or other cardiac performance parameters. Still further, techniques are described for estimating conduction delays based on impedance or admittance values and for tracking heart failure therefrom.
摘要翻译：提供了基于测量的传导延迟来估计左心房压力（LAP）或其他心脏性能参数的技术。特别地，LAP是基于室间传导延迟估计的。存储在装置内的预定转换因子用于将各种导通延迟转换为LAP值或其他适当的心脏性能参数。转换因子可以是例如由外部系统（诸如外部编程器）执行的初始校准过程期间导出的斜率和基线值。在一些示例中，可以通过可植入装置本身周期性地重新校准斜率和基线值。还描述了基于估计的LAP或其他心脏性能参数自适应地调整起搏参数的技术。此外，描述了用于基于阻抗或导纳值估计导通延迟并用于跟踪其心力衰竭的技术。

8. 发明授权

US08868165B1 Use of cardiogenic impedance waveform morphology to analyze cardiac conditions and to adjust treatment therapy 有权
标题翻译：使用心源阻抗波形形态分析心脏状况并调整治疗疗法
公开(公告)号：US08868165B1
公开(公告)日：2014-10-21
申请号：US11863516
申请日：2007-09-28
申请人： Yelena Nabutovsky , Dorin Panescu , Weiqun Yang , Mihir Naware
发明人： Yelena Nabutovsky , Dorin Panescu , Weiqun Yang , Mihir Naware
IPC分类号： A61B5/053 , A61B5/04
CPC分类号： A61B5/053 , A61B5/0205 , A61B5/04 , A61B5/042 , A61B5/04525 , A61B5/0538 , A61B5/7246 , A61N1/3627 , A61N1/36521
摘要： In specific embodiments, one or more cardiogenic impedance signal template is stored, where each template has a corresponding morphology. Additionally, one or more cardiogenic impedance signal is obtained using electrodes implanted within a patient, where each signal has a corresponding morphology. The morphology of one or more obtained cardiogenic impedance signal is compared to the morphology of one or more stored template, to determine one or more metric indicative of similarity between the compared morphologies. The one or more metric indicative of similarity is used to analyze the patient's cardiac condition, to discriminate among arrhythmias and/or to adjust a cardiac pacing parameter.
摘要翻译：在具体实施例中，存储一个或多个心源阻抗信号模板，其中每个模板具有对应的形态。另外，使用植入患者体内的电极获得一个或多个心源性阻抗信号，其中每个信号具有相应的形态。将一个或多个获得的心源阻抗信号的形态与一个或多个存储的模板的形态进行比较，以确定指示比较形态之间的相似性的一个或多个度量。使用指示相似性的一个或多个度量来分析患者的心脏状况，区分心律失常和/或调整心脏起搏参数。

9. 发明授权

US08306623B2 Tissue characterization using intracardiac impedances with an implantable lead system 有权
标题翻译：使用可植入引导系统的心内阻抗的组织表征
公开(公告)号：US08306623B2
公开(公告)日：2012-11-06
申请号：US13149507
申请日：2011-05-31
申请人： Louis Wong , Cem Shaquer , Gene A. Bornzin , Euljoon Park , Andre Walker , Dorin Panescu , Jiong Xia , Shahrooz Shahparnia
发明人： Louis Wong , Cem Shaquer , Gene A. Bornzin , Euljoon Park , Andre Walker , Dorin Panescu , Jiong Xia , Shahrooz Shahparnia
IPC分类号： A61N1/18
CPC分类号： A61B5/02028 , A61B5/0031 , A61B5/029 , A61B5/0538 , A61B5/08 , A61B5/4878 , A61N1/3627 , A61N1/36521 , A61N1/3702
摘要： An implantable system acquires intracardiac impedance with an implantable lead system. In one implementation, the system generates frequency-rich, low energy, multi-phasic waveforms that provide a net-zero charge and a net-zero voltage. When applied to bodily tissues, current pulses or voltage pulses having the multi-phasic waveform provide increased specificity and sensitivity in probing tissue. The effects of the applied pulses are sensed as a corresponding waveform. The waveforms of the applied and sensed pulses can be integrated to obtain corresponding area values that represent the current and voltage across a spectrum of frequencies. These areas can be compared to obtain a reliable impedance value for the tissue. Frequency response, phase delay, and response to modulated pulse width can also be measured to determine a relative capacitance of the tissue, indicative of infarcted tissue, blood to tissue ratio, degree of edema, and other physiological parameters.
摘要翻译：可植入系统采用可植入引线系统获得心内阻抗。在一个实现中，该系统产生提供净零电荷和净零电压的富频率，低能量，多相波形。当应用于身体组织时，具有多相波形的电流脉冲或电压脉冲在探测组织中提供增加的特异性和灵敏度。所施加的脉冲的影响被感测为对应的波形。施加和感测的脉冲的波形可以被积分，以获得表示频谱范围内的电流和电压的相应面积值。可以比较这些区域以获得组织的可靠的阻抗值。还可以测量频率响应，相位延迟和对调制脉冲宽度的响应，以确定组织的相对电容，指示梗死组织，血液与组织之比，水肿程度和其他生理参数。

10. 发明授权

US08280511B2 Systems and methods for use by an implantable medical device for detecting heart failure based on the independent information content of immittance vectors 有权
标题翻译：由植入式医疗装置用于根据导纳矢量的独立信息内容检测心力衰竭的系统和方法
公开(公告)号：US08280511B2
公开(公告)日：2012-10-02
申请号：US12168750
申请日：2008-07-07
申请人： Wenxia Zhao , Dorin Panescu , Anders Bjorling
发明人： Wenxia Zhao , Dorin Panescu , Anders Bjorling
IPC分类号： A61N1/365
CPC分类号： A61N1/36521 , A61B5/053 , A61B5/0538 , A61N1/3627
摘要： Techniques are provided for detecting heart failure or other medical conditions within a patient using an implantable medical device, such as pacemaker or implantable cardioverter/defibrillator, or external system. In one example, physiological signals, such as immittance-based signals, are sensed within the patient along a plurality of different vectors, and the amount of independent informational content among the physiological signals of the different vectors is determined. Heart failure is then detected by the implantable device based on a significant increase in the amount of independent informational content among the physiological signals. In response, therapy may be controlled, diagnostic information stored, and/or warning signals generated. In other examples, at least some of these functions are performed by an external system.
摘要翻译：提供了用于使用可植入医疗装置（例如起搏器或植入式心律转复器/去纤颤器或外部系统）来检测患者心脏衰竭或其他医疗状况的技术。在一个示例中，沿着多个不同的向量在患者体内感测诸如基于导纳的信号的生理信号，并且确定不同矢量的生理信号中的独立信息内容的量。基于生理信号中独立信息内容量的显着增加，可植入装置检测心力衰竭。作为响应，可以控制治疗，存储诊断信息和/或生成警告信号。在其他示例中，这些功能中的至少一些由外部系统执行。

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